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Kafan S, Fattahi MR, Akhbari Shojaei M, Hossein Nezhad A, Imankhan M, Jahansouz D, Montazeri M, Hadadi A, Fattahi S, Iranmehr A, Pazoki M, Rahimzadeh H. Comparing Therapeutic versus Prophylactic Enoxaparin Therapy in Severe COVID-19 Patients: A Randomized Clinical Trial. Med J Islam Repub Iran 2023; 37:129. [PMID: 38318404 PMCID: PMC10843207 DOI: 10.47176/mjiri.37.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Indexed: 02/07/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has been associated with a hypercoagulopathy state; however, the efficacy of different anticoagulant regimens in preventing thrombotic events is not clear. We aimed to compare therapeutic versus prophylactic enoxaparin therapy in severe COVID-19 patients. Methods In this single-center, open-label, randomized controlled trial, adult patients with severe COVID-19 presentations and an increased D-dimer level of more than 4 times the normal upper limit were randomly assigned to receive either prophylactic or therapeutic dose of enoxaparin. All patients were observed for at least 4 months regarding the overall survival as the primary outcome. Hospitalization duration, the need for intensive care unit (ICU) admission, the need for mechanical ventilation, and major adverse events (MAEs) were also analyzed as the secondary outcomes. Survival analysis was done via Kaplan-Meier curves and the Log-rank test. Cox regression was used, adjusting for baseline variables. Results Overall, 237 patients (152 men and 85 women) were randomized to either arm (121 to prophylactic and 116 to therapeutic groups). The mortality rate was 27 (22.3%) and 52 (44.8%) in prophylactic and therapeutic arms, respectively. Prophylactic enoxaparin was associated with better survival in the log-rank test (P < 0.001; HR, 0.42). Additionally, a significantly lower rate of ICU admission, a lower rate of MAEs, and shorter hospitalization were observed in the prophylactic arm (P < 0.001, P = 0.009, and P = 0.028, respectively). Conclusion The results of the current study were in favor of anticoagulant treatment with prophylactic doses of enoxaparin. Still, due to the limitations of this paper, we suggest that these findings be treated cautiously.
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Affiliation(s)
- Samira Kafan
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Fattahi
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Student Research Committee, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Akhbari Shojaei
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Hossein Nezhad
- School of Medicine, Islamic Azad University, Tonekabon Medical Branch, Tonekabon, Iran
| | - Mahshid Imankhan
- School of Medicine, Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Davoud Jahansouz
- Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahnaz Montazeri
- Department of Infectious Disease, Tehran University of Medical Sciences, Tehran, Iran
| | - Azar Hadadi
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Infectious Disease, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Fattahi
- Department of Clinical Psychology, Tehran University of Medical Sciences, Tehran, Iran
| | - Arad Iranmehr
- Neurosurgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Pazoki
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hormat Rahimzadeh
- Department of Nephrology Disease, Tehran University of Medical Sciences, Tehran, Iran
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Dada SA, Dele-Ojo BF, Raimi TH, Ojo P, Adeoti AO, Fadare JO, Rafiu MO, Dada OE, Olabanji JK. Clinical and Epidemiological Characteristics of Hospitalized COVID-19 Patients in an Isolation Centre in South-West Nigeria. Cureus 2023; 15:e46992. [PMID: 38021567 PMCID: PMC10640905 DOI: 10.7759/cureus.46992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION The clinical presentation of coronavirus disease 2019 (COVID-19) can vary widely, and while the primary infection involves the respiratory system, other organs can also be affected. This study presents the clinical and epidemiological characteristics of hospitalized COVID-19 patients in a tertiary hospital in Ado Ekiti, South-West Nigeria. MATERIALS AND METHODS This is a retrospective study involving COVID-19 patients admitted to the isolation ward between August 2020 and January 2021. The data used for this study was obtained from the patient's medical record, which includes demographic characteristics, clinical presentation, baseline co-morbidities, and laboratory investigations. RESULTS The average age of the patients was 60.3 years, and more than two-thirds were male. The most common symptoms were fever, shortness of breath, cough, and tiredness. Comorbidities identified among the patients included diabetes mellitus, heart disease, obesity, and chronic kidney disease. The most common radiological findings were bilateral homogeneous patchy opacities and peripheral fluffy infiltrates. The overall mortality rate was 21.9%, with 13 deaths in patients with severe disease. Age and duration of admission were found to be significant predictors of death. CONCLUSION The results of this study provide valuable insights into the clinical presentation of COVID-19 in Nigeria and may guide future management strategies for similar infections.
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Affiliation(s)
- Samuel A Dada
- Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, NGA
| | - Bolade F Dele-Ojo
- Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, NGA
| | - Taiwo H Raimi
- Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, NGA
| | - Peter Ojo
- Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, NGA
| | - Adekunle O Adeoti
- Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, NGA
| | - Joseph O Fadare
- Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, NGA
| | - Mojeed O Rafiu
- Department of Internal Medicine, Institute of Viral Haemorrhagic Fever and Emergent Pathogens, Irrua Specialist Teaching Hospital, Irrua Edo State, NGA
| | - Oluwamayowa E Dada
- Department of Health Information Management, Federal Teaching Hospital, Ido Ekiti, NGA
| | - Jimoh K Olabanji
- Department of Surgery, Ekiti State University Teaching Hospital, Ado Ekiti, NGA
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3
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Sarıoğlu E, Sarıaltın SY, Çoban T. Neurological complications and effects of COVID-19: Symptoms and conceivable mechanisms. BRAIN HEMORRHAGES 2023; 4:154-173. [PMID: 36789140 PMCID: PMC9911160 DOI: 10.1016/j.hest.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/04/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, China. The new coronavirus disease (COVID-19) was declared a global pandemic by the World Health Organization (WHO) in March 2020. SARS-CoV-2 can invade the nervous system aside from infecting the respiratory system as its primary target. The most common nervous system symptoms of COVID-19 are stated as headache, myalgia, fatigue, nausea, vomiting, sudden and unexplained anosmia, and ageusia. More severe conditions such as encephalomyelitis, acute myelitis, thromboembolic events, ischemic stroke, intracerebral hemorrhage, Guillain-Barré-syndrome, Bell's palsy, rhabdomyolysis, and even coma have also been reported. Cohort studies revealed that neurological findings are associated with higher morbidity and mortality. The neurological symptoms and manifestations caused by SARS-CoV-2 and COVID-19 are examined and summarized in this article.
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Affiliation(s)
- Elif Sarıoğlu
- Ankara University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, 06560 Ankara, Turkey
| | - Sezen Yılmaz Sarıaltın
- Ankara University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, 06560 Ankara, Turkey
| | - Tülay Çoban
- Ankara University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, 06560 Ankara, Turkey
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Xiang M, Wu X, Jing H, Novakovic VA, Shi J. The intersection of obesity and (long) COVID-19: Hypoxia, thrombotic inflammation, and vascular endothelial injury. Front Cardiovasc Med 2023; 10:1062491. [PMID: 36824451 PMCID: PMC9941162 DOI: 10.3389/fcvm.2023.1062491] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
The role of hypoxia, vascular endothelial injury, and thrombotic inflammation in worsening COVID-19 symptoms has been generally recognized. Damaged vascular endothelium plays a crucial role in forming in situ thrombosis, pulmonary dysfunction, and hypoxemia. Thrombotic inflammation can further aggravate local vascular endothelial injury and affect ventilation and blood flow ratio. According to the results of many studies, obesity is an independent risk factor for a variety of severe respiratory diseases and contributes to high mechanical ventilation rate, high mortality, and slow recovery in COVID-19 patients. This review will explore the mechanisms by which obesity may aggravate the acute phase of COVID-19 and delay long COVID recovery by affecting hypoxia, vascular endothelial injury, and thrombotic inflammation. A systematic search of PubMed database was conducted for papers published since January 2020, using the medical subject headings of "COVID-19" and "long COVID" combined with the following keywords: "obesity," "thrombosis," "endothelial injury," "inflammation," "hypoxia," "treatment," and "anticoagulation." In patients with obesity, the accumulation of central fat restricts the expansion of alveoli, exacerbating the pulmonary dysfunction caused by SARS-CoV-2 invasion, inflammatory damage, and lung edema. Abnormal fat secretion and immune impairment further aggravate the original tissue damage and inflammation diffusion. Obesity weakens baseline vascular endothelium function leading to an early injury and pre-thrombotic state after infection. Enhanced procoagulant activity and microthrombi promote early obstruction of the vascular. Obesity also prolongs the duration of symptoms and increases the risk of sequelae after hospital discharge. Persistent viral presence, long-term inflammation, microclots, and hypoxia may contribute to the development of persistent symptoms, suggesting that patients with obesity are uniquely susceptible to long COVID. Early interventions, including supplemental oxygen, comprehensive antithrombotic therapy, and anti-inflammatory drugs, show effectiveness in many studies in the prevention of serious hypoxia, thromboembolic events, and systemic inflammation, and are therefore recommended to reduce intensive care unit admission, mortality, and sequelae.
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Affiliation(s)
- Mengqi Xiang
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Xiaoming Wu
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Haijiao Jing
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Valerie A. Novakovic
- Department of Research, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA, United States
| | - Jialan Shi
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China,Department of Research, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA, United States,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, United States,*Correspondence: Jialan Shi, ,
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5
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Charpentier E, Redheuil A, Bourron O, Boussouar S, Lucidarme O, Zarai M, Kachenoura N, Bouazizi K, Salem JE, Hekimian G, Kerneis M, Amoura Z, Allenbach Y, Hatem S, Jeannin AC, Andreelli F, Phan F. Cardiac adipose tissue volume assessed by computed tomography is a specific and independent predictor of early mortality and critical illness in COVID-19 in type 2-diabetic patients. Cardiovasc Diabetol 2022; 21:294. [PMID: 36587209 PMCID: PMC9805370 DOI: 10.1186/s12933-022-01722-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/06/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Patients with type 2-diabetes mellitus (T2D), are characterized by visceral and ectopic adipose tissue expansion, leading to systemic chronic low-grade inflammation. As visceral adiposity is associated with severe COVID-19 irrespective of obesity, we aimed to evaluate and compare the predictive value for early intensive care or death of three fat depots (cardiac, visceral and subcutaneous) using computed tomography (CT) at admission for COVID-19 in consecutive patients with and without T2D. METHODS Two hundred and two patients admitted for COVID-19 were retrospectively included between February and June 2020 and distributed in two groups: T2D or non-diabetic controls. Chest CT with cardiac (CATi), visceral (VATi) and subcutaneous adipose tissue (SATi) volume measurements were performed at admission. The primary endpoint was a composite outcome criteria including death or ICU admission at day 21 after admission. Threshold values of adipose tissue components predicting adverse outcome were determined. RESULTS One hundred and eight controls [median age: 76(IQR:59-83), 61% male, median BMI: 24(22-27)] and ninety-four T2D patients [median age: 70(IQR:61-77), 70% male, median BMI: 27(24-31)], were enrolled in this study. At day 21 after admission, 42 patients (21%) had died from COVID-19, 48 (24%) required intensive care and 112 (55%) were admitted to a conventional care unit (CMU). In T2D, CATi was associated with early death or ICU independently from age, sex, BMI, dyslipidemia, CRP and coronary calcium (CAC). (p = 0.005). Concerning T2D patients, the cut-point for CATi was > 100 mL/m2 with a sensitivity of 0.83 and a specificity of 0.50 (AUC = 0.67, p = 0.004) and an OR of 4.71 for early ICU admission or mortality (p = 0.002) in the fully adjusted model. Other adipose tissues SATi or VATi were not significantly associated with early adverse outcomes. In control patients, age and male sex (OR = 1.03, p = 0.04) were the only predictors of ICU or death. CONCLUSIONS Cardiac adipose tissue volume measured in CT at admission was independently predictive of early intensive care or death in T2D patients with COVID-19 but not in non-diabetics. Such automated CT measurement could be used in routine in diabetic patients presenting with moderate to severe COVID-19 illness to optimize individual management and prevent critical evolution.
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Affiliation(s)
- Etienne Charpentier
- grid.411439.a0000 0001 2150 9058Sorbonne Université, Unité d’imagerie cardiovasculaire et thoracique, Hôpital La Pitié Salpêtrière (AP-HP), Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France, Paris, France
| | - Alban Redheuil
- grid.411439.a0000 0001 2150 9058Sorbonne Université, Unité d’imagerie cardiovasculaire et thoracique, Hôpital La Pitié Salpêtrière (AP-HP), Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France, Paris, France
| | - Olivier Bourron
- grid.462844.80000 0001 2308 1657Sorbonne Université, Département de diabétologie, Hôpital La Pitié Salpêtrière (AP-HP), Institute of Cardiometabolism and Nutrition, Paris, France, Paris, France ,grid.417925.cCentre de Recherche Des Cordeliers, INSERM, UMR_S 1138, Paris, France
| | - Samia Boussouar
- grid.411439.a0000 0001 2150 9058Sorbonne Université, Unité d’imagerie cardiovasculaire et thoracique, Hôpital La Pitié Salpêtrière (AP-HP), Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France, Paris, France
| | - Olivier Lucidarme
- grid.462844.80000 0001 2308 1657Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France ,grid.462844.80000 0001 2308 1657Service d’imagerie specialisee et d’urgence SISU, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Sorbonne Université, Paris, France
| | - Mohamed Zarai
- grid.477396.80000 0004 3982 4357Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Nadjia Kachenoura
- grid.462844.80000 0001 2308 1657Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - Khaoula Bouazizi
- grid.462844.80000 0001 2308 1657Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - Joe-Elie Salem
- grid.462844.80000 0001 2308 1657Department of Pharmacology, CIC-1901, INSERM, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Guillaume Hekimian
- grid.462844.80000 0001 2308 1657Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Sorbonne Université, Paris, France
| | - Matthieu Kerneis
- grid.462844.80000 0001 2308 1657AP-HP, Hôpital La Pitié-Salpêtrière, ACTION Study Group, Département de Cardiologie, Sorbonne Université, Paris, France
| | - Zahir Amoura
- grid.462844.80000 0001 2308 1657Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Institut e3M, Hôpital de La Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013 Paris, France
| | - Yves Allenbach
- grid.462844.80000 0001 2308 1657AP-HP, Département de Médecine Interne Et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Stephane Hatem
- grid.477396.80000 0004 3982 4357Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Anne-Caroline Jeannin
- grid.462844.80000 0001 2308 1657Sorbonne Université, Département de diabétologie, Hôpital La Pitié Salpêtrière (AP-HP), Institute of Cardiometabolism and Nutrition, Paris, France, Paris, France
| | - Fabrizio Andreelli
- grid.462844.80000 0001 2308 1657Sorbonne Université, Département de diabétologie, Hôpital La Pitié Salpêtrière (AP-HP), Institute of Cardiometabolism and Nutrition, Paris, France, Paris, France ,grid.462844.80000 0001 2308 1657Nutrition and ObesitiesSystemic Approaches (NutriOmics) Research Unit, INSERM, UMRS U1269, Sorbonne Université, Paris, France
| | - Franck Phan
- grid.462844.80000 0001 2308 1657Sorbonne Université, Département de diabétologie, Hôpital La Pitié Salpêtrière (AP-HP), Institute of Cardiometabolism and Nutrition, Paris, France, Paris, France ,grid.417925.cCentre de Recherche Des Cordeliers, INSERM, UMR_S 1138, Paris, France
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Xiang M, Wu X, Jing H, Liu L, Wang C, Wang Y, Novakovic VA, Shi J. The impact of platelets on pulmonary microcirculation throughout COVID-19 and its persistent activating factors. Front Immunol 2022; 13:955654. [PMID: 36248790 PMCID: PMC9559186 DOI: 10.3389/fimmu.2022.955654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/15/2022] [Indexed: 12/05/2022] Open
Abstract
Patients with COVID-19 often have hypoxemia, impaired lung function, and abnormal imaging manifestations in acute and convalescent stages. Alveolar inflammation, pulmonary vasculitis, and thromboembolism synergistically damage the blood-air barrier, resulting in increased pulmonary permeability and gas exchange disorders. The incidence of low platelet counts correlates with disease severity. Platelets are also involved in the impairment of pulmonary microcirculation leading to abnormal lung function at different phases of COVID-19. Activated platelets lose the ability to protect the integrity of blood vessel walls, increasing the permeability of pulmonary microvasculature. High levels of platelet activation markers are observed in both mild and severe cases, short and long term. Therefore, the risk of thrombotic events may always be present. Vascular endothelial injury, immune cells, inflammatory mediators, and hypoxia participate in the high reactivity and aggregation of platelets in various ways. Microvesicles, phosphatidylserine (PS), platelets, and coagulation factors are closely related. The release of various cell-derived microvesicles can be detected in COVID-19 patients. In addition to providing a phospholipid surface for the synthesis of intrinsic factor Xase complex and prothrombinase complex, exposed PS also promotes the decryption of tissue factor (TF) which then promotes coagulant activity by complexing with factor VIIa to activate factor X. The treatment of COVID-19 hypercoagulability and thrombosis still focuses on early intervention. Antiplatelet therapy plays a role in relieving the disease, inhibiting the formation of the hypercoagulable state, reducing thrombotic events and mortality, and improving sequelae. PS can be another potential target for the inhibition of hypercoagulable states.
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Affiliation(s)
- Mengqi Xiang
- Department of Hematology, the First Hospital, Harbin Medical University, Harbin, China
| | - Xiaoming Wu
- Department of Hematology, the First Hospital, Harbin Medical University, Harbin, China
| | - Haijiao Jing
- Department of Hematology, the First Hospital, Harbin Medical University, Harbin, China
| | - Langjiao Liu
- Department of Hematology, the First Hospital, Harbin Medical University, Harbin, China
| | - Chunxu Wang
- Department of Hematology, the First Hospital, Harbin Medical University, Harbin, China
| | - Yufeng Wang
- Department of Hematology, the First Hospital, Harbin Medical University, Harbin, China
| | - Valerie A. Novakovic
- Department of Research, Veterans Affairs (VA) Boston Healthcare System, Harvard Medical School, Boston, MA, United States
| | - Jialan Shi
- Department of Hematology, the First Hospital, Harbin Medical University, Harbin, China
- Department of Research, Veterans Affairs (VA) Boston Healthcare System, Harvard Medical School, Boston, MA, United States
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
- *Correspondence: Jialan Shi, ;
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Abumweis S, Alrefai W, Alzoughool F. Association of obesity with COVID-19 diseases severity and mortality: A meta-analysis of studies. OBESITY MEDICINE 2022; 33:100431. [PMID: 35702736 PMCID: PMC9181395 DOI: 10.1016/j.obmed.2022.100431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022]
Abstract
Background The literature on COVID-19 infection is growing every single day, and evidence of presence or absence of association between obesity and COVID-19 adverse outcomes should be revisited. Therefore, this study summarizes the pooled association of obesity with COVID-19 adverse outcomes and mortality. Methods We searched PubMed and Science direct databases using specific terms and defined criteria. Data were analyzed using Comprehensive Meta-Analysis V2 (Biostat, Englewood, NJ, USA)) random-effect models were used to calculate the odds ratio (OR) with 95% confidence intervals (95% CIs) of infection severity and mortality associated with obesity. Results Results revealed that obesity is not associated with COVID-19 mortality (OR = 1.1; 95%CI: 0.8 to 1.3) but with other adverse outcomes (OR = 2.4; 95%CI: 1.7 to 3.3). Conclusion Our findings support previous findings that obesity is associated with COVID-19 severity.
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Affiliation(s)
- Suhad Abumweis
- College of Pharmacy, Al Ain University, 64141, Abu Dhabi, United Arab Emirates
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan
| | - Waed Alrefai
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Foad Alzoughool
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan
- Faculty of Health Sciences, Fujairah Women's College, Higher Colleges of Technology, United Arab Emirates
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Yang D, Li H, Chen Y, Ren W, Dong M, Li C, Jiao Q. Immunomodulatory mechanisms of abatacept: A therapeutic strategy for COVID-19. Front Med (Lausanne) 2022; 9:951115. [PMID: 35957855 PMCID: PMC9357915 DOI: 10.3389/fmed.2022.951115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by coronavirus-2 (SARS-CoV-2) infection has rapidly spread throughout the world and become a major threat to human beings. Cytokine storm is a major cause of death in severe patients. Abatacept can suppress cytokines used as antirheumatic drugs in clinical applications. This study analyzed the molecular mechanisms of abatacept treatment for COVID-19. Differentially expressed genes (DEGs) were identified by analyzing expression profiling of abatacept treatment for rheumatoid arthritis (RA) patients and SARS-CoV-2 infection patients. We found that 59 DEGs were upregulated in COVID-19 patients and downregulated following abatacept treatment. Gene set enrichment analysis (GSEA) and Gene Ontology (GO) analysis showed that immune and inflammatory responses were potential regulatory mechanisms. Moreover, we verified 8 targeting genes and identified 15 potential drug candidates for the treatment of COVID-19. Our study illustrated that abatacept could be a promising property for preventing severe COVID-19, and we predicted alternative potential drugs for the treatment of SARS-CoV-2 infection.
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Affiliation(s)
- Dinglong Yang
- Second Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Hetong Li
- Second Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Yujing Chen
- School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Weiping Ren
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Mingjie Dong
- Second Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Chunjiang Li
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Qiang Jiao
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Qiang Jiao
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9
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Thakor JC, Dinesh M, Manikandan R, Bindu S, Sahoo M, Sahoo D, Dhawan M, Pandey MK, Tiwari R, Emran TB, Dhama K, Chaicumpa W. Swine coronaviruses (SCoVs) and their emerging threats to swine population, inter-species transmission, exploring the susceptibility of pigs for SARS-CoV-2 and zoonotic concerns. Vet Q 2022; 42:125-147. [PMID: 35584308 PMCID: PMC9225692 DOI: 10.1080/01652176.2022.2079756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Swine coronaviruses (SCoVs) are one of the most devastating pathogens affecting the livelihoods of farmers and swine industry across the world. These include transmissible gastroenteritis virus (TGEV), porcine epidemic diarrhea virus (PEDV), porcine respiratory coronavirus (PRCV), porcine hemagglutinating encephalomyelitis virus (PHEV), swine acute diarrhea syndrome coronavirus (SADS-CoV), and porcine delta coronavirus (PDCoV). Coronaviruses infect a wide variety of animal species and humans because these are having single stranded-RNA that accounts for high mutation rates and thus could break the species barrier. The gastrointestinal, cardiovascular, and nervous systems are the primary organ systems affected by SCoVs. Infection is very common in piglets compared to adult swine causing high mortality in the former. Bat is implicated to be the origin of all CoVs affecting animals and humans. Since pig is the only domestic animal in which CoVs cause a wide range of diseases; new coronaviruses with high zoonotic potential could likely emerge in the future as observed in the past. The recently emerged severe acute respiratory syndrome coronavirus virus-2 (SARS-CoV-2), causing COVID-19 pandemic in humans, has been implicated to have animal origin, also reported from few animal species, though its zoonotic concerns are still under investigation. This review discusses SCoVs and their epidemiology, virology, evolution, pathology, wildlife reservoirs, interspecies transmission, spill-over events and highlighting their emerging threats to swine population. The role of pigs amid ongoing SARS-CoV-2 pandemic will also be discussed. A thorough investigation should be conducted to rule out zoonotic potential of SCoVs and to design appropriate strategies for their prevention and control.
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Affiliation(s)
- Jigarji C Thakor
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh-243122, India
| | - Murali Dinesh
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh-243122, India
| | - Rajendran Manikandan
- Immunology Section, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh-243122, India
| | - Suresh Bindu
- Immunology Section, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh-243122, India
| | - Monalisa Sahoo
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh-243122, India
| | - Diptimayee Sahoo
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh-243122, India
| | - Manish Dhawan
- Department of Microbiology, Punjab Agricultural University, Ludhiana-141004, India.,The Trafford Group of Colleges, Manchester-WA14 5PQ, United Kingdom
| | - Megha Katare Pandey
- Department of Translational Medicine Center, All India Institute of Medical Sciences, Bhopal-462043, Madhya Pradesh, India
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidyalaya Evam Go Anusandhan Sansthan (DUVASU), Mathura-281001, India
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong-4381, Bangladesh
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh-243122, India
| | - Wanpen Chaicumpa
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok-10700, Thailand
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Pirola GM, Rubilotta E, Castellani D, Pancani F, Rosadi S, Giannantoni A, Asimakopoulos AD, Gubbiotti M. Increased risk of transurethral and suprapubic catheter self-extraction in COVID-19 patients: real-life experience. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S24-S30. [PMID: 35559699 DOI: 10.12968/bjon.2022.31.9.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION This study evaluated the prevalence of transurethral catheter self-removal in critically-ill COVID-19 non-sedated adult patients compared with non-COVID-19 controls. METHODS COVID-19 patients who self-extracted transurethral or suprapubic catheters needing a urological intervention were prospectively included (group A). Demographic data, medical and nursing records, comorbidities and nervous system symptoms were evaluated. Agitation, anxiety and delirium were assessed by the Richmond Agitation and Sedation Scale (RASS). The control group B were non-COVID-19 patients who self-extracted transurethral/suprapubic catheter in a urology unit (subgroup B1) and geriatric unit (subgroup B2), requiring a urological intervention in the same period. RESULTS 37 men and 11 women were enrolled in group A. Mean RASS score was 3.1 ± 1.8. There were 5 patients in subgroup B1 and 11 in subgroup B2. Chronic comorbidities were more frequent in group B than the COVID-19 group (P<0.01). COVID-19 patients had a significant difference in RASS score (P<0.006) and catheter self-extraction events (P<0.001). Complications caused by traumatic catheter extractions (severe urethrorrhagia, longer hospital stay) were greater in COVID-19 patients. CONCLUSION This is the first study focusing on the prevalence and complications of catheter self-removal in COVID-19 patients. An increased prevalence of urological complications due to agitation and delirium related to COVID-19 has been demonstrated-the neurological sequelae of COVID-19 must be considered during hospitalisation.
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Affiliation(s)
- Giacomo Maria Pirola
- Medical Doctor, Urologist, Department of Urology, San Donato Hospital, Arezzo, Italy
| | | | - Daniele Castellani
- Medical Doctor, Urologist, Department of Urology, Ospedali Riuniti di Ancona, Le Marche Polytechnic University, Ancona, Italy
| | - Flavia Pancani
- Medical Doctor, Anaesthetist, Department of Anaesthesia, San Donato Hospital, Arezzo, Italy
| | - Stefano Rosadi
- Medical Doctor, Urologist, Department of Urology, San Donato Hospital, Arezzo, Italy
| | - Antonella Giannantoni
- Professor, Medical Doctor, Urologist, Department of Medical and Surgical Sciences and Neurosciences, Functional and Surgical Urology Unit, University of Siena, Italy
| | | | - Marilena Gubbiotti
- Medical Doctor, Urologist, Department of Urology, San Donato Hospital, Arezzo, Italy
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de Marignan D, Vacheron CH, Ader F, Lecocq M, Richard JC, Frobert E, Casalegno JS, Couray-Targe S, Argaud L, Rimmele T, Aubrun F, Dailler F, Fellahi JL, Bohe J, Piriou V, Allaouchiche B, Friggeri A, Wallet F. A retrospective comparison of COVID-19 and seasonal influenza mortality and outcomes in the ICUs of a French university hospital. Eur J Anaesthesiol 2022; 39:427-435. [PMID: 35200203 DOI: 10.1097/eja.0000000000001672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND SARS-Cov-2 (COVID-19) has become a major worldwide health concern since its appearance in China at the end of 2019. OBJECTIVE To evaluate the intrinsic mortality and burden of COVID-19 and seasonal influenza pneumonia in ICUs in the city of Lyon, France. DESIGN A retrospective study. SETTING Six ICUs in a single institution in Lyon, France. PATIENTS Consecutive patients admitted to an ICU with SARS-CoV-2 pneumonia from 27 February to 4 April 2020 (COVID-19 group) and seasonal influenza pneumonia from 1 November 2015 to 30 April 2019 (influenza group). A total of 350 patients were included in the COVID-19 group (18 refused to consent) and 325 in the influenza group (one refused to consent). Diagnosis was confirmed by RT-PCR. Follow-up was completed on 1 April 2021. MAIN OUTCOMES AND MEASURES Differences in 90-day adjusted-mortality between the COVID-19 and influenza groups were evaluated using a multivariable Cox proportional hazards model. RESULTS COVID-19 patients were younger, mostly men and had a higher median BMI, and comorbidities, including immunosuppressive condition or respiratory history were less frequent. In univariate analysis, no significant differences were observed between the two groups regarding in-ICU mortality, 30, 60 and 90-day mortality. After Cox modelling adjusted on age, sex, BMI, cancer, sepsis-related organ failure assessment (SOFA) score, simplified acute physiology score SAPS II score, chronic obstructive pulmonary disease and myocardial infarction, the probability of death associated with COVID-19 was significantly higher in comparison to seasonal influenza [hazard ratio 1.57, 95% CI (1.14 to 2.17); P = 0.006]. The clinical course and morbidity profile of both groups was markedly different; COVID-19 patients had less severe illness at admission (SAPS II score, 37 [28 to 48] vs. 48 [39 to 61], P < 0.001 and SOFA score, 4 [2 to 8] vs. 8 [5 to 11], P < 0.001), but the disease was more severe considering ICU length of stay, duration of mechanical ventilation, PEEP level and prone positioning requirement. CONCLUSION After ICU admission, COVID-19 was associated with an increased risk of death compared with seasonal influenza. Patient characteristics, clinical course and morbidity profile of these diseases is markedly different.
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Affiliation(s)
- Donatien de Marignan
- From the Service de Médecine Intensive Réanimation anesthésie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite (DdM, C-HV, ML, JB, VP, BA, AF, FW), Service de Bio statistique - Bio-informatique, Pôle Santé Publique (C-HV), Service de Maladies infectieuses et tropicales, Hôpital de la Croix Rousse, Hospices Civils de Lyon (FAd), Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, ENS Lyon, Claude Bernard Lyon University (FAd, FW), Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon (CR), Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATISUMR5220, U1206 (JCR), LaboratoiredeVirologie, Institutdes Agents Infectieux (IAI), Hospices Civilsde Lyon (EF, JSC), Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, Team VirPatH, ENS Lyon, Claude Bernard Lyon University (EF, JSC), Pôlede Santé Publique, Departementd'Information Médicale, Hôpital De La Croix Rousse (SC-T), Service de médecine intensive réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon (LA), Service d'anesthésie réanimation, Hôpital Edouard Herriot, Hospices Civilsde Lyon, Lyon (TR), Service d'Anesthéesie réanimation, Hôpital de la Croix Rousse, Hospices Civilsde Lyon, Lyon (FAu), Service d'anesthésie réanimation, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon (FD), Service d'Anesthésie réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron (JLF), Health Services and Performance Research - HESPER, Université Claude Bernard Lyon 1, Facultedé Médecine, Lyon (VP), Pulmonary and Cardiovascular Agression in Sepsis (APCSe), and Universitée de Lyon, VetAgro Sup, Campus Vétérinaire de Lyon, UPSP 2016. A101, Marcy l'Étoile, France (BA)
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12
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Cataño-Correa JC, Cardona-Arias JA, Porras-Mancilla JP, Tabares-García M. Comparison of Survival and Clinical Profile of Adults with COVID-19 Hospitalized in Two Clinics in Medellín, Colombia. CURRENT CLINICAL MICROBIOLOGY REPORTS 2022; 9:11-19. [PMID: 35433195 PMCID: PMC8993667 DOI: 10.1007/s40588-022-00179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 12/15/2022]
Abstract
Purpose of Review This study compares the survival and clinical profile of hospitalized adults with COVID-19 in two clinics in the city of Medellín, Colombia, with a prospective study with 198 patients in clinic A and 201 in clinic B. Comparisons were made with chi-square and Mann–Whitney U, factors associated with survival were identified with a Cox regression. Recent Findings The proportion of deaths was 7.1% in clinic A with a mean survival of 51.9 days (95% CI = 45–59); in clinic B 13.9% of patients died with mean survival of 37.8 days (95% CI = 32–43). The most prevalent comorbidities were hypertension (41.6%), diabetes (23.8%), obesity (15.0%), hypothyroidism (13.0%), dyslipidemia (11.0%), and chronic lung disease (10.8%) with similar proportions in both clinics. There were also differences by the clinic in the most prevalent complications: bacterial pneumonia (18.8%), acute renal failure (14.3%), and encephalopathy (9.5%). There were no differences in the days of hospitalization, mechanical ventilation (clinic A 23.7% and clinic B 29.4%) and admission to the ICU (25.3% in A and 32.3% in B). Summary We evidence the heterogeneity of the survival and the clinical profile of the patients who are cared for by two institutions of the same city. These findings demonstrate the need to conduct unique studies for each institution, which poses a significant challenge for hospital epidemiology programs due to the impossibility of extrapolating evidence from other healthcare institutions and the need to implement personalized medicine programs given the clinical diversity of patients hospitalized for COVID-19.
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13
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Tisminetzky M, Delude C, Hebert T, Carr C, Goldberg RJ, Gurwitz JH. Age, Multiple Chronic Conditions, and COVID-19: A Literature Review. J Gerontol A Biol Sci Med Sci 2022; 77:872-878. [PMID: 33367606 PMCID: PMC7799222 DOI: 10.1093/gerona/glaa320] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Various patient demographic and clinical characteristics have been associated with poor outcomes for individuals with coronavirus disease 2019 (COVID-19). To describe the importance of age and chronic conditions in predicting COVID-19-related outcomes. METHODS Search strategies were conducted in PubMed/MEDLINE. Daily alerts were created. RESULTS A total of 28 studies met our inclusion criteria. Studies varied broadly in sample size (n = 21 to more than 17,000,000). Participants' mean age ranged from 48 years to 80 years, and the proportion of male participants ranged from 44% to 82%. The most prevalent underlying conditions in patients with COVID-19 were hypertension (range: 15%-69%), diabetes (8%-40%), cardiovascular disease (CVD) (4%-61%), chronic pulmonary disease (1%-33%), and chronic kidney disease (range 1%-48%). These conditions were each associated with an increased in-hospital case fatality rate (CFR) ranging from 1% to 56%. Overall, older adults have a substantially higher case fatality rate (CFR) as compared to younger individuals affected by COVID-19 (42% for those <65 vs 65% > 65 years). Only one study examined the association of chronic conditions and the risk of dying across different age groups; their findings suggested similar trends of increased risk in those < 65 years and those > 65 years as compared to those without these conditions. CONCLUSIONS There has been a traditional, single-condition approach to consideration of how chronic conditions and advancing age relate to COVID-19 outcomes. A more complete picture of the impact of burden of multimorbidity and advancing patient age is needed.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Primary Care Institute, Worcester, Massachusetts, USA
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, USA
| | | | - Tara Hebert
- Meyers Primary Care Institute, Worcester, Massachusetts, USA
| | - Catherine Carr
- Lamar Soutter Library, University of Massachusetts Medical School, Worcester, USA
| | - Robert J Goldberg
- Meyers Primary Care Institute, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, USA
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, Worcester, Massachusetts, USA
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, USA
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14
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Raeisi T, Mozaffari H, Sepehri N, Darand M, Razi B, Garousi N, Alizadeh M, Alizadeh S. The negative impact of obesity on the occurrence and prognosis of the 2019 novel coronavirus (COVID-19) disease: a systematic review and meta-analysis. Eat Weight Disord 2022; 27:893-911. [PMID: 34247342 PMCID: PMC8272688 DOI: 10.1007/s40519-021-01269-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The 2019 novel coronavirus (COVID-19) is an emerging pandemic, with a disease course varying from asymptomatic infection to critical disease resulting to death. Recognition of prognostic factors is essential because of its growing prevalence and high clinical costs. This meta-analysis aimed to evaluate the global prevalence of obesity in COVID-19 patients and to investigate whether obesity is a risk factor for the COVID-19, COVID-19 severity, and its poor clinical outcomes including hospitalization, intensive care unit (ICU) admission, need for mechanical ventilation, and mortality. METHODS The study protocol was registered in PROSPERO (CRD42020203386). A systematic search of Scopus, Medline, and Web of Sciences was conducted from 31 December 2019 to 1 June 2020 to find pertinent studies. After selection, 54 studies from 10 different countries were included in the quantitative analyses. Pooled odds ratios (OR) with 95% confidence intervals (CIs) were calculated to assess the associations. RESULTS The prevalence of obesity was 33% (95% CI 30.0%-35.0%) among patients with COVID-19. Obesity was significantly associated with susceptibility to COVID-19 (OR = 2.42, 95% CI 1.58-3.70; moderate certainty) and COVID-19 severity (OR = 1.62, 95% CI 1.48-1.76; low certainty). Furthermore, obesity was a significant risk factor for hospitalization (OR = 1.75, 95% CI 1.47-2.09; very low certainty), mechanical ventilation (OR = 2.24, 95% CI 1.70-2.94; low certainty), intensive care unit (ICU) admission (OR = 1.75, 95% CI 1.38-2.22; low certainty), and death (OR = 1.23, 95% CI 1.06-1.41; low certainty) in COVID-19 patients. In the subgroup analyses, these associations were supported by the majority of subgroups. CONCLUSION Obesity is associated with COVID-19, need for hospitalization, mechanical ventilation, ICU admission, and death due to COVID-19. LEVEL OF EVIDENCE Level I, systematic reviews and meta-analyses.
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Affiliation(s)
- Tahereh Raeisi
- Department of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hadis Mozaffari
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, Canada
| | | | - Mina Darand
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahman Razi
- Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Nazila Garousi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Alizadeh
- Department of Medical Surgical Nursing, Nasibeh Nursing and Midwifery School, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahab Alizadeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Abstract
COVID-19 has threatened human lives. Countries have implemented various interventions such as vaccination, mask-wearing, body temperature screening, and isolation. However, the effectiveness of single and combined interventions has not yet been accurately analyzed. In this study, an improved SEIR model considering both real human indoor close contact behaviors and susceptibility to COVID-19 was established. Taking Hong Kong as an example, a quantitative assessment of the relationship between the efficiency of single and combined interventions and implementation time and intensity was carried out. The results showed that the infection risk (one-hour close contact with an infected person) of COVID-19 of students, workers, and non-workers/non-students was 3.1%, 8.7%, and 13.6%, respectively. Workplace closures were more effective among built environment interventions. If mask-wearing was mandatorily required in schools, workplaces, supermarkets, shopping centers, and public transport, COVID-19 could not be totally restricted. Workers should be prioritized for vaccination, followed by non-workers/non-students and students. Among all interventions, reducing close contact rate and increasing vaccination rate were better interventions. There was no COVID-19 outbreak (basic reproduction number R0 = 1) if the close contact reduction rate was 59.9% or the vaccination rate reached 89.5%. The results may provide scientific support for COVID-19 prevention and control.
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16
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Ko RE, Oh DK, Choi SM, Park S, Park JE, Lee JG, Kim YT, Jeon K. Lung transplantation for severe COVID-19-related ARDS. Ther Adv Respir Dis 2022; 16:17534666221081035. [PMID: 35253546 PMCID: PMC8902188 DOI: 10.1177/17534666221081035] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Lung transplantation (LT) is the gold standard for various end-stage chronic
lung diseases and could be a salvage therapeutic option in acute respiratory
distress syndrome (ARDS). However, LT is uncertain in patients with
coronavirus disease 2019 (COVID-19)-related ARDS who failed to recover
despite optimal management including extracorporeal membrane oxygenation
(ECMO). This study aims to describe the pooled experience of LT for patients
with severe COVID-19-related ARDS in Korea. Methods: A nationwide multicenter retrospective observational study was performed with
consecutive LT for severe COVID-19-related ARDS in South Korea (June
2020–June 2021). Data were collected and compared with other LTs after
bridging with ECMO from the Korean Organ Transplantation Registry. Results: Eleven patients with COVID-19-related ARDS underwent LT. The median age was
60.0 years [interquartile range (IQR), 57.5–62.5; six males]. All patients
were supported with venovenous ECMO at LT listing and received
rehabilitation before LT. Patients were transplanted at a median of 49 (IQR,
32–66) days after ECMO cannulation. Primary graft dysfunction within 72 h of
LT developed in two (18.2%). One patient expired 4 days after LT due to
sepsis and one patient underwent retransplantation for graft failure. After
a median follow-up of 322 (IQR, 299–397) days, 10 patients are alive and
recovering well. Compared with other LTs after bridging with ECMO
(n = 27), post-transplant outcomes were similar between
the two groups. Conclusions: LT in patients with unresolving COVID-19-related ARDS were effective with
reasonable short-term outcome.
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Affiliation(s)
- Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Ji Eun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea
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d'Etienne JP, Alanis N, Chou E, Garrett JS, Kirby JJ, Bryant DP, Shaikh S, Schrader CD, Wang H. Validation of a simplified comorbidity evaluation predicting clinical outcomes among patients with coronavirus disease 2019 – A multicenter retrospective observation study. Am J Emerg Med 2022; 56:57-62. [PMID: 35366439 PMCID: PMC8907112 DOI: 10.1016/j.ajem.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/24/2022] [Accepted: 03/05/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives We compared and validated the performance accuracy of simplified comorbidity evaluation compared to the Charlson Comorbidity Index (CCI) predicting COVID-19 severity. In addition, we also determined whether risk prediction of COVID-19 severity changed during different COVID-19 pandemic outbreaks. Methods We enrolled all patients whose SARS-CoV-2 PCR tests were performed at six different hospital Emergency Departments in 2020. Patients were divided into three groups based on the various COVID-19 outbreaks in the US (first wave: March–May 2020, second wave: June–September 2020, and third wave: October–December 2020). A simplified comorbidity evaluation was used as an independent risk factor to predict clinical outcomes using multivariate logistic regressions. Results A total of 22,248 patients were included, for which 7023 (32%) patients tested COVID-19 positive. Higher percentages of COVID-19 patients with more than three chronic conditions had worse clinical outcomes (i.e., hospital and intensive care unit admissions, receiving invasive mechanical ventilations, and in-hospital mortality) during all three COVID-19 outbreak waves. Conclusions This simplified comorbidity evaluation was validated to be associated with COVID clinical outcomes. Such evaluation did not perform worse when compared with CCI to predict in-hospital mortality.
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Affiliation(s)
- James P d'Etienne
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
| | - Naomi Alanis
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
| | - Eric Chou
- Department of Emergency Medicine, Baylor University Medical Center, 3305 Worth St, Dallas, TX 75246, United States of America.
| | - John S Garrett
- Department of Emergency Medicine, Baylor University Medical Center, 3305 Worth St, Dallas, TX 75246, United States of America.
| | - Jessica J Kirby
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
| | - David P Bryant
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
| | - Sajid Shaikh
- Department of Information Technology, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
| | - Chet D Schrader
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
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Heldman MR, Kates OS, Safa K, Kotton CN, Multani A, Georgia SJ, Steinbrink JM, Alexander BD, Blumberg EA, Haydel B, Hemmige V, Hemmersbach-Miller M, La Hoz RM, Moni L, Condor Y, Flores S, Munoz CG, Guitierrez J, Diaz EI, Diaz D, Vianna R, Guerra G, Loebe M, Yabu JM, Kramer KH, Tanna SD, Ison MG, Rakita RM, Malinis M, Azar MM, McCort ME, Singh PP, Velioglu A, Mehta SA, van Duin D, Goldman JD, Lease ED, Wald A, Limaye AP, Fisher CE. Delayed mortality among solid organ transplant recipients hospitalized for COVID-19. Clin Infect Dis 2022; 78:ciac159. [PMID: 35212363 PMCID: PMC9383518 DOI: 10.1093/cid/ciac159] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Most studies of solid organ transplant (SOT) recipients with COVID-19 focus on outcomes within one month of illness onset. Delayed mortality in SOT recipients hospitalized for COVID-19 has not been fully examined. METHODS We used data from a multicenter registry to calculate mortality by 90 days following initial SARS-CoV-2 detection in SOT recipients hospitalized for COVID-19 and developed multivariable Cox proportional-hazards models to compare risk factors for death by days 28 and 90. RESULTS Vital status at day 90 was available for 936 of 1117 (84%) SOT recipients hospitalized for COVID-19: 190 of 936 (20%) died by 28 days and an additional 56 of 246 deaths (23%) occurred between days 29 and 90. Factors associated with mortality by day 90 included: age > 65 years [aHR 1.8 (1.3-2.4), p =<0.001], lung transplant (vs. non-lung transplant) [aHR 1.5 (1.0-2.3), p=0.05], heart failure [aHR 1.9 (1.2-2.9), p=0.006], chronic lung disease [aHR 2.3 (1.5-3.6), p<0.001] and body mass index ≥ 30 kg/m 2 [aHR 1.5 (1.1-2.0), p=0.02]. These associations were similar for mortality by day 28. Compared to diagnosis during early 2020 (March 1-June 19, 2020), diagnosis during late 2020 (June 20-December 31, 2020) was associated with lower mortality by day 28 [aHR 0.7 (0.5-1.0, p=0.04] but not by day 90 [aHR 0.9 (0.7-1.3), p=0.61]. CONCLUSIONS In SOT recipients hospitalized for COVID-19, >20% of deaths occurred between 28 and 90 days following SARS-CoV-2 diagnosis. Future investigations should consider extending follow-up duration to 90 days for more complete mortality assessment.
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Affiliation(s)
- Madeleine R Heldman
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Olivia S Kates
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kassem Safa
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Ashrit Multani
- Department of Medicine, David Geffen School of Medicine at the University of California–Los Angeles, Los Angeles, California, USA
| | | | - Julie M Steinbrink
- Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Barbara D Alexander
- Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Emily A Blumberg
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brandy Haydel
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vagish Hemmige
- Division of Infectious Disease, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | | | - Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lisset Moni
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Yesabeli Condor
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Sandra Flores
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Carlos G Munoz
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Juan Guitierrez
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Esther I Diaz
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Daniela Diaz
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Rodrigo Vianna
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Giselle Guerra
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Matthias Loebe
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Julie M Yabu
- Department of Medicine, David Geffen School of Medicine at the University of California–Los Angeles, Los Angeles, California, USA
| | - Kailey Hughes Kramer
- Transplant Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sajal D Tanna
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael G Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert M Rakita
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Maricar Malinis
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marwan M Azar
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Margaret E McCort
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pooja P Singh
- Division of Nephrology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Arzu Velioglu
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Sapna A Mehta
- New York University Langone Transplant Institute, New York, New York, USA
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jason D Goldman
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Swedish Medical Center, Seattle, Washington, USA
| | - Erika D Lease
- Division of Pulmonology, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Anna Wald
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Ajit P Limaye
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Cynthia E Fisher
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
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Hamilton CA, Ayyala D, Walsh D, Bramwell C, Walker C, Wilson Dib R, Gosse J, Ladak A, Morissette P, Rao A, Chao A, Vazquez J. Small Towns, Big Cities: Rural and Urban Disparities among Hospitalized Patients with COVID-19 in the Central Savannah River Area. Open Forum Infect Dis 2022; 9:ofac050. [PMID: 35198652 PMCID: PMC8860164 DOI: 10.1093/ofid/ofac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/26/2022] [Indexed: 11/14/2022] Open
Abstract
Background There is a lack of data surrounding the impact of coronavirus disease 2019 (COVID-19) among rural and urban communities. This study aims to determine whether there are differences in epidemiologic characteristics and clinical outcomes among individuals with COVID-19 among these communities. Methods This was a retrospective analysis of 155 patients admitted to a single-center tertiary academic hospital located in Augusta, Georgia, with a large proportion of hospitalized patients transferred from or residing in rural and urban counties. Hospitalized adult patients were included in the study if they were admitted to AUMC between March 13, 2020, and June 25, 2020, and had a positive polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 regardless of the presence or absence of symptomatology. Demographics, admission data, and 30-day outcomes were examined overall and by geographical variation. Results Urban patients were more likely to be admitted to the general medical floor (P = .01), while rural patients were more likely to require an escalation in the level of care within 24 hours of admission (P = .02). In contrast, of the patients who were discharged or expired at day 30, there were no statistically significant differences in either total hospital length of stay or intensive care unit length of stay between the populations. Conclusions There may be many social determinants of health that limit a rural patient’s ability to seek prompt medical care and contribute to decompensation within the first 24 hours of admission. This study provides insight into the differences in clinical course among patients admitted from different community settings and when accounting for comorbid conditions.
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Affiliation(s)
- Caroline A Hamilton
- Department of Medicine, Division of Infectious Disease, Augusta University, 1120 15th Street, Augusta, Georgia, 30912, USA
| | - Deepak Ayyala
- Department of Population Health Sciences, Augusta University, 1120 15th Street, Augusta, Georgia, 30912, USA
| | - David Walsh
- Department of Medicine, Division of Hospital Medicine, Augusta University, 1120 15th Street, Augusta, Georgia, 30912, USA
| | - Christian Bramwell
- Department of Medicine, Division of Family Medicine, Augusta University, 1120 15th Street, Augusta, Georgia, 30912, USA
| | - Christopher Walker
- Department of Medicine, Division of Internal Medicine, Augusta University, 1120 15th Street, Augusta, Georgia, 30912, USA
| | - Rita Wilson Dib
- Department of Medicine, Division of Internal Medicine, Augusta University, 1120 15th Street, Augusta, Georgia, 30912, USA
| | - Jessica Gosse
- Department of Medicine, Division of Internal Medicine, Augusta University, 1120 15th Street, Augusta, Georgia, 30912, USA
| | - Amber Ladak
- Department of Medicine, Division of Infectious Disease, Augusta University, 1120 15th Street, Augusta, Georgia, 30912, USA
| | - Patricia Morissette
- Department of Medicine, Division of Hospital Medicine, Augusta University, 1120 15th Street, Augusta, Georgia, 30912, USA
| | - Arni Rao
- Department of Medicine, Division of Infectious Disease, Augusta University, 1120 15th Street, Augusta, Georgia, 30912, USA
| | - Andrew Chao
- Department of Medicine, Division of Infectious Disease, Augusta University, 1120 15th Street, Augusta, Georgia, 30912, USA
| | - Jose Vazquez
- Department of Medicine, Division of Infectious Disease, Augusta University, 1120 15th Street, Augusta, Georgia, 30912, USA
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20
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Ayodele O, Ren K, Zhao J, Signorovitch J, Jonsson Funk M, Zhu J, Bao Y, Gondek K, Keenan H. Real-world treatment patterns and clinical outcomes for inpatients with COVID-19 in the US from September 2020 to February 2021. PLoS One 2021; 16:e0261707. [PMID: 34962924 PMCID: PMC8714107 DOI: 10.1371/journal.pone.0261707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/07/2021] [Indexed: 12/15/2022] Open
Abstract
The objective of this retrospective cohort study was to describe pre-treatment characteristics, treatment patterns, health resource use, and clinical outcomes among adults hospitalized with COVID-19 in the United States (US) who initiated common treatments for COVID-19. The Optum® COVID-19 electronic health records database was used to identify patients >18 years, diagnosed with COVID-19, who were admitted to an inpatient setting and received treatments of interest for COVID-19 between September 2020 and January 2021. Patients were stratified into cohorts based on index treatment use. Patient demographics, medical history, care setting, medical procedures, subsequent treatment use, patient disposition, clinical improvement, and outcomes were summarized descriptively. Among a total of 26,192 patients identified, the most prevalent treatments initiated were dexamethasone (35.4%) and dexamethasone + remdesivir (14.9%), and dexamethasone was the most common subsequent treatment. At day 14 post-index, <10% of patients received any treatments of interest. Mean (standard deviation [SD]) patient age was 65.6 (15.6) years, and the most prevalent comorbidities included hypertension (44.8%), obesity (35.4%), and diabetes (25.7%). At the end of follow-up, patients had a mean (SD) 8.1 (6.6) inpatient days and 1.4 (4.1) days with ICU care. Oxygen supplementation, non-invasive, or invasive ventilation was required by 4.5%, 3.0%, and 3.1% of patients, respectively. At the end of follow-up, 84.2% of patients had evidence of clinical improvement, 3.1% remained hospitalized, 83.8% were discharged, 4% died in hospital, and 9.1% died after discharge. Although the majority of patients were discharged alive, no treatments appeared to alleviate the inpatient morbidity and mortality associated with COVID-19. This highlights an unmet need for effective treatment options for patients hospitalized with COVID-19.
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Affiliation(s)
- Olulade Ayodele
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
- * E-mail:
| | - Kaili Ren
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Jing Zhao
- Analysis Group, Data Sciences Institute, Boston, MA, United States of America
| | - James Signorovitch
- Analysis Group, Data Sciences Institute, Boston, MA, United States of America
| | - Michele Jonsson Funk
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States of America
| | - Julia Zhu
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, NJ, United States of America
| | - Ying Bao
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, NJ, United States of America
| | - Kathleen Gondek
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Hillary Keenan
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
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21
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Aggarwal AN, Agarwal R, Dhooria S, Prasad KT, Sehgal IS, Muthu V. Impact of Asthma on Severity and Outcomes in COVID-19. Respir Care 2021; 66:1912-1923. [PMID: 34584009 PMCID: PMC9993793 DOI: 10.4187/respcare.09113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We conducted this systematic review to evaluate whether asthma increases the risk of severe disease and adverse outcomes among subjects with COVID-19. METHODS We queried the PubMed and Embase databases for studies indexed through December 2020. We included studies providing data on severe disease, hospitalization, ICU care, need for mechanical ventilation, or mortality among subjects with COVID-19 with and without asthma. We calculated the relative risk for each reported outcome of interest and used random effects modeling to summarize the data. RESULTS We retrieved 1,832 citations, and included 90 studies, in our review. Most publications reported data retrieved from electronic records of retrospective subject cohorts. Only 25 studies were judged to be of high quality. Subjects with asthma and COVID-19 had a marginally higher risk of hospitalization (summary relative risk 1.13, 95% CI 1.03-1.24) but not for severe disease (summary relative risk 1.17, 95% CI 0.62-2.20), ICU admission (summary relative risk 1.13, 95% CI 0.96-1.32), mechanical ventilation (summary relative risk 1.05, 95% CI 0.85-1.29), or mortality (summary relative risk 0.92, 95% CI 0.82-1.04) as compared to subjects with COVID-19 without asthma. CONCLUSIONS Comorbid asthma increases risk of COVID-19-related hospitalization but not severe disease or other adverse outcomes in subjects with COVID-19.
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Affiliation(s)
- Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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22
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Yin Y, Rohli KE, Shen P, Lu H, Liu Y, Dou Q, Zhang L, Kong X, Yang S, Jia P. The epidemiology, pathophysiological mechanisms, and management toward COVID-19 patients with Type 2 diabetes: A systematic review. Prim Care Diabetes 2021; 15:899-909. [PMID: 34600859 PMCID: PMC8418914 DOI: 10.1016/j.pcd.2021.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 08/09/2021] [Accepted: 08/31/2021] [Indexed: 02/05/2023]
Abstract
This review comprehensively summarizes epidemiologic evidence of COVID-19 in patients with Type 2 diabetes, explores pathophysiological mechanisms, and integrates recommendations and guidelines for patient management. We found that diabetes was a risk factor for diagnosed infection and poor prognosis of COVID-19. Patients with diabetes may be more susceptible to adverse outcomes associated with SARS-CoV-2 infection due to impaired immune function and possible upregulation of enzymes that mediate viral invasion. The chronic inflammation caused by diabetes, coupled with the acute inflammatory reaction caused by SARS-CoV-2, results in a propensity for inflammatory storm. Patients with diabetes should be aware of their increased risk for COVID-19.
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Affiliation(s)
- Yun Yin
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Kristen E Rohli
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Pengyue Shen
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Haonan Lu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yuenan Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qingyu Dou
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China; National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China.
| | - Peng Jia
- School of Resources and Environmental Science, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China.
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23
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Puri A, He L, Giri M, Wu C, Zhao Q. Comparison of comorbidities among severe and non-severe COVID-19 patients in Asian versus non-Asian populations: A systematic review and meta-analysis. Nurs Open 2021; 9:733-751. [PMID: 34761532 PMCID: PMC8661719 DOI: 10.1002/nop2.1126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/25/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the comorbidities among severe and non-severe COVID-19 patients in Asian versus non-Asian populations. DESIGN Systemic review and Meta-analysis. METHODS A systematic literature search was conducted using PubMed, Embase, Scopus and the web of science Database up to 24 March 2021. Odds ratios were calculated using a random-effects model. RESULTS We identified 66 studies including 39 Asian and 27 non-Asian studies. This study demonstrated that the proportion of hypertension was significantly higher in severe group than in non-severe group for Asian (OR = 2.46) and non-Asian (OR = 1.60, 95% CI: 1.37-1.86, I2 = 84%; p < .00001) patients. Similarly, the proportion of diabetes, cardiovascular disease and chronic kidney disease was significantly higher in severe group than in non-severe group for both Asian and non-Asian studies. We found no statistically significant difference between the severe versus non-severe group for cancer (OR = 1.26) and chronic obstructive pulmonary disease (OR = 1.32) among non-Asian patients.
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Affiliation(s)
- Anju Puri
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin He
- Department of Respiratory and Critical Care Medicine, Fuling Central Hospital of Chongqing City, Chongqing, China
| | - Mohan Giri
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chengfei Wu
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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24
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Zhang N, Jack Chan PT, Jia W, Dung CH, Zhao P, Lei H, Su B, Xue P, Zhang W, Xie J, Li Y. Analysis of efficacy of intervention strategies for COVID-19 transmission: A case study of Hong Kong. ENVIRONMENT INTERNATIONAL 2021; 156:106723. [PMID: 34161908 PMCID: PMC8214805 DOI: 10.1016/j.envint.2021.106723] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 05/25/2023]
Abstract
By the end of February 2021, COVID-19 had spread to over 230 countries, with more than 100 million confirmed cases and 2.5 million deaths. To control infection spread with the least disruption to economic and societal activities, it is crucial to implement the various interventions effectively. In this study, we developed an agent-based SEIR model, using real demographic and geographic data from Hong Kong, to analyse the efficiency of various intervention strategies in preventing infection by the SARS-CoV-2 virus. Close contact route including short-range airborne is considered as the main transmission routes for COVID-19 spread. Contact tracing is not that useful if all other interventions have been fully deployed. The number of infected individuals could be halved if people reduced their close contact rate by 25%. For reducing transmission, students should be prioritized for vaccination rather than retired older people and preschool aged children. Home isolation, and taking the nucleic acid test (NAT) as soon as possible after symptom onset, are much more effective interventions than wearing masks in public places. Temperature screening in public places only disrupted the infection spread by a small amount when other interventions have been fully implemented. Our results may be useful for other highly populated cities, when choosing their intervention strategies to prevent outbreaks of COVID-19 and similar diseases.
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Affiliation(s)
- Nan Zhang
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China; Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Pak-To Jack Chan
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Wei Jia
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China; Zhejiang Institute of Research and Innovation, The University of Hong Kong, Lin An, Zhejiang, China
| | - Chung-Hin Dung
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Pengcheng Zhao
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Hao Lei
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Boni Su
- China Electric Power Planning & Engineering Institute, Beijing, China
| | - Peng Xue
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China
| | - Weirong Zhang
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China
| | - Jingchao Xie
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China.
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25
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Geng J, Yu X, Bao H, Feng Z, Yuan X, Zhang J, Chen X, Chen Y, Li C, Yu H. Chronic Diseases as a Predictor for Severity and Mortality of COVID-19: A Systematic Review With Cumulative Meta-Analysis. Front Med (Lausanne) 2021; 8:588013. [PMID: 34540855 PMCID: PMC8440884 DOI: 10.3389/fmed.2021.588013] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/05/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Given the ongoing coronavirus disease 2019 (COVID-19) pandemic and the consequent global healthcare crisis, there is an urgent need to better understand risk factors for symptom deterioration and mortality among patients with COVID-19. This systematic review aimed to meet the need by determining the predictive value of chronic diseases for COVID-19 severity and mortality. Methods: We searched PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Complete to identify studies published between December 1, 2019, and December 31, 2020. Two hundred and seventeen observational studies from 26 countries involving 624,986 patients were included. We assessed the risk of bias of the included studies and performed a cumulative meta-analysis. Results: We found that among COVID-19 patients, hypertension was a very common condition and was associated with higher severity, intensive care unit (ICU) admission, acute respiratory distress syndrome, and mortality. Chronic obstructive pulmonary disease was the strongest predictor for COVID-19 severity, admission to ICU, and mortality, while asthma was associated with a reduced risk of COVID-19 mortality. Patients with obesity were at a higher risk of experiencing severe symptoms of COVID-19 rather than mortality. Patients with cerebrovascular disease, chronic liver disease, chronic renal disease, or cancer were more likely to become severe COVID-19 cases and had a greater probability of mortality. Conclusions: COVID-19 patients with chronic diseases were more likely to experience severe symptoms and ICU admission and faced a higher risk of mortality. Aggressive strategies to combat the COVID-19 pandemic should target patients with chronic diseases as a priority.
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Affiliation(s)
- JinSong Geng
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoLan Yu
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - HaiNi Bao
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - Zhe Feng
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoYu Yuan
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - JiaYing Zhang
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoWei Chen
- Library and Reference Department, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - YaLan Chen
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - ChengLong Li
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
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26
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Longino A, Riveros T, Risa E, Hebert C, Krieger J, Coppess S, McGuire F, Bhatraju PK, Town J, Johnson NJ. Respiratory Mechanics in a Cohort of Critically Ill Subjects With COVID-19 Infection. Respir Care 2021; 66:1601-1609. [PMID: 34465572 DOI: 10.4187/respcare.09064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with coronavirus disease 2019 (COVID-19) often develop acute hypoxemic respiratory failure and receive invasive mechanical ventilation. Much remains unknown about their respiratory mechanics, including the trajectories of pulmonary compliance and [Formula: see text]/[Formula: see text], the prognostic value of these parameters, and the effects of prone positioning. We described respiratory mechanics among subjects with COVID-19 who were intubated during the first month of hospitalization. METHODS We included patients with COVID-19 who were mechanically ventilated between February and May 2020. Daily values of pulmonary compliance, [Formula: see text], [Formula: see text], and the use of prone positioning were abstracted from electronic medical records. The trends were analyzed separately over days 1-10 and days 1-35 of intubation, stratified by prone positioning use, survival, and initial [Formula: see text]/[Formula: see text]. RESULTS Among 49 subjects on mechanical ventilation day 1, the mean compliance was 41 mL/cm H2O, decreasing to 25 mL/cm H2O by day 14, the median duration of mechanical ventilation. In contrast, the [Formula: see text]/[Formula: see text] on day 1 was similar to day 14. The overall mean compliance was greater among the non-survivors versus the survivors (27 mL/cm H2O vs 24 mL/cm H2O; P = .005), whereas [Formula: see text]/[Formula: see text] was higher among the survivors versus the non-survivors over days 1-10 (159 mm Hg vs 138 mm Hg; P = .002) and days 1-35 (175 mm Hg vs 153 mm Hg; P < .001). The subjects who underwent early prone positioning had lower compliance during days 1-10 (27 mL/cm H2O vs 33 mL/cm H2O; P < .001) and lower [Formula: see text]/[Formula: see text] values over days 1-10 (139.9 mm Hg vs 167.4 mm Hg; P < .001) versus those who did not undergo prone positioning. After day 21 of hospitalization, the average compliance of the subjects who had early prone positioning surpassed that of the subjects who did not have prone positioning. CONCLUSIONS Respiratory mechanics of the subjects with COVID-19 who were on mechanical ventilation were characterized by persistently low respiratory system compliance and [Formula: see text]/[Formula: see text], similar to ARDS due to other etiologies. The [Formula: see text]/[Formula: see text] was more tightly associated with mortality than with compliance.
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Affiliation(s)
- August Longino
- Division of General Internal Medicine, University of Colorado, Aurora, Colorado.
| | - Toni Riveros
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington
| | - Erik Risa
- School of Medicine, University of Washington Medical Center, Seattle, Washington
| | - Chris Hebert
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington
| | - Joshua Krieger
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington
| | - Steven Coppess
- Department of Emergency Medicine, University of Washington Medical Center, Seattle, Washington
| | - Flynn McGuire
- School of Medicine, University of Washington Medical Center, Seattle, Washington
| | - Pavan K Bhatraju
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington
| | - James Town
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington
| | - Nicholas J Johnson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington.,Department of Emergency Medicine, University of Washington Medical Center, Seattle, Washington
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Tagliabue M, Ridolfo AL, Pina P, Rizzolo G, Belbusti S, Antinori S, Beltrami M, Cattaneo D, Gervasoni C. Preventing COVID-19 in assisted living facilities: An impossible task pending vaccination roll out. Prev Med Rep 2021; 23:101471. [PMID: 34221853 PMCID: PMC8233410 DOI: 10.1016/j.pmedr.2021.101471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 05/12/2021] [Accepted: 06/23/2021] [Indexed: 12/23/2022] Open
Abstract
Here, we aimed to describe the clinical outcomes of the residents of a long-term care facility during its closure to visitors and suppliers in response to the first COVID-19 pandemic from February 23 to June 22, 2020, and the results of the facility-wide SARS-CoV-2 testing of residents and staff in June 2020 before its partially reopening. Seventy-four residents and 53 members of staff were included in the present study. The staff underwent nasopharyngeal swab tests for SARS-CoV-2, and both the staff and residents underwent serological tests to detect IgG antibodies against SARS-CoV-2. The results of all of the tests were negative. Conversely, 94% of residents and 38% members of the staff were tested positive to the nasopharyngeal swab tests during the second COVID-19 pandemic wave (data collected from November 1 to November 30, 2020). Our experience suggests that, in the presence of a life-threatening pandemic such as SARS-CoV-2 infection, the prompt use of restrictive procedures can prevent the spread and progression of disease in assisted living facilities in the short term but may fail in the long term, especially when the prevalence of the COVID-19 greatly increased outside the facility enhancing the risk of import the disease from outside. SARS-CoV-2 vaccination of residents and staff members would contribute to control/limit the prevalence and the spread of the virus.
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Affiliation(s)
| | - Anna Lisa Ridolfo
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Paolo Pina
- Cesare e Emilio Prandoni ONLUS, Torno, Italy
| | | | | | - Spinello Antinori
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Martina Beltrami
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Dario Cattaneo
- Gestione Ambulatoriale Politerapie (GAP) Outpatient Clinic, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Cristina Gervasoni
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
- Gestione Ambulatoriale Politerapie (GAP) Outpatient Clinic, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
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Patanavanich R, Glantz SA. Smoking is associated with worse outcomes of COVID-19 particularly among younger adults: a systematic review and meta-analysis. BMC Public Health 2021; 21:1554. [PMID: 34399729 PMCID: PMC8366155 DOI: 10.1186/s12889-021-11579-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 07/30/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Smoking impairs lung immune function and damages upper airways, increasing risks of contracting and severity of infectious diseases. This paper quantifies the association between smoking and COVID-19 disease progression. METHODS We searched PubMed and Embase for studies published from January 1-May 25, 2020. We included studies reporting smoking behavior of COVID-19 patients and progression of disease, including death. We used random effects meta-analysis, meta-regression and locally weighted regression and smoothing to examine relationships in the data. RESULTS We identified 46 peer-reviewed papers with a total of 22,939 COVID-19 patients, 5421 (23.6%) experienced disease progression and 2914 (12.7%) with a history of smoking (current and former smokers). Among those with a history of smoking, 33.5% experienced disease progression, compared with 21.9% of non-smokers. The meta-analysis confirmed an association between ever smoking and COVID-19 progression (OR 1.59, 95% CI 1.33-1.89, p = 0.001). Ever smoking was associated with increased risk of death from COVID-19 (OR 1.19, 95% CI 1.02-1.39, p = 0.003). We found no significant difference (p = 0.864) between the effects of ever smoking on COVID-19 disease progression between adjusted and unadjusted analyses, suggesting that smoking is an independent risk factor for COVID-19 disease progression. We also found the risk of having COVID-19 progression higher among younger adults (p = 0.001), with the effect most pronounced among younger adults under about 45 years old. CONCLUSIONS Smoking is an independent risk for having progression of COVID-19, including mortality. The effects seem to be higher among young people. Smoking prevention and cessation should remain a priority for the public, physicians, and public health professionals during the COVID-19 pandemic.
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Affiliation(s)
- Roengrudee Patanavanich
- Center for Tobacco Control Research and Education, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143-1390, USA
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Nakhon Pathom, Thailand
| | - Stanton A Glantz
- Center for Tobacco Control Research and Education, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143-1390, USA.
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D V, Sharma A, Kumar A, Flora SJS. Neurological Manifestations in COVID-19 Patients: A Meta-Analysis. ACS Chem Neurosci 2021; 12:2776-2797. [PMID: 34260855 PMCID: PMC8291134 DOI: 10.1021/acschemneuro.1c00353] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023] Open
Abstract
Common symptoms such as dizziness, headache, olfactory dysfunction, nausea, vomiting, etc. in COVID-19 patients have indicated the involvement of the nervous system. However, the exact association of the nervous system with COVID-19 infection is still unclear. Thus, we have conducted a meta-analysis of clinical studies associated with neurological problems in COVID-19 patients. We have searched for electronic databases with MeSH terms, and the studies for analysis were selected based on inclusion and exclusion criteria and quality assessment. The Stats Direct (version 3) was used for the analysis. The pooled prevalence with 95% confidence interval of various neurological manifestations reported in the COVID-19 patients was found to be headache 14.6% (12.2-17.2), fatigue 33.6% (29.5-37.8), olfactory dysfunction 26.4% (21.8-31.3), gustatory dysfunction 27.2% (22.3-32.3), vomiting 6.7% (5.5-8.0), nausea 9.8% (8.1-11.7), dizziness 6.7% (4.7-9.1), myalgia 21.4% (18.8-24.1), seizure 4.05% (2.5-5.8), cerebrovascular diseases 9.9% (6.8-13.4), sleep disorders 14.9% (1.9-36.8), altered mental status 17.1% (12.3-22.5), neuralgia 2.4% (0.8-4.7), arthralgia 19.9% (15.3-25.0), encephalopathy 23.5% (14.3-34.1), encephalitis 0.6% (0.2-1.3), malaise 38.3% (24.7-52.9), confusion 14.2% (6.9-23.5), movement disorders 5.2% (1.7-10.4), and Guillain-Barre syndrome 6.9% (2.3-13.7). However, the heterogeneity among studies was found to be high. Various neurological manifestations related to the central nervous system (CNS) and peripheral nervous system (PNS) are associated with COVID-19 patients.
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Affiliation(s)
- Vitalakumar D
- Department of Pharmacology and Toxicology,
National Institute of Pharmaceutical Education and Research
(NIPER)-Raeberali, Lucknow 226002, India
| | - Ankita Sharma
- Department of Biotechnology, National
Institute of Pharmaceutical Education and Research (NIPER)-Raeberali,
Lucknow 226002, India
| | - Anoop Kumar
- Department of Pharmacology and Clinical Research, Delhi
Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi
Pharmaceutical Sciences & Research University (DPSRU), New Delhi
110017, India
| | - S. J. S. Flora
- Department of Pharmacology and Toxicology,
National Institute of Pharmaceutical Education and Research
(NIPER)-Raeberali, Lucknow 226002, India
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Cai Z, Yang Y, Zhang J. Obesity is associated with severe disease and mortality in patients with coronavirus disease 2019 (COVID-19): a meta-analysis. BMC Public Health 2021; 21:1505. [PMID: 34348687 PMCID: PMC8334342 DOI: 10.1186/s12889-021-11546-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 07/23/2021] [Indexed: 02/08/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has led to global research to predict those who are at greatest risk of developing severe disease and mortality. The aim of this meta-analysis was to determine the associations between obesity and the severity of and mortality due to COVID-19. Methods We searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies evaluating the associations of obesity with COVID-19. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random- or fixed-effects models. Meta-regression analyses were conducted to estimate regression coefficients. Results Forty-six studies involving 625,153 patients were included. Compared with nonobese patients, obese patients had a significantly increased risk of infection. (OR 2.73, 95% CI 1.53–4.87; I2 = 96.8%), hospitalization (OR 1.72, 95% CI 1.55–1.92; I2 = 47.4%), clinically severe disease (OR 3.81, 95% CI 1.97–7.35; I2 = 57.4%), mechanical ventilation (OR 1.66, 95% CI 1.42–1.94; I2 = 41.3%), intensive care unit (ICU) admission (OR 2.25, 95% CI 1.55–3.27; I2 = 71.5%), and mortality (OR 1.61, 95% CI 1.29–2.01; I2 = 83.1%). Conclusion Patients with obesity may have a greater risk of infection, hospitalization, clinically severe disease, mechanical ventilation, ICU admission, and mortality due to COVID-19. Therefore, it is important to increase awareness of these associations with obesity in COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11546-6.
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Affiliation(s)
- Zixin Cai
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yan Yang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Dixon BE, Grannis SJ, Lembcke LR, Valvi N, Roberts AR, Embi PJ. The synchronicity of COVID-19 disparities: Statewide epidemiologic trends in SARS-CoV-2 morbidity, hospitalization, and mortality among racial minorities and in rural America. PLoS One 2021; 16:e0255063. [PMID: 34297747 PMCID: PMC8301667 DOI: 10.1371/journal.pone.0255063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023] Open
Abstract
Background Early studies on COVID-19 identified unequal patterns in hospitalization and mortality in urban environments for racial and ethnic minorities. These studies were primarily single center observational studies conducted within the first few weeks or months of the pandemic. We sought to examine trends in COVID-19 morbidity, hospitalization, and mortality over time for minority and rural populations, especially during the U.S. fall surge. Methods Data were extracted from a statewide cohort of all adult residents in Indiana tested for SARS-CoV-2 infection between March 1 and December 31, 2020, linked to electronic health records. Primary measures were per capita rates of infection, hospitalization, and death. Age adjusted rates were calculated for multiple time periods corresponding to public health mitigation efforts. Comparisons across time within groups were compared using ANOVA. Results Morbidity and mortality increased over time with notable differences among sub-populations. Initially, hospitalization rates among racial minorities were 3–4 times higher than whites, and mortality rates among urban residents were twice those of rural residents. By fall 2020, hospitalization and mortality rates in rural areas surpassed those of urban areas, and gaps between black/brown and white populations narrowed. Changes across time among demographic groups was significant for morbidity and hospitalization. Cumulative morbidity and mortality were highest among minority groups and in rural communities. Conclusions The synchronicity of disparities in COVID-19 by race and geography suggests that health officials should explicitly measure disparities and adjust mitigation as well as vaccination strategies to protect those sub-populations with greater disease burden.
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Affiliation(s)
- Brian E. Dixon
- Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Bloomington, Indiana, United States of America
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States of America
- * E-mail:
| | - Shaun J. Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States of America
- Department of Family Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Lauren R. Lembcke
- Research Data Services, Regenstrief Institute, Indianapolis, Indiana, United States of America
| | - Nimish Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States of America
| | - Anna R. Roberts
- Research Data Services, Regenstrief Institute, Indianapolis, Indiana, United States of America
| | - Peter J. Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States of America
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
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Cataño-Correa JC, Cardona-Arias JA, Porras Mancilla JP, García MT. Bacterial superinfection in adults with COVID-19 hospitalized in two clinics in Medellín-Colombia, 2020. PLoS One 2021; 16:e0254671. [PMID: 34255801 PMCID: PMC8277025 DOI: 10.1371/journal.pone.0254671] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/30/2021] [Indexed: 12/23/2022] Open
Abstract
COVID-19 represents high morbidity and mortality, its complications and lethality have increased due to bacterial superinfections. We aimed to determine the prevalence of bacterial superinfection in adults with COVID-19, hospitalized in two clinics in Medellín-Colombia during 2020, and its distribution according to sociodemographic and clinical conditions. A cross sectional study was made with 399 patients diagnosed with COVID-19 by RT-PCR. We determined the prevalence of bacterial superinfection and its factors associated with crude and adjusted prevalence ratios by a generalized linear model. The prevalence of superinfection was 49.6%, with 16 agents identified, the most frequent were Klebsiella (pneumoniae and oxytoca) and Staphylococcus aureus. In the multivariate adjustment, the variables with the strongest association with bacterial superinfection were lung disease, encephalopathy, mechanical ventilation, hospital stay, and steroid treatment. A high prevalence of bacterial superinfections, a high number of agents, and multiple associated factors were found. Among these stood out comorbidities, complications, days of hospitalization, mechanical ventilation, and steroid treatment. These results are vital to identifying priority clinical groups, improving the care of simultaneous infections with COVID-19 in people with the risk factors exposed in the population studied, and identifying bacteria of public health interest.
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Martinot M, Eyriey M, Gravier S, Bonijoly T, Kayser D, Ion C, Mohseni-Zadeh M, Camara S, Dubois J, Haerrel E, Drouaine J, Kaiser J, Ongagna JC, Schieber-Pachart A, Kempf C. Predictors of mortality, ICU hospitalization, and extrapulmonary complications in COVID-19 patients. Infect Dis Now 2021; 51:518-525. [PMID: 34242842 PMCID: PMC8260549 DOI: 10.1016/j.idnow.2021.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/08/2021] [Accepted: 07/01/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE A major coronavirus disease 2019 (COVID-19) outbreak occurred in Northeastern France in spring 2020. This single-center retrospective observational cohort study aimed to compare patients with severe COVID-19 and those with non-severe COVID-19 (survivors vs. non-survivors, ICU patients vs. non-ICU patients) and to describe extrapulmonary complications. PATIENTS AND METHODS We included all patients with a confirmed diagnosis of COVID-19 admitted to Colmar Hospital in March 2020. RESULTS We examined 600 patients (median age 71.09 years; median body mass index: 26.9 kg/m2); 57.7% were males, 86.3% had at least one comorbidity, 153 (25.5%) required ICU hospitalization, and 115 (19.1%) died. Baseline independent factors associated with death were older age (>75 vs. ≤75 years), male sex, oxygen supply, chronic neurological, renal, and pulmonary diseases, diabetes, cancer, low platelet and hemoglobin counts, and high levels of C-reactive protein (CRP) and serum creatinine. Factors associated with ICU hospitalization were age <75 years, oxygen supply, chronic pulmonary disease, absence of dementia, and high levels of CRP, hemoglobin, and serum creatinine. Among the 600 patients, 80 (13.3%) had an acute renal injury, 33 (5.5%) had a cardiovascular event, 27 (4.5%) had an acute liver injury, 24 (4%) had venous thromboembolism, eight (1.3%) had a neurological event, five (0.8%) had rhabdomyolysis, and one had acute pancreatitis. Most extrapulmonary complications occurred in ICU patients. CONCLUSION This study highlighted the main risk factors for ICU hospitalization and death caused by severe COVID-19 and the frequency of numerous extrapulmonary complications in France.
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Affiliation(s)
- M Martinot
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France.
| | - M Eyriey
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - S Gravier
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - T Bonijoly
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - D Kayser
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - C Ion
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - M Mohseni-Zadeh
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - S Camara
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - J Dubois
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - E Haerrel
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - J Drouaine
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - J Kaiser
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France; Pharmacy Department, Hôpitaux Civils de Colmar, Colmar, France
| | - J C Ongagna
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | | | - C Kempf
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
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Chandler CM, Reid MC, Cherian S, Sabath DE, Edlefsen KL. Comparison of Blood Counts and Markers of Inflammation and Coagulation in Patients With and Without COVID-19 Presenting to the Emergency Department in Seattle, WA. Am J Clin Pathol 2021; 156:185-197. [PMID: 34151348 PMCID: PMC8344698 DOI: 10.1093/ajcp/aqab052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives We compared complete blood count (CBC) with differential and markers of inflammation and coagulation in patients with and without coronavirus disease 2019 (COVID-19) presenting to emergency departments in Seattle, WA. Methods We reviewed laboratory values for 1 week following each COVID-19 test for adult patients who received a standard severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction (RT-PCR) test before April 13, 2020. Results were compared by COVID-19 status and clinical course. Results In total 1,027 patients met inclusion criteria. Patients with COVID-19 (n = 155) had lower leukocytes (P < .0001), lymphocytes (P < .0001), platelets (P < .0001), and higher hemoglobin (P = .0140) than those without, but absolute differences were small. Serum albumin was lower in patients with COVID-19 (P < .0001) and serum albumin, neutrophil to lymphocyte ratio (NLR), and red cell distribution width (RDW) were each associated with disease severity. NLR did not differ between patients with COVID-19 and those without (P = .8012). Conclusions Patients with COVID-19 had modestly lower leukocyte, lymphocyte, and platelet counts and higher hemoglobin values than patients without COVID-19. The NLR, serum albumin, and RDW varied with disease severity, regardless of COVID-19 status.
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Affiliation(s)
| | - Molly C Reid
- Epidemiology, University of Washington, Seattle, WA, USA
| | - Sindhu Cherian
- Departments of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Daniel E Sabath
- Departments of Laboratory Medicine and Pathology, Seattle, WA, USA
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Dumortier J, Duvoux C, Roux O, Altieri M, Barraud H, Besch C, Caillard S, Coilly A, Conti F, Dharancy S, Durand F, Francoz C, Garaix F, Houssel-Debry P, Kounis I, Lassailly G, Laverdure N, Leroy V, Mallet M, Mazzola A, Meunier L, Radenne S, Richardet JP, Vanlemmens C, Hazzan M, Saliba F. Covid-19 in liver transplant recipients: the French SOT COVID registry. Clin Res Hepatol Gastroenterol 2021; 45:101639. [PMID: 33636654 PMCID: PMC7843027 DOI: 10.1016/j.clinre.2021.101639] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/14/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Notwithstanding the ongoing coronavirus disease-2019 (Covid-19) pandemic, information on its clinical presentation and prognosis in organ transplant recipients remains limited. The aim of this registry-based observational study was to report the characteristics and clinical outcomes of liver transplant (LT) recipients included in the French nationwide Registry of Solid Organ Transplant Recipients with Covid-19. METHODS COVID-19 was diagnosed in patients who had a positive PCR assay for SARS-CoV-2 or in presence of typical lung lesions on imaging or specific SARS-CoV-2 antibodies. Clinical and laboratory characteristics, management of immunosuppression, treatment for Covid-19, and clinical outcomes (hospitalization, admission to intensive care unit, mechanical ventilation, or death) were recorded. RESULTS Of the 104 patients, 67 were admitted to hospital and 37 were managed at home (including all 13 children). Hospitalized patients had a median age of 65.2 years (IQR: 58.1 - 73.2 years) and two thirds were men. Most common comorbidities included overweight (67.3%), hypertension (61.2%), diabetes (50.7%), cardiovascular disease (20.9%) and respiratory disease (16.4%). SARS-CoV-2 infection was identified after a median of 92.8 months (IQR: 40.1 - 194.7 months) from LT. During hospitalization, antimetabolites, mTOR inhibitor, and CNIs were withdrawn in 41.9%, 30.0% and 12.5% of patients, respectively. The composite endpoint of severe Covid-19 within 30 days after diagnosis was reached by 33.0% of the adult patients. The 30-day mortality rate was 20.0%, and 28.1% for hospitalized patients. Multivariate analysis identified that age was independently associated with mortality. CONCLUSION In our large nationwide study, Covid-19 in LT recipients was associated with a high mortality rate.
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Affiliation(s)
- Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Unité de Transplantation Hépatique et Université Claude Bernard Lyon 1, Lyon, France,Corresponding author
| | | | - Olivier Roux
- APHP, Hôpital Beaujon, Service d'Hépatologie et Transplantation Hépatique - Université Paris Diderot - INSERM U1149, Clichy, France
| | - Mario Altieri
- Hôpital Côte de Nacre, Service d'Hépato-Gastroentérologie, Nutrition et Oncologie Digestive, Caen, France
| | - Hélène Barraud
- CHU Tours, Hôpital Trousseau Service de Chirurgie Digestive, Oncologique et Endocrinienne, Transplantation Hépatique, Tours, France
| | - Camille Besch
- CHRU Hautepierre, Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Strasbourg, France
| | - Sophie Caillard
- CHRU Hautepierre, Service de Néphrologie et Transplantation et INSERM, IRM UMR-S 1109, Strasbourg, France
| | - Audrey Coilly
- AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, INSERM, Unité 1193, Villejuif, France
| | - Filomena Conti
- APHP – Hôpital de la Pitié Salpétrière, Service d’Hépatologie et Transplantation Hépatique, Paris, France
| | - Sébastien Dharancy
- CHRU Lille, Hôpital Claude Huriez, Service des Maladies de l’appareil Digestif et Université de Lille, Lille, France
| | - François Durand
- APHP, Hôpital Beaujon, Service d'Hépatologie et Transplantation Hépatique - Université Paris Diderot - INSERM U1149, Clichy, France
| | - Claire Francoz
- APHP, Hôpital Beaujon, Service d'Hépatologie et Transplantation Hépatique - Université Paris Diderot - INSERM U1149, Clichy, France
| | - Florentine Garaix
- APHM, Hôpital La Timone, Service de Pédiatrie Multidisciplinaire, Marseille, France
| | - Pauline Houssel-Debry
- Hôpital Universitaire de Pontchaillou, Service d’Hépatologie et Transplantation Hépatique, Rennes, France
| | - Ilias Kounis
- AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, INSERM, Unité 1193, Villejuif, France
| | - Guillaume Lassailly
- CHRU Lille, Hôpital Claude Huriez, Service des Maladies de l’appareil Digestif et Université de Lille, Lille, France
| | - Noémie Laverdure
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Unité d’Hépato-gastroentérologie et Nutrition Pédiatriques, Lyon, France
| | - Vincent Leroy
- APHP, Hôpital Henri Mondor, Service d’Hépatologie, Créteil, France
| | - Maxime Mallet
- APHP – Hôpital de la Pitié Salpétrière, Service d’Hépatologie et Transplantation Hépatique, Paris, France
| | - Alessandra Mazzola
- APHP – Hôpital de la Pitié Salpétrière, Service d’Hépatologie et Transplantation Hépatique, Paris, France
| | - Lucy Meunier
- CHU Saint Eloi, Département d’Hépatologie et Transplantation Hépatique, Montpellier, France
| | - Sylvie Radenne
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d'Hépato-Gastroentérologie, Lyon, France
| | | | - Claire Vanlemmens
- Hôpital Jean Minjoz, Service d'Hépatologie et Soins Intensifs Digestifs, Besançon, France
| | - Marc Hazzan
- CHRU Lille, Hôpital Claude Huriez, Service de Néphrologie et Transplantation et Université de Lille, Lille, France
| | - Faouzi Saliba
- AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, INSERM, Unité 1193, Villejuif, France
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Fang FC, Benson CA, del Rio C, Edwards KM, Fowler VG, Fredricks DN, Limaye AP, Murray BE, Naggie S, Pappas PG, Patel R, Paterson DL, Pegues DA, Petri WA, Schooley RT. COVID-19-Lessons Learned and Questions Remaining. Clin Infect Dis 2021; 72:2225-2240. [PMID: 33104186 PMCID: PMC7797746 DOI: 10.1093/cid/ciaa1654] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Indexed: 12/13/2022] Open
Abstract
In this article, the editors of Clinical Infectious Diseases review some of the most important lessons they have learned about the epidemiology, clinical features, diagnosis, treatment and prevention of SARS-CoV-2 infection and identify essential questions about COVID-19 that remain to be answered.
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Affiliation(s)
- Ferric C Fang
- Departments of Laboratory Medicine and Pathology, Microbiology, and Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Constance A Benson
- Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA USA
| | - Carlos del Rio
- Departments of Medicine and Global Health, Emory University School of Medicine, Atlanta, GA USA
| | - Kathryn M Edwards
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Vance G Fowler
- Department of Medicine, Duke University School of Medicine, Durham, NC USA
| | - David N Fredricks
- Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | - Ajit P Limaye
- Departments of Laboratory Medicine and Pathology, Microbiology, and Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Barbara E Murray
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX USA
| | - Susanna Naggie
- Department of Medicine, Duke University School of Medicine, Durham, NC USA
| | - Peter G Pappas
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Robin Patel
- Departments of Laboratory Medicine and Pathology, and Medicine, Mayo Clinic, Rochester, MN USA
| | - David L Paterson
- Department of Medicine, University of Queensland Centre for Clinical Research, Herston, QLD Australia
| | - David A Pegues
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - William A Petri
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA USA
| | - Robert T Schooley
- Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA USA
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Ko JY, Danielson ML, Town M, Derado G, Greenlund KJ, Kirley PD, Alden NB, Yousey-Hindes K, Anderson EJ, Ryan PA, Kim S, Lynfield R, Torres SM, Barney GR, Bennett NM, Sutton M, Talbot HK, Hill M, Hall AJ, Fry AM, Garg S, Kim L. Risk Factors for Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization: COVID-19-Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System. Clin Infect Dis 2021; 72:e695-e703. [PMID: 32945846 PMCID: PMC7543371 DOI: 10.1093/cid/ciaa1419] [Citation(s) in RCA: 192] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/16/2020] [Indexed: 01/08/2023] Open
Abstract
Background Data on risk factors for COVID-19-associated hospitalization are needed to guide prevention efforts and clinical care. We sought to identify factors independently associated with COVID-19-associated hospitalizations Methods U.S. community-dwelling adults (≥18 years) hospitalized with laboratory-confirmed COVID-19 during March 1–June 23, 2020 were identified from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a multi-state surveillance system. To calculate hospitalization rates by age, sex, and race/ethnicity strata, COVID-NET data served as the numerator and Behavioral Risk Factor Surveillance System estimates served as the population denominator for characteristics of interest. Underlying medical conditions examined included hypertension, coronary artery disease, history of stroke, diabetes, obesity [BMI ≥30 kg/m 2], severe obesity [BMI≥40 kg/m 2], chronic kidney disease, asthma, and chronic obstructive pulmonary disease. Generalized Poisson regression models were used to calculate adjusted rate ratios (aRR) for hospitalization Results Among 5,416 adults, hospitalization rates were higher among those with ≥3 underlying conditions (versus without)(aRR: 5.0; 95%CI: 3.9, 6.3), severe obesity (aRR:4.4; 95%CI: 3.4, 5.7), chronic kidney disease (aRR:4.0; 95%CI: 3.0, 5.2), diabetes (aRR:3.2; 95%CI: 2.5, 4.1), obesity (aRR:2.9; 95%CI: 2.3, 3.5), hypertension (aRR:2.8; 95%CI: 2.3, 3.4), and asthma (aRR:1.4; 95%CI: 1.1, 1.7), after adjusting for age, sex, and race/ethnicity. Adjusting for the presence of an individual underlying medical condition, higher hospitalization rates were observed for adults aged ≥65, 45-64 (versus 18-44 years), males (versus females), and non-Hispanic black and other race/ethnicities (versus non-Hispanic whites) Conclusion Our findings elucidate groups with higher hospitalization risk that may benefit from targeted preventive and therapeutic interventions
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Affiliation(s)
- Jean Y Ko
- COVID-NET Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service, Rockville, Maryland, USA
| | - Melissa L Danielson
- COVID-NET Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Machell Town
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gordana Derado
- COVID-NET Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pam Daily Kirley
- California Emerging Infections Program, Oakland, California, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Evan J Anderson
- Department of Medicine and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia, USA.,Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | | | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St Paul, Minnesota, USA
| | | | - Grant R Barney
- New York State Department of Health, Albany, New York, USA
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Mary Hill
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Aron J Hall
- COVID-NET Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alicia M Fry
- COVID-NET Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service, Rockville, Maryland, USA
| | - Shikha Garg
- COVID-NET Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service, Rockville, Maryland, USA
| | - Lindsay Kim
- COVID-NET Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service, Rockville, Maryland, USA
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Stroever SJ, Ostapenko D, Scatena R, Pusztai D, Coritt L, Frimpong AA, Nee P. Medication Use Among Patients With COVID-19 in a Large, National Dataset: Cerner Real-World Data™. Clin Ther 2021; 43:e173-e196. [PMID: 33958234 PMCID: PMC8049452 DOI: 10.1016/j.clinthera.2021.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE The outbreak of coronavirus disease 2019 (COVID-19) required clinicians to use knowledge of therapeutic mechanisms of established drugs to piece together treatment regimens. The purpose of this study is to examine the trends in medication use among patients with COVID-19 across the United States using a national dataset. METHODS We conducted a cross-sectional study of the COVID-19 cohort in the Cerner Real-World Data warehouse, which includes deidentified patient information for encounters associated with COVID-19 from December 1, 2019, through June 30, 2020. The primary variables of interest were medications given to patients during their inpatient COVID-19 treatment. We also identified demographic characteristics, calculated the proportion of patients with each medication, and stratified data by demographic variables. FINDINGS Our sample included 51,169 inpatients from every region of the United States. Males and females were equally represented, and most patients were white and non-Hispanic. The largest proportion of patients were older than 45 years. Corticosteroids were used the most among all patients (56.5%), followed by hydroxychloroquine (17.4%), tocilizumab (3.1%), and lopinavir/ritonavir (1.1%). We found substantial variation in medication use by region, race, ethnicity, sex, age, and insurance status. IMPLICATIONS Variations in medication use are likely attributable to multiple factors, including the timing of the pandemic by region in the United States and processes by which medications are introduced and disseminated. This study is the first of its kind to assess trends in medication use in a national dataset and is the first large, descriptive study of pharmacotherapy in hospitalized patients with COVID-19. It provides an important glimpse into prescribing patterns during a pandemic.
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Affiliation(s)
| | - Daniel Ostapenko
- Department of Innovation and Research, Nuvance Health, Danbury, Connecticut
| | - Robyn Scatena
- Department of Critical Care, Nuvance Health, Norwalk, Connecticut
| | - Daniel Pusztai
- Department of Pharmacy, Norwalk Hospital, Norwalk, Connecticut
| | - Lauren Coritt
- University of Vermont, Larner College of Medicine, Burlington, Vermond
| | - Akua A Frimpong
- University of Vermont, Larner College of Medicine, Burlington, Vermond
| | - Paul Nee
- Department of Infectious Diseases, Nuvance Health, Danbury, Connecticut
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Kim HJ, Hwang H, Hong H, Yim JJ, Lee J. A systematic review and meta-analysis of regional risk factors for critical outcomes of COVID-19 during early phase of the pandemic. Sci Rep 2021; 11:9784. [PMID: 33963250 PMCID: PMC8105319 DOI: 10.1038/s41598-021-89182-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/22/2021] [Indexed: 01/08/2023] Open
Abstract
The mortality rates of COVID-19 vary across the globe. While some risk factors for poor prognosis of the disease are known, regional differences are suspected. We reviewed the risk factors for critical outcomes of COVID-19 according to the location of the infected patients, from various literature databases from January 1 through June 8, 2020. Candidate variables to predict the outcome included patient demographics, underlying medical conditions, symptoms, and laboratory findings. The risk factors in the overall population included sex, age, and all inspected underlying medical conditions. Symptoms of dyspnea, anorexia, dizziness, fatigue, and certain laboratory findings were also indicators of the critical outcome. Underlying respiratory disease was associated higher risk of the critical outcome in studies from Asia and Europe, but not North America. Underlying hepatic disease was associated with a higher risk of the critical outcome from Europe, but not from Asia and North America. Symptoms of vomiting, anorexia, dizziness, and fatigue were significantly associated with the critical outcome in studies from Asia, but not from Europe and North America. Hemoglobin and platelet count affected patients differently in Asia compared to those in Europe and North America. Such regional discrepancies should be considered when treating patients with COVID-19.
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Affiliation(s)
- Hyung-Jun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Hyeontaek Hwang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Hyunsook Hong
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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Gülsen A, König IR, Jappe U, Drömann D. Effect of comorbid pulmonary disease on the severity of COVID-19: A systematic review and meta-analysis. Respirology 2021; 26:552-565. [PMID: 33955623 PMCID: PMC8207055 DOI: 10.1111/resp.14049] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 02/12/2021] [Accepted: 02/24/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID‐19) caused by infection with severe acute respiratory syndrome coronavirus 2 was first detected in Wuhan, China, in late 2019 and continues to spread worldwide. Persistent questions remain about the relationship between the severity of COVID‐19 and comorbid diseases, as well as other chronic pulmonary conditions. In this systematic review and meta‐analysis, we aimed to examine in detail whether the underlying chronic obstructive pulmonary diseases (COPD), asthma and chronic respiratory diseases (CRDs) were associated with an increased risk of more severe COVID‐19. A comprehensive literature search was performed using five international search engines. In the initial search, 722 articles were identified. After eliminating duplicate records and further consideration of eligibility criteria, 53 studies with 658,073 patients were included in the final analysis. COPD was present in 5.2% (2191/42,373) of patients with severe COVID‐19 and in 1.4% (4203/306,151) of patients with non‐severe COVID‐19 (random‐effects model; OR = 2.58, 95% CI = 1.99–3.34, Z = 7.15, p < 0.001). CRD was present in 8.6% (3780/44,041) of patients with severe COVID‐19 and in 5.7% (16,057/280,447) of patients with non‐severe COVID‐19 (random‐effects model; OR = 2.14, 95% CI = 1.74–2.64, Z = 7.1, p < 0.001). Asthma was present in 2.3% (1873/81,319) of patients with severe COVID‐19 and in 2.2% (11,796/538,737) of patients with non‐severe COVID‐19 (random‐effects model; OR = 1.13, 95% CI = 0.79–1.60, Z = 0.66, p = 0.50). In conclusion, comorbid COPD and CRD were clearly associated with a higher severity of COVID‐19; however, no association between asthma and severe COVID‐19 was identified.
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Affiliation(s)
- Askin Gülsen
- Division of Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, Germany.,Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Luebeck, Luebeck, Germany
| | - Inke R König
- Institute of Medical Biometry and Statistics, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), University of Luebeck, Luebeck, Germany
| | - Uta Jappe
- Division of Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, Germany.,Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Luebeck, Luebeck, Germany
| | - Daniel Drömann
- Department of Pneumology, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), University of Luebeck, Luebeck, Germany
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Li X, Zhong X, Wang Y, Zeng X, Luo T, Liu Q. Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis. PLoS One 2021; 16:e0250602. [PMID: 33939733 PMCID: PMC8092779 DOI: 10.1371/journal.pone.0250602] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/11/2021] [Indexed: 01/08/2023] Open
Abstract
Objective We aimed to systematically identify the possible risk factors responsible for severe cases. Methods We searched PubMed, Embase, Web of science and Cochrane Library for epidemiological studies of confirmed COVID-19, which include information about clinical characteristics and severity of patients’ disease. We analyzed the potential associations between clinical characteristics and severe cases. Results We identified a total of 41 eligible studies including 21060 patients with COVID-19. Severe cases were potentially associated with advanced age (Standard Mean Difference (SMD) = 1.73, 95% CI: 1.34–2.12), male gender (Odds Ratio (OR) = 1.51, 95% CI:1.33–1.71), obesity (OR = 1.89, 95% CI: 1.44–2.46), history of smoking (OR = 1.40, 95% CI:1.06–1.85), hypertension (OR = 2.42, 95% CI: 2.03–2.88), diabetes (OR = 2.40, 95% CI: 1.98–2.91), coronary heart disease (OR: 2.87, 95% CI: 2.22–3.71), chronic kidney disease (CKD) (OR = 2.97, 95% CI: 1.63–5.41), cerebrovascular disease (OR = 2.47, 95% CI: 1.54–3.97), chronic obstructive pulmonary disease (COPD) (OR = 2.88, 95% CI: 1.89–4.38), malignancy (OR = 2.60, 95% CI: 2.00–3.40), and chronic liver disease (OR = 1.51, 95% CI: 1.06–2.17). Acute respiratory distress syndrome (ARDS) (OR = 39.59, 95% CI: 19.99–78.41), shock (OR = 21.50, 95% CI: 10.49–44.06) and acute kidney injury (AKI) (OR = 8.84, 95% CI: 4.34–18.00) were most likely to prevent recovery. In summary, patients with severe conditions had a higher rate of comorbidities and complications than patients with non-severe conditions. Conclusion Patients who were male, with advanced age, obesity, a history of smoking, hypertension, diabetes, malignancy, coronary heart disease, hypertension, chronic liver disease, COPD, or CKD are more likely to develop severe COVID-19 symptoms. ARDS, shock and AKI were thought to be the main hinderances to recovery.
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Affiliation(s)
- Xinyang Li
- School of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - Xianrui Zhong
- Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
| | - Yongbo Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiantao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ting Luo
- School of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - Qing Liu
- Department of Epidemiology and Health Statistics, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
- * E-mail:
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Kirby JJ, Shaikh S, Bryant DP, Ho AF, d'Etienne JP, Schrader CD, Wang H. A Simplified Comorbidity Evaluation Predicting Clinical Outcomes Among Patients With Coronavirus Disease 2019. J Clin Med Res 2021; 13:237-244. [PMID: 34007362 PMCID: PMC8110217 DOI: 10.14740/jocmr4476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/26/2021] [Indexed: 01/08/2023] Open
Abstract
Background Patients with coronavirus disease 2019 (COVID-19) have shown a range of clinical outcomes. Previous studies have reported that patient comorbidities are predictive of worse clinical outcomes, especially when patients have multiple chronic diseases. We aim to: 1) derive a simplified comorbidity evaluation and determine its accuracy of predicting clinical outcomes (i.e., hospital admission, intensive care unit (ICU) admission, ventilation, and in-hospital mortality); and 2) determine its performance accuracy in comparison to well-established comorbidity indexes. Methods This was a single-center retrospective observational study. We enrolled all emergency department (ED) patients with COVID-19 from March 1, 2020, to December 31, 2020. A simplified comorbidity evaluation (COVID-related high-risk chronic condition (CCC)) was derived to predict different clinical outcomes using multivariate logistic regressions. In addition, chronic diseases included in the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) were scored, and its accuracy of predicting COVID-19 clinical outcomes was also compared with the CCC. Results Data were retrieved from 90,549 ED patient visits during the study period, among which 3,864 patients were COVID-19 positive. Forty-seven point nine percent (1,851/3,864) were admitted to the hospital, 9.4% (364) patients were admitted to the ICU, 6.2% (238) received invasive mechanical ventilation, and 4.6% (177) patients died in the hospital. The CCC evaluation correlated well with the four studied clinical outcomes. The adjusted odds ratios of predicting in-hospital death from CCC was 2.84 (95% confidence interval (CI): 1.81 - 4.45, P < 0.001). C-statistics of CCC predicting in-hospital all-cause mortality was 0.73 (0.69 - 0.76), similar to those of the CCI's (0.72) and ECI's (0.71, P = 0.0513). Conclusions CCC can accurately predict clinical outcomes among patients with COVID-19. Its performance accuracies for such predictions are not inferior to those of the CCI or ECI's.
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Affiliation(s)
- Jessica J Kirby
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.,These authors contributed equally to this article
| | - Sajid Shaikh
- Department of Information Technology, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.,These authors contributed equally to this article
| | - David P Bryant
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Amy F Ho
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - James P d'Etienne
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Chet D Schrader
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
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Ramphul K, Lohana P, Ramphul Y, Park Y, Mejias S, Dhillon BK, Sombans S, Verma R. Hypertension, diabetes mellitus, and cerebrovascular disease predispose to a more severe outcome of COVID-19. Arch Med Sci Atheroscler Dis 2021; 6:e30-e39. [PMID: 34027212 PMCID: PMC8117084 DOI: 10.5114/amsad.2021.105255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/07/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The world is currently facing the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The total number of cases of coronavirus disease 2019 (COVID-19) is rising daily and no vaccine has yet been approved. While the pathophysiology behind the virus is still being studied, many possible several risk factors using small sample sizes have been found. MATERIAL AND METHODS We conducted a pooled analysis using several databases such as Medline, Scopus, Wangfang, Web of Science, Research Square, medrxiv, and Google Scholar to identify studies reporting severe and non-severe groups of COVID-19 patients. The odds ratios as well as the 95% confidence intervals for hypertension, diabetes, and cerebrovascular disease leading to severe COVID-19 were calculated using R-software. RESULTS Fifty-three articles were used for our analysis and they involved 30,935 confirmed cases of COVID-19 from several countries across the world. The odds ratio for severe COVID-19 in hypertensive patients, diabetics, and patients with a history of cerebrovascular disease was 2.58 (95% confidence interval (CI): 2.16-3.08, from 53 studies), 2.17 (95% CI: 1.72-2.74, from 44 studies), and 2.63 (95% CI: 1.80-3.85, from 25 studies), respectively. CONCLUSIONS Our analysis confirms that patients with hypertension, diabetes, or cerebrovascular disease are at a higher risk of a severe outcome of COVID-19. It is thus vital for physicians to identify the main risk factors for a severe outcome of this disease.
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Affiliation(s)
- Kamleshun Ramphul
- Department of Pediatrics, Shanghai Xin Hua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Petras Lohana
- Department of Medicine, Liaquat University of Medical and Health Sciences Hospital, Jamshroo, Pakistan
| | - Yogeshwaree Ramphul
- Department of Medicine, Sir Seewoosagur Ramgoolam National Hospital, Pamplemousses, Mauritius
| | - Yun Park
- Department of Orthodontics, Affiliation: Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Stephanie Mejias
- Department of Medicine, University Iberoamericana UNIBE, School of Medicine, Santo Domingo, Dominican Republic
| | | | - Shaheen Sombans
- Department of Medicine, Bharati Vidyapeeth University Medical College and Hospital, Pune, India
| | - Renuka Verma
- Department of Medicine, Guru Gobind Singh Medical College, Punjab, India
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Terry PD, Heidel RE, Dhand R. Asthma in Adult Patients with COVID-19. Prevalence and Risk of Severe Disease. Am J Respir Crit Care Med 2021; 203:893-905. [PMID: 33493416 PMCID: PMC8017581 DOI: 10.1164/rccm.202008-3266oc] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
Rationale: Health outcomes of people with coronavirus disease (COVID-19) range from no symptoms to severe illness and death. Asthma, a common chronic lung disease, has been considered likely to increase the severity of COVID-19, although data addressing this hypothesis have been scarce until very recently.Objectives: To review the epidemiologic literature related to asthma's potential role in COVID-19 severity.Methods: Studies were identified through the PubMed (MEDLINE) and medRxiv (preprint) databases using the search terms "asthma," "SARS-CoV-2" (severe acute respiratory syndrome coronavirus 2), and "COVID-19," and by cross-referencing citations in identified studies that were available in print or online before December 22, 2020.Measurements and Main Results: Asthma prevalence data were obtained from studies of people with COVID-19 and regional health statistics. We identified 150 studies worldwide that allowed us to compare the prevalence of asthma in patients with COVID-19 by region, disease severity, and mortality. The results of our analyses do not provide clear evidence of increased risk of COVID-19 diagnosis, hospitalization, severity, or mortality due to asthma.Conclusions: These findings could provide some reassurance to people with asthma regarding its potential to increase their risk of severe morbidity from COVID-19.
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Affiliation(s)
| | | | - Rajiv Dhand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
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How the Heart Was Involved in COVID-19 during the First Pandemic Phase: A Review. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2021; 2:124-139. [PMID: 36417195 PMCID: PMC9620895 DOI: 10.3390/epidemiologia2010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/10/2021] [Accepted: 03/12/2021] [Indexed: 12/15/2022]
Abstract
Coronavirus disease (COVID-19) was first observed in Wuhan, Hubei Province (China) in December 2019, resulting in an acute respiratory syndrome. Only later was COVID-19 considered a public health emergency of international concern and, on 11 March 2020, the WHO classified it as pandemic. Despite being a respiratory virus, the clinical manifestations are also characterized by cardiological involvement, especially in patients suffering from previous comorbidities such as hypertension and diabetes mellitus, its complications being potentially serious or fatal. Despite the efforts made by the scientific community to identify pathophysiological mechanisms, they still remain unclear. A fundamental role is played by the angiotensin 2 converting enzyme, known for its effects at the cardiovascular level and for its involvement in COVID-19 pathogenesis. The goal of this paper was to highlight the mechanisms and knowledge related to cardiovascular involvement during the first pandemic phase, as well as to emphasize the main cardiological complications in infected patients.
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Fadl N, Ali E, Salem TZ. COVID-19: Risk Factors Associated with Infectivity and Severity. Scand J Immunol 2021; 93:e13039. [PMID: 33710663 PMCID: PMC8265317 DOI: 10.1111/sji.13039] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 02/06/2023]
Abstract
COVID‐19 is highly transmissible; however, its severity varies from one
individual to another. Variability among different isolates of the virus and among
its receptor (ACE2) may contribute to this severity, but comorbidity plays a major
role on disease prognosis. Many comorbidities have been reported to be associated
with severe COVID‐19 patients. We have collected data from retrospective studies
which include clinical and epidemiological features of patients and categorize them
into severe/mild, ICU/non‐ICU and survivors/dead patients. In this review, we give an
update about SARS‐CoV‐2 structure with emphasis on the possible reasons for the
severity of the virus in patients. We also collected information and patients’ data
to highlight the relation between COVID‐19 patients and comorbidities.
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Affiliation(s)
- Nahla Fadl
- Biomedical Sciences Program, University of Science and Technology, Zewail City of Science and Technology, Giza, Egypt
| | - Esraa Ali
- Biomedical Sciences Program, University of Science and Technology, Zewail City of Science and Technology, Giza, Egypt
| | - Tamer Z Salem
- Biomedical Sciences Program, University of Science and Technology, Zewail City of Science and Technology, Giza, Egypt.,Department of Microbial Genetics, AGERI, ARC, Giza, Egypt.,National Biotechnology Network of Expertise (NBNE), Academy of Science Research and Technology (ASRT), Cairo, Egypt
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47
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Abdelrahman Z, Liu Q, Jiang S, Li M, Sun Q, Zhang Y, Wang X. Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis. Front Pharmacol 2021; 12:607408. [PMID: 33790785 PMCID: PMC8005525 DOI: 10.3389/fphar.2021.607408] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/06/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Limited data on the efficacy and safety of currently applied COVID-19 therapeutics and their impact on COVID-19 outcomes have raised additional concern. Objective and Methods: To estimate the efficacy and safety of COVID-19 therapeutics, we performed meta-analyses of the studies reporting clinical features and treatments of COVID-19 published from January 21 to September 6, 2020. Results: We included 136 studies that involved 102,345 COVID-19 patients. The most prevalent treatments were antibiotics (proportion: 0.59, 95% CI: [0.51, 0.67]) and antivirals (proportion: 0.52, 95% CI: [0.44, 0.60]). The combination of lopinavir/ritonavir and Arbidol was the most effective in treating COVID-19 (standardized mean difference (SMD) = 0.68, 95% CI: [0.15, 1.21]). The use of corticosteroids was associated with a small clinical improvement (SMD = -0.40, 95% CI: [-0.85, -0.23]), but with a higher risk of disease progression and death (mortality: RR = 9.26, 95% CI: [4.81, 17.80]; hospitalization length: RR = 1.54, 95% CI: [1.39, 1.72]; severe adverse events: RR = 2.65, 95% CI: [2.09, 3.37]). The use of hydroxychloroquine was associated with a higher risk of death (RR = 1.68, 95% CI: [1.18, 2.38]). The combination of lopinavir/ritonavir, ribavirin, and interferon-β (RR = 0.34, 95% CI: [0.22, 0.54]); hydroxychloroquine (RR = 0.58, 95% CI: [0.39, 0.58]); and lopinavir/ritonavir (RR = 0.72, 95% CI: [0.56, 0.91]) was associated with reduced hospitalization length. Hydrocortisone (RR = 0.05, 95% CI: [0.03, 0.10]) and remdesivir (RR = 0.74, 95% CI: [0.62, 0.90]) were associated with lower incidence of severe adverse events. Dexamethasone was not significant in reducing disease progression (RR = 0.45, 95% CI: [0.16, 1.25]) and mortality (RR = 0.90, 95% CI: [0.70, 1.16]). The estimated combination of corticosteroids with antivirals was associated with a better clinical improvement than antivirals alone (SMD = -1.09, 95% CI: [-1.64, -0.53]). Conclusion: Antivirals are safe and effective in COVID-19 treatment. Remdesivir cannot significantly reduce COVID-19 mortality and hospitalization length, while it is associated with a lower incidence of severe adverse events. Corticosteroids could increase COVID-19 severity, but it could be beneficial when combined with antivirals. Our data are potentially valuable for the clinical treatment and management of COVID-19 patients.
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Affiliation(s)
- Zeinab Abdelrahman
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Qian Liu
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Shanmei Jiang
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Mengyuan Li
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Qingrong Sun
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Yue Zhang
- Pinghu Hospital of Shenzhen University, Shenzhen, China
- Futian Hospital for Rheumatic Diseases, Shenzhen, China
- Department of Rheumatology and Immunology, The First Clinical College of Harbin Medical University, Harbin, China
| | - Xiaosheng Wang
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
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Predictors of disease severity and outcome of hospitalized renal transplant recipients with COVID-19 infection: a systematic review of a globally representative sample. ACTA ACUST UNITED AC 2021; 59:10-42. [PMID: 33155999 DOI: 10.2478/rjim-2020-0034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Indexed: 02/07/2023]
Abstract
Introduction. COVID-19 presents a special challenge to the kidney transplant population.Methods. A systematic review of articles that examined COVID-19 in kidney transplant recipients was performed. Patients' demographics, clinical, laboratory and radiological presentations, immunosuppression modification, and COVID-19 specific management were abstracted and analyzed. COVID-19 severity was classified into mild, moderate, and severe. Disease outcome was classified by whether the patient was discharged, still hospitalized, or died.Results. 44 articles reporting individual data and 13 articles reporting aggregated data on 149 and 561 kidney transplant recipients respectively with COVID-19 from Asia, Europe and America fulfilled all inclusion and exclusion criteria. Among studies reporting case specific data, 76% of cases had severe disease. Compared to patients with mild/moderate disease, patients with severe disease had higher CRP, LDH, Ferritin, D-dimer and were more likely to have bilateral lung involvement at presentation and longer time since transplantation (P < 0.05 for all). Recipients' age, gender and comorbidities did not impact disease severity. Patients with severe disease had a more aggressive CNI reduction and more antiviral medications utilization. Outcome was reported on 145 cases, of those 34 (23%) died all with severe disease. Longer duration from transplant to disease diagnosis, hypoxia and higher LDH were associated with mortality (P < 0.05). Different immunosuppression reduction strategies, high dose parenteral corticosteroids use and various antiviral combinations did not demonstrate survival advantage. Similar finding was observed for studies reporting aggregated data.Conclusion. COVID-19 in kidney transplant patients is associated with high rate of disease severity and fatality. Higher LDH and longer time since transplantation predicted both disease severity and mortality. None of the COVID-19 specific treatment correlated with, or improved disease outcome in kidney transplant recipients.
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Gerayeli FV, Milne S, Cheung C, Li X, Yang CWT, Tam A, Choi LH, Bae A, Sin DD. COPD and the risk of poor outcomes in COVID-19: A systematic review and meta-analysis. EClinicalMedicine 2021; 33:100789. [PMID: 33758801 PMCID: PMC7971471 DOI: 10.1016/j.eclinm.2021.100789] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) are highly susceptible from respiratory exacerbations from viral respiratory tract infections. However, it is unclear whether they are at increased risk of COVID-19 pneumonia or COVID-19-related mortality. We aimed to determine whether COPD is a risk factor for adverse COVID-19 outcomes including hospitalization, severe COVID-19, or death. METHODS Following the PRISMA guidelines, we performed a systematic review of COVID-19 clinical studies published between November 1st, 2019 and January 28th, 2021 (PROSPERO ID: CRD42020191491). We included studies that quantified the number of COPD patients, and reported at least one of the following outcomes stratified by COPD status: hospitalization; severe COVID-19; ICU admission; mechanical ventilation; acute respiratory distress syndrome; or mortality. We meta-analyzed the results of individual studies to determine the odds ratio (OR) of these outcomes in patients with COPD compared to those without COPD. FINDINGS Fifty-nine studies met the inclusion criteria, and underwent data extraction. Most studies were retrospective cohort studies/case series of hospitalized patients. Only four studies examined the effects of COPD on COVID-19 outcomes as their primary endpoint. In aggregate, COPD was associated with increased odds of hospitalization (OR 4.23, 95% confidence interval [CI] 3.65-4.90), ICU admission (OR 1.35, 95% CI 1.02-1.78), and mortality (OR 2.47, 95% CI 2.18-2.79). INTERPRETATION Having a clinical diagnosis of COPD significantly increases the odds of poor clinical outcomes in patients with COVID-19. COPD patients should thus be considered a high-risk group, and targeted for preventative measures and aggressive treatment for COVID-19 including vaccination.
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Affiliation(s)
- Firoozeh V. Gerayeli
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC Canada
| | - Stephen Milne
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC Canada
- Division of Respiratory Medicine, University of British Columbia, Vancouver, BC Canada
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Chung Cheung
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC Canada
| | - Xuan Li
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC Canada
| | - Cheng Wei Tony Yang
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC Canada
| | - Anthony Tam
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC Canada
| | - Lauren H. Choi
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC Canada
| | - Annie Bae
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC Canada
| | - Don D. Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC Canada
- Division of Respiratory Medicine, University of British Columbia, Vancouver, BC Canada
- Corresponding author.
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50
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Andrade JA, Muzykovsky K, Truong J. Risk factors for mortality in COVID-19 patients in a community teaching hospital. J Med Virol 2021; 93:3184-3193. [PMID: 33595120 PMCID: PMC8014291 DOI: 10.1002/jmv.26885] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/29/2021] [Accepted: 02/15/2021] [Indexed: 02/06/2023]
Abstract
As of December 2020, there were over 450,000 confirmed coronavirus disease 2019 (COVID‐19) cases in New York City (NYC) with approximately 25,000 deaths. Previous literature identified advanced age, higher severity of illness, elevated inflammatory biomarkers, acute organ dysfunction, comorbidities, and presentation from long‐term care facility as risk factors for mortality in patients from Wuhan, China, and the United States. Additional studies conducted in NYC are warranted to confirm these findings. The objective of this study was to assess the risk factors for in‐hospital mortality in patients with confirmed COVID‐19 infections. This was a retrospective case‐control study at The Brooklyn Hospital Center, a 464‐bed community teaching hospital. Adult patients with a confirmed COVID‐19 infection and who received at least 24 h of COVID‐19 therapy were included. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for in‐hospital mortality. Two‐hundred and eighty four patients were included, of whom 95 (33.5%) were nonsurvivors and 189 (66.5%) patients were survivors. Multivariate analysis showed higher in‐hospital mortality with advanced age (odds ratio [OR] 6.476; 95% confidence interval [CI], 1.827–22.953), presentation from long‐term care facility (OR 4.259; 95% CI 1.481–12.250), elevated total bilirubin (OR 4.947; 95% CI 1.048–23.350), vasopressor initiation (OR 36.262; 95% CI 5.319–247.216), and development of renal failure (OR 36.261; 95% CI 2.667–493.046). Risk factors associated with mortality for patients with COVID‐19 in a community teaching hospital included advanced age, vasopressor initiation, development of renal failure, elevated total bilirubin, and presentation from long‐term care facility. In this retrospective case‐control study of 284 patients with coronavirus disease 2019, risk factors associated with in‐hospital mortality included advanced age, presentation from long‐term care facility, elevated total bilirubin, vasopressor therapy initiation, and development of renal failure.
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Affiliation(s)
- Justin A Andrade
- Department of Pharmacotherapy, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Karina Muzykovsky
- Department of Pharmacotherapy, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - James Truong
- Department of Pharmacotherapy, The Brooklyn Hospital Center, Brooklyn, New York, USA
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