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Wang Y, Zhang F, Byrd JB, Yu H, Ye X, He Y. Differential COVID-19 Symptoms Given Pandemic Locations, Time, and Comorbidities During the Early Pandemic. Front Med (Lausanne) 2022; 9:770031. [PMID: 35155491 PMCID: PMC8831795 DOI: 10.3389/fmed.2022.770031] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/04/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 pandemic is disaster to public health worldwide. Better perspective on COVID's features early in its course-prior to the development of vaccines and widespread variants-may prove useful in the understanding of future pandemics. Ontology provides a standardized integrative method for knowledge modeling and computer-assisted reasoning. In this study, we systematically extracted and analyzed clinical phenotypes and comorbidities in COVID-19 patients found at different countries and regions during the early pandemic using an ontology-based bioinformatics approach, with the aim to identify new insights and hidden patterns of the COVID-19 symptoms. RESULTS A total of 48 research articles reporting analysis of first-hand clinical data from over 40,000 COVID-19 patients were surveyed. The patients studied therein were diagnosed with COVID-19 before May 2020. A total of 18 commonly-occurring phenotypes in these COVID-19 patients were first identified and then classified into different hierarchical groups based on the Human Phenotype Ontology (HPO). This meta-analytic approach revealed that fever, cough, and the loss of smell and taste were ranked as the most commonly-occurring phenotype in China, the US, and Italy, respectively. We also found that the patients from Europe and the US appeared to have more frequent occurrence of many nervous and abdominal symptom phenotypes (e.g., loss of smell, loss of taste, and diarrhea) than patients from China during the early pandemic. A total of 22 comorbidities, such as diabetes and kidney failure, were found to commonly exist in COVID-19 patients and positively correlated with the severity of the disease. The knowledge learned from the study was further modeled and represented in the Coronavirus Infectious Disease Ontology (CIDO), supporting semantic queries and analysis. Furthermore, also considering the symptoms caused by new viral variants at the later stages, a spiral model hypothesis was proposed to address the changes of specific symptoms during different stages of the pandemic. CONCLUSIONS Differential patterns of symptoms in COVID-19 patients were found given different locations, time, and comorbidity types during the early pandemic. The ontology-based informatics provides a unique approach to systematically model, represent, and analyze COVID-19 symptoms, comorbidities, and the factors that influence the disease outcomes.
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Affiliation(s)
- Yang Wang
- Guizhou University School of Medicine, Guiyang, China
- NHC Key Laboratory of Immunological Diseases, Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital and People's Hospital of Guizhou University, Guiyang, China
| | - Fengwei Zhang
- Guizhou University School of Medicine, Guiyang, China
| | - J. Brian Byrd
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Hong Yu
- Guizhou University School of Medicine, Guiyang, China
- NHC Key Laboratory of Immunological Diseases, Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital and People's Hospital of Guizhou University, Guiyang, China
| | - Xianwei Ye
- Guizhou University School of Medicine, Guiyang, China
- NHC Key Laboratory of Immunological Diseases, Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital and People's Hospital of Guizhou University, Guiyang, China
- *Correspondence: Xianwei Ye
| | - Yongqun He
- Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, United States
- Yongqun He
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Piciu A, Manole S, Piciu D, Dreve T, Roman A. Asymptomatic COVID-19 cancer patients incidentally discovered during F18-FDG PET/CT monitoring. Med Pharm Rep 2021; 94:58-64. [PMID: 33629050 PMCID: PMC7880066 DOI: 10.15386/mpr-1776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/18/2020] [Accepted: 10/05/2020] [Indexed: 12/25/2022] Open
Abstract
Background The aim of the study was to present the PET/CT imaging features in a small series of asymptomatic patients with known cancer pathologies, infected with the SARS-CoV-2 virus, which were incidentally discovered during their monitoring scan of F18-FDG PET/CT. Methods We included in our study a number of five cases (3 female and 2 male) out of 478 patients examined by F18-FDG PET/CT between March - April 2020, with confirmed diagnostic of cancer. Four patients had lung damages suggestive for the mentioned viral infection and 1 patient had multiple lung metastases from thyroid cancer. All patients were asymptomatic for acute respiratory disease at the time of examination, being subsequently confirmed for the viral infection by specific PCR analysis. Results The asymptomatic positive SARS-CoV-2 cancer patients discovered incidentally in PET/CT F18-FDG represent 0.83% and their imaging characteristics were suggestive for high FDG activity in the lung despite the lack of respiratory symptoms. Conclusion The SARS CoV-2 viral infection in asymptomatic cancer patients is a very rare possibility, but represents a challenging scenario both for the differential diagnosis in cancer and also for the epidemiologic context.
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Affiliation(s)
- Andra Piciu
- Department of Medical Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Manole
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,CT Clinic, Cluj-Napoca, Romania
| | - Doina Piciu
- CT Clinic, Cluj-Napoca, Romania.,Department of Endocrine Tumors and Nuclear Medicine, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | | | - Andrei Roman
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,CT Clinic, Cluj-Napoca, Romania
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Mei Q, Wang AY, Bryant A, Yang Y, Li M, Wang F, Du S, Kurts C, Wu P, Ma K, Wu L, Chen H, Luo J, Li Y, Hu G, Yuan X, Li J. Survival Factors and Metabolic Pathogenesis in Elderly Patients (≥65) With COVID-19: A Multi-Center Study. Front Med (Lausanne) 2021; 7:595503. [PMID: 33585504 PMCID: PMC7873923 DOI: 10.3389/fmed.2020.595503] [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] [Received: 09/08/2020] [Accepted: 12/04/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Elderly patients infected with COVID-19 are reported to be facing a substantially increased risk of mortality. Clinical characteristics, treatment options, and potential survival factors remain under investigation. This study aimed to fill this gap and provide clinically relevant factors associated with survival of elderly patients with COVID-19. Methods: In this multi-center study, elderly patients (age ≥65 years old) with laboratory-confirmed COVID-19 from 4 Wuhan hospitals were included. The clinical end point was hospital discharge or deceased with last date of follow-up on Jul. 08, 2020. Clinical, demographic, and laboratory data were collected. Univariate and multivariate analysis were performed to analyze survival and risk factors. A metabolic flux analysis using a large-scale molecular model was applied to investigate the pathogenesis of SARS-CoV-2 with regard to metabolism pathways. Results: A total of 223 elderly patients infected with COVID-19 were included, 91 (40.8%) were discharged and 132 (59.2%) deceased. Acute respiratory distress syndrome (ARDS) developed in 140 (62.8%) patients, 23 (25.3%) of these patients survived. Multivariate analysis showed that potential risk factors for mortality were elevated D-Dimer (odds ratio: 1.13 [95% CI 1.04 - 1.22], p = 0.005), high immune-related metabolic index (6.42 [95% CI 2.66–15.48], p < 0.001), and increased neutrophil-to-lymphocyte ratio (1.08 [95% 1.03–1.13], p < 0.001). Elderly patients receiving interferon atmotherapy showed an increased probability of survival (0.29 [95% CI 0.17–0.51], p < 0.001). Based on these factors, an algorithm (AlgSurv) was developed to predict survival for elderly patients. The metabolic flux analysis showed that 12 metabolic pathways including phenylalanine (odds ratio: 28.27 [95% CI 10.56–75.72], p < 0.001), fatty acid (15.61 [95% CI 6.66–36.6], p < 0.001), and pyruvate (12.86 [95% CI 5.85–28.28], p < 0.001) showed a consistently lower flux in the survivors vs. the deceased subgroup. This may reflect a key pathogenic mechanism of COVID-19 infection. Conclusion: Several factors such as interferon atmotherapy and recreased activity of specific metabolic pathways were found to be associated with survival of elderly patients. Based on these findings, a survival algorithm (AlgSurv) was developed to assist the clinical stratification for elderly patients. Dysregulation of the metabolic pathways revealed in this study may aid in the drug and vaccine development against COVID-19.
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Affiliation(s)
- Qi Mei
- Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Amanda Y Wang
- The Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia.,Concord Clinical School, The University of Sydney, Newtown, NSW, Australia.,Department of Renal Medicine, Concord Repatriation General Hospital, Newtown, NSW, Australia
| | - Amy Bryant
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Idaho State University, Meridian, ID, United States
| | - Yang Yang
- Renmin Hospital of Wuhan University, Wuhan, China
| | - Ming Li
- Department of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Fei Wang
- Department of Chinese Medicine, Tongji Medical College, Wuhan No. 1 Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shangming Du
- Ludwig Maximilian University of Munich, Munich, Germany
| | - Christian Kurts
- Institute of Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Patrick Wu
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong, China
| | - Ke Ma
- Department and Institute of Infectious Disease, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Wu
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Huawen Chen
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jinlong Luo
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Li
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Guangyuan Hu
- Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xianglin Yuan
- Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Li
- Institute of Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, Bonn, Germany
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Mei Q, Wang AY, Bryant A, Yang Y, Li M, Wang F, Zhao JW, Ma K, Wu L, Chen H, Luo J, Du S, Halfter K, Li Y, Kurts C, Hu G, Yuan X, Li J. Development and validation of prognostic model for predicting mortality of COVID-19 patients in Wuhan, China. Sci Rep 2020; 10:22451. [PMID: 33384422 PMCID: PMC7775455 DOI: 10.1038/s41598-020-78870-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/24/2020] [Indexed: 12/28/2022] Open
Abstract
Novel coronavirus 2019 (COVID-19) infection is a global public health issue, that has now affected more than 200 countries worldwide and caused a second wave of pandemic. Severe adult respiratory syndrome-CoV-2 (SARS-CoV-2) pneumonia is associated with a high risk of mortality. However, prognostic factors predicting poor clinical outcomes of individual patients with SARS-CoV-2 pneumonia remain under intensive investigation. We conducted a retrospective, multicenter study of patients with SARS-CoV-2 who were admitted to four hospitals in Wuhan, China from December 2019 to February 2020. Mortality at the end of the follow up period was the primary outcome. Factors predicting mortality were also assessed and a prognostic model was developed, calibrated and validated. The study included 492 patients with SARS-CoV-2 who were divided into three cohorts: the training cohort (n = 237), the validation cohort 1 (n = 120), and the validation cohort 2 (n = 135). Multivariate analysis showed that five clinical parameters were predictive of mortality at the end of follow up period, including advanced age [odds ratio (OR), 1.1/years increase (p < 0.001)], increased neutrophil-to-lymphocyte ratio [(NLR) OR, 1.14/increase (p < 0.001)], elevated body temperature on admission [OR, 1.53/°C increase (p = 0.005)], increased aspartate transaminase [OR, 2.47 (p = 0.019)], and decreased total protein [OR, 1.69 (p = 0.018)]. Furthermore, the prognostic model drawn from the training cohort was validated with validation cohorts 1 and 2 with comparable area under curves (AUC) at 0.912, 0.928, and 0.883, respectively. While individual survival probabilities were assessed, the model yielded a Harrell's C index of 0.758 for the training cohort, 0.762 for the validation cohort 1, and 0.711 for the validation cohort 2, which were comparable among each other. A validated prognostic model was developed to assist in determining the clinical prognosis for SARS-CoV-2 pneumonia. Using this established model, individual patients categorized in the high risk group were associated with an increased risk of mortality, whereas patients predicted to be in the low risk group had a higher probability of survival.
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Affiliation(s)
- Qi Mei
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Amanda Y Wang
- The Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Concord Clinical School, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia
| | - Amy Bryant
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Idaho State University, Meridian, ID, USA
| | - Yang Yang
- Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Ming Li
- Department of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, Hubei, People's Republic of China
| | - Fei Wang
- Department of Chinese Medicine, Wuhan No.1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Jia Wei Zhao
- The Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Ke Ma
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Liang Wu
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Huawen Chen
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Jinlong Luo
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Shangming Du
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Kathrin Halfter
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Yong Li
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Christian Kurts
- Institute of Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Guangyuan Hu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
| | - Xianglin Yuan
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
| | - Jian Li
- Institute of Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, Bonn, Germany
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Yao K, Hasegawa S, Tagashira Y, Takamatsu A, Uenoyama Y, Shimizu K, Honda H. Experience of 101 patients with coronavirus infectious disease 2019 (COVID-19) at a tertiary care center in Japan. J Infect Chemother 2020; 27:413-417. [PMID: 33342681 PMCID: PMC7832134 DOI: 10.1016/j.jiac.2020.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/13/2020] [Accepted: 11/26/2020] [Indexed: 01/08/2023]
Abstract
Introduction Clusters of novel coronavirus infectious disease of 2019 (COVID-19) have spread to become a global pandemic imposing a significant burden on healthcare systems. The lack of an effective treatment and the emergence of varied and complicated clinical courses in certain populations have rendered treatment of patients hospitalized for COVID-19 difficult. Methods Tokyo Metropolitan Tama Medical Center, a public tertiary acute care center located in Tokyo, the epicenter of COVID-19 in Japan, has been admitting patients with COVID-19 since February 2020. The present, retrospective, case-series study aimed to investigate the clinical course and outcomes of patients with COVID-19 hospitalized at the study institution. Results In total, 101 patients with COVID-19 were admitted to our hospital to receive inpatient care. Eleven patients (10.9%) received ECMO, and nine patients (8.9%) died during hospitalization after COVID-19 was diagnosed. A history of smoking and obesity were most commonly encountered among patients with a complicated clinical course. Most patients who died requested to be transferred to advanced palliative care in the early course of their hospitalization. Conclusions Our experience of caring for these patients demonstrated a relatively lower mortality rate and higher survival rate in those with extracorporeal membrane oxygenation placement than previous reports from other countries and underscored the importance of proactive, advanced care planning in the early course of hospitalization.
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Affiliation(s)
- Kenta Yao
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Shinya Hasegawa
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Yasuaki Tagashira
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Akane Takamatsu
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Yuki Uenoyama
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Keiki Shimizu
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Hitoshi Honda
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan.
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Wahab SF, Løgstrup BB. Atypical manifestations of COVID-19 in general practice: a case of gastrointestinal symptoms. BMJ Case Rep 2020; 13:e237520. [PMID: 32859618 PMCID: PMC10577779 DOI: 10.1136/bcr-2020-237520] [Citation(s) in RCA: 4] [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] [Accepted: 08/13/2020] [Indexed: 02/06/2023] Open
Abstract
During the previous months, we have seen the rapid pandemic spread of SARS-CoV-2. Despite being considered a respiratory virus, it has become clear that other clinical presentations are possible and some of these are quite frequent. In this paper, a case of a man in his late 70s showing atypical symptoms in general practice is presented. Apart from fever, the patient complained of diarrhoea, borborygmus, loss of appetite and nausea. He developed no respiratory symptoms during his disease. Due to his symptoms, malignant disease was suspected, and he was referred for further testing which revealed typical COVID-19 findings on a chest CT scan. The occurrence of atypical symptoms is discussed, including the importance of recognising these in an ongoing pandemic.
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