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Iqbal K, Banga A, Arif TB, Rathore SS, Bhurwal A, Naqvi SKB, Mehdi M, Kumar P, Salklan MM, Iqbal A, Ahmed J, Sharma N, Lal A, Kashyap R, Bansal V, Domecq JP. Anticoagulant use before COVID-19 diagnosis prevent COVID-19 associated acute venous thromboembolism or not: A systematic review and meta-analysis. World J Methodol 2024; 14:92983. [DOI: 10.5662/wjm.v14.i3.92983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/24/2024] [Accepted: 05/11/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Coagulopathy and thromboembolic events are associated with poor outcomes in coronavirus disease 2019 (COVID-19) patients. There is conflicting evidence on the effects of chronic anticoagulation on mortality and severity of COVID-19 disease.
AIM To summarize the body of evidence on the effects of pre-hospital anticoagulation on outcomes in COVID-19 patients.
METHODS A Literature search was performed on LitCovid PubMed, WHO, and Scopus databases from inception (December 2019) till June 2023 for original studies reporting an association between prior use of anticoagulants and patient outcomes in adults with COVID-19. The primary outcome was the risk of thromboembolic events in COVID-19 patients taking anticoagulants. Secondary outcomes included COVID-19 disease severity, in terms of intensive care unit admission or invasive mechanical ventilation/intubation requirement in patients hospitalized with COVID-19 infection, and mortality. The random effects models were used to calculate crude and adjusted odds ratios (aORs) with 95% confidence intervals (95%CIs).
RESULTS Forty-six observational studies met our inclusion criteria. The unadjusted analysis found no association between prior anticoagulation and thromboembolic event risk [n = 43851, 9 studies, odds ratio (OR)= 0.67 (0.22, 2.07); P = 0.49; I2 = 95%]. The association between prior anticoagulation and disease severity was non-significant [n = 186782; 22 studies, OR = 1.08 (0.78, 1.49); P = 0.64; I2 = 89%]. However, pre-hospital anticoagulation significantly increased all-cause mortality risk [n = 207292; 35 studies, OR = 1.72 (1.37, 2.17); P < 0.00001; I2 = 93%]. Pooling adjusted estimates revealed a statistically non-significant association between pre-hospital anticoagulation and thromboembolic event risk [aOR = 0.87 (0.42, 1.80); P = 0.71], mortality [aOR = 0.94 (0.84, 1.05); P = 0.31], and disease severity [aOR = 0.96 (0.72, 1.26); P = 0.76].
CONCLUSION Prehospital anticoagulation was not significantly associated with reduced risk of thromboembolic events, improved survival, and lower disease severity in COVID-19 patients.
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Affiliation(s)
- Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Akshat Banga
- Department of Internal Medicine, Sawai Man Singh Medical College, Jaipur 302004, India
| | - Taha Bin Arif
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Sawai Singh Rathore
- Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur 342003, Rajasthan, India
| | - Abhishek Bhurwal
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ 08901, United States
| | | | - Muhammad Mehdi
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Pankaj Kumar
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Mitali Madhu Salklan
- Department of Internal Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Ayman Iqbal
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Jawad Ahmed
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Nikhil Sharma
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Rahul Kashyap
- Department of Research, Wellspan Health, York, PA 17403, United States
| | - Vikas Bansal
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
| | - Juan Pablo Domecq
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
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2
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Boutkourt F, van Haaps T, Brüggemann R, Bhoelan S, ten Cate H, Kruip MJHA, Spaetgens B, van Es N, Roest T, Joling KJ, Meijer K, Hugtenburg J. The effect of current antithrombotic therapy on mortality in nursing home residents with COVID-19: a multicentre retrospective cohort study. Age Ageing 2024; 53:afae094. [PMID: 38748450 PMCID: PMC11095411 DOI: 10.1093/ageing/afae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 01/31/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The first wave of COVID led to an alarmingly high mortality rate among nursing home residents (NHRs). In hospitalised patients, the use of anticoagulants may be associated with a favourable prognosis. However, it is unknown whether the use of antithrombotic medication also protected NHRs from COVID-19-related mortality. OBJECTIVES To investigate the effect of current antithrombotic therapy in NHRs with COVID-19 on 30-day all-cause mortality during the first COVID-19 wave. METHODS We performed a retrospective cohort study linking electronic health records and pharmacy data in NHRs with COVID-19. A propensity score was used to match NHRs with current use of therapeutic dose anticoagulants to NHRs not using anticoagulant medication. The primary outcome was 30-day all-cause mortality, which was evaluated using a logistic regression model. In a secondary analysis, multivariable logistic regression was performed in the complete study group to compare NHRs with current use of therapeutic dose anticoagulants and those with current use of antiplatelet therapy to those without such medication. RESULTS We included 3521 NHRs with COVID-19 based on a positive RT-PCR for SARS-CoV-2 or with a well-defined clinical suspicion of COVID-19. In the matched propensity score analysis, NHRs with current use of therapeutic dose anticoagulants had a significantly lower all-cause mortality (OR = 0.73; 95% CI: 0.58-0.92) compared to NHRs who did not use therapeutic anticoagulants. In the secondary analysis, current use of therapeutic dose anticoagulants (OR: 0.62; 95% CI: 0.48-0.82) and current use of antiplatelet therapy (OR 0.80; 95% CI: 0.64-0.99) were both associated with decreased mortality. CONCLUSIONS During the first COVID-19 wave, therapeutic anticoagulation and antiplatelet use were associated with a reduced risk of all-cause mortality in NHRs. Whether these potentially protective effects are maintained in vaccinated patients or patients with other COVID-19 variants, remains unknown.
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Affiliation(s)
- Firdaouss Boutkourt
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, location VUmc, De Boelelaan 1117, Amsterdam, The Netherlands
- Farmadam Pharmacy Group, Contactweg 127, Amsterdam, The Netherlands
| | - Thijs van Haaps
- Department of Vascular Medicine, Amsterdam UMC, location AMC Meibergdreef 9, Amsterdam, The Netherlands
- Pulmonary Hypertension & Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Reneé Brüggemann
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Soerajja Bhoelan
- Department of Hematology, UMC Groningen, University of Groningen, The Netherlands
| | - Hugo ten Cate
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marieke J H A Kruip
- Department of Hematology, Erasmus MC Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bart Spaetgens
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Nick van Es
- Department of Vascular Medicine, Amsterdam UMC, location AMC Meibergdreef 9, Amsterdam, The Netherlands
- Pulmonary Hypertension & Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Tineke Roest
- Farmadam Pharmacy Group, Contactweg 127, Amsterdam, The Netherlands
| | - Karlijn J Joling
- Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands, Department of Medicine for Older People, Amsterdam UMC, Location VUmc, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Karina Meijer
- Department of Hematology, UMC Groningen, University of Groningen, The Netherlands
| | - Jacqueline Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, location VUmc, De Boelelaan 1117, Amsterdam, The Netherlands
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3
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Yousefi P, Soltani S, Siri G, Rezayat SA, Gholami A, Zafarani A, Razizadeh MH, Alborzi E, Mokhtary‐Irani G, Abedi B, Karampoor S, Tabibzadeh A, Farahani A. Coagulopathy and thromboembolic events a pathogenic mechanism of COVID-19 associated with mortality: An updated review. J Clin Lab Anal 2023; 37:e24941. [PMID: 37431777 PMCID: PMC10431412 DOI: 10.1002/jcla.24941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023] Open
Abstract
During 2019, the SARS-CoV-2 emerged from China, and during months, COVID-19 spread in many countries around the world. The expanding data about pathogenesis of this virus could elucidate the exact mechanism by which COVID-19 caused death in humans. One of the pathogenic mechanisms of this disease is coagulation. Coagulation disorders that affect both venous and arterial systems occur in patients with COVID-19. The possible mechanism involved in the coagulation could be excessive inflammation induced by SARS-CoV-2. However, it is not yet clear well how SARS-CoV-2 promotes coagulopathy. However, some factors, such as pulmonary endothelial cell damage and some anticoagulant system disorders, are assumed to have an important role. In this study, we assessed conducted studies about COVID-19-induced coagulopathy to obtain clearer vision of the wide range of manifestations and possible pathogenesis mechanisms.
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Affiliation(s)
- Parastoo Yousefi
- Department of Virology, School of MedicineIran University of Medical SciencesTehranIran
| | - Saber Soltani
- Department of Virology, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Goli Siri
- Department of Internal Medicine, Amir Alam HospitalTehran University of Medical SciencesTehranIran
| | - Sara Akhavan Rezayat
- Department of Health Care Management and Economics, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Ali Gholami
- School of MedicineArak University of Medical SciencesArakIran
| | - Alireza Zafarani
- Department of Hematology and Blood Banking, Faculty of Allied MedicineIran University of Medical SciencesTehranIran
| | | | - Ehsan Alborzi
- Department of Virology, School of MedicineIran University of Medical SciencesTehranIran
| | - Golnaz Mokhtary‐Irani
- Department of Virology, Faculty of MedicineAhvaz Jondishapur University of Medical SciencesAhvazIran
| | - Behnam Abedi
- Department of Medical Laboratory SciencesKhomein University of Medical SciencesKhomeinIran
| | - Sajad Karampoor
- Department of Virology, School of MedicineIran University of Medical SciencesTehranIran
- Gastrointestinal and Liver Diseases Research CenterIran University of Medical SciencesTehranIran
| | - Alireza Tabibzadeh
- Department of Virology, School of MedicineIran University of Medical SciencesTehranIran
| | - Abbas Farahani
- Department of Medical Laboratory SciencesKhomein University of Medical SciencesKhomeinIran
- Molecular and Medicine Research CenterKhomein University of Medical SciencesKhomeinIran
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4
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Nilsen A, Lichtwarck B, Eriksen S, Mork Rokstad AM. Clinical expressions, characteristics and treatments of confirmed COVID-19 in nursing home residents: a systematic review. BMC Geriatr 2023; 23:101. [PMID: 36803435 PMCID: PMC9936944 DOI: 10.1186/s12877-023-03826-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The coronavirus 2019 (COVID-19) pandemic has led to a high rate of infections, frequent outbreaks, and high mortality rates in nursing homes (NH) worldwide. To protect and improve the treatment and care of the vulnerable NH population, it is pivotal to systematise and synthesise data from cases of COVID-19 among NH residents. In our systematic review, we therefore aimed to describe the clinical expressions, characteristics, and treatments of NH residents confirmed to have COVID-19. METHODS We conducted two comprehensive literature searches in several electronic databases: (1) PubMed, (2) CINAHL, (3) AgeLine, (4) Embase, and (5) PsycINFO in April and July 2021. Of the 438 articles screened, 19 were included in our sample, and we used the Newcastle-Ottawa Assessment Scale to assess the quality of the reported studies. A weighted mean (Mweighted), was calculated to account for the large variation in sample sizes of the studies, and due to heterogeneity among the studies, we report our findings in a narrative synthesis. RESULTS According to the mean weights (Mweighted), common symptoms and signs in NH residents confirmed to have COVID-19 were fever (53.7%), cough (56.5%), hypoxia (32.3%), and delirium or confusion (31.2%). Common comorbidities were hypertension (78.6%), dementia or cognitive impairment (55.3%), and cardiovascular diseases (52.0%). Six studies presented data concerning medical and pharmacological treatments, such as inhalers, oxygen supplementation, anticoagulation, and parenteral/enteral fluids or nutrition. The treatments were used to improve outcomes, as part of palliative care, or as end-of-life treatment. Transfers to hospital for NH residents with confirmed COVID-19 were reported in six of the included studies, and the rate of hospital transfers ranged from 6.9% to 50% in this population. In the 17 studies reporting mortality, 40.2% of the NH residents died during the studies' observation periods. CONCLUSIONS Our systematic review allowed us to summarise important clinical findings about COVID-19 among NH residents and to identify the population's risk factors for serious illness and death caused by the disease. However, the treatment and care of NH residents with severe COVID-19 warrant further investigation.
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Affiliation(s)
- Anita Nilsen
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway.
| | - Bjørn Lichtwarck
- grid.412929.50000 0004 0627 386XThe Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Siren Eriksen
- grid.417292.b0000 0004 0627 3659Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway ,grid.458172.d0000 0004 0389 8311Lovisenberg Diaconal University College, Oslo, Norway
| | - Anne Marie Mork Rokstad
- grid.411834.b0000 0004 0434 9525Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway ,grid.417292.b0000 0004 0627 3659Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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5
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Visser AGR, Winkens B, Schols JMGA, Janknegt R, Spaetgens B. The impact of polypharmacy on 30-day COVID-related mortality in nursing home residents: a multicenter retrospective cohort study. Eur Geriatr Med 2023; 14:51-57. [PMID: 36484958 PMCID: PMC9734791 DOI: 10.1007/s41999-022-00723-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Both the coronavirus (COVID-19) disease and polypharmacy pose a serious threat to nursing home (NH) residents. This study aimed to assess the impact of polypharmacy on 30-day COVID-related mortality in NH residents with COVID-19. METHODS Multicenter retrospective cohort study including NH residents from 15 NHs in the Netherlands. The impact of polypharmacy on 30-day COVID-related mortality was evaluated and assessed using multivariable logistic regression analyses with correction for age, sex, CCI, BMI and vaccination status. RESULTS In total, 348 NH residents were included, with a mean age of 84 years (SD = 8); 65% were female, 70% lived in a psychogeriatric ward, with a main diagnosis of dementia. 30-day COVID-related mortality was 27.3%. We found a significant, positive association between the total number of medications and 30-day COVID-related mortality (OR 1.09; 95% CI 1.001-1.20, p = 0.046), after adjustment for age, sex, Charlson Comorbidity Index (CCI), Body Mass Index (BMI) and vaccination status. After additional correction for dementia (model 2) and use of PPI, vitamin D, antipsychotics and antithrombotics (model 3), this effect remained positive, but was no longer significant. CONCLUSION Nursing home residents with a higher number of medications and who were not vaccinated, had a higher 30-day COVID-related mortality. These findings have important implications for the management of COVID-19 in the frail NH population. As such they underline the importance of deprescribing on the one hand, but also of improving vaccination rates on the other.
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Affiliation(s)
- Anne G R Visser
- Zuyderland Elderly Care, Sittard, The Netherlands. .,Departments Health Services Research and Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jos M G A Schols
- Departments Health Services Research and Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Rob Janknegt
- Departments Health Services Research and Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Bartholomeus Spaetgens
- Section Geriatric Medicine, Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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6
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Beobide Telleria I, Ferro Uriguen A, Laso Lucas E, Sannino Menicucci C, Enriquez Barroso M, López de Munain Arregui A. Risk factors associated with COVID-19 infection and mortality in nursing homes. Aten Primaria 2022; 54:102463. [PMID: 36148713 PMCID: PMC9444496 DOI: 10.1016/j.aprim.2022.102463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/29/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this paper was to analyse the association of demographic, clinical and pharmacological risk factors with the presence of SARS-COV-2 virus infection, as well as to know the variables related to mortality from COVID-19 in nursing home (NH) residents. DESIGN Retrospective case-control study. The study variables of those residents who acquired the infection (case) were compared with those of the residents who did not acquire it (control). A subgroup analysis was carried out to study those variables related to mortality. SITE: Nursing homes in the region of Guipúzcoa (Spain). PARTICIPANTS AND INTERVENTIONS 4 NHs with outbreaks of SARS-CoV-2 between March and December 2020 participated in the study. The infectivity and, secondary, mortality was studied, as well as demographic, clinical and pharmacological variables associated with them. Data were collected from the computerised clinical records. MAIN MEASUREMENTS Infection and mortality rate. Risk factors associated with infection and mortality. RESULTS 436 residents were studied (median age 87 years (IQR 11)), 173 acquired SARS-CoV-2 (39.7%). People with dementia and Global Deterioration Scale ≥6 were less likely to be infected by SARS-CoV-2 virus [OR=0.65 (95% CI 0.43-0.97; p<.05)]. Overall case fatality rate was 10.3% (a mortality of 26% among those who acquired the infection). COVID-19 mortality was significantly associated with a Global Deterioration Scale ≥6 (OR=4.9 (95% CI 1.5-16.1)), COPD diagnosis (OR=7.8 (95% CI 1.9-31.3)) and antipsychotic use (OR=3.1 (95% CI 1.0-9.0)). CONCLUSIONS Advanced dementia has been associated with less risk of SARS-CoV-2 infection but higher risk of COVID-19 mortality. COPD and chronic use of antipsychotics have also been associated with mortality. These results highlight the importance of determining the stage of diseases such as dementia as well as maintaining some caution in the use of some drugs such as antipsychotics.
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Affiliation(s)
- Idoia Beobide Telleria
- Pharmacy Department, Ricardo Bermingham Hospital (Matia Foundation), San Sebastián, Spain.
| | | | - Esther Laso Lucas
- Pharmacy Department, Ricardo Bermingham Hospital (Matia Foundation), San Sebastián, Spain
| | | | | | - Adolfo López de Munain Arregui
- Department of Neurology, Hospital Universitario Donostia-OSAKIDETZA, Neurosciences Area, Institute Biodonostia, Spain; Department of Neurosciences, School of Medicine and Surgery, University of the Basque Country, San Sebastián, Spain; CIBERNED (Institute Carlos III), Madrid, Spain
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7
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Zhang XS, Charland K, Quach C, Nguyen QD, Zinszer K. Institutional, therapeutic, and individual factors associated with 30-day mortality after COVID-19 diagnosis in Canadian long-term care facilities. J Am Geriatr Soc 2022; 70:3210-3220. [PMID: 35906882 PMCID: PMC9353371 DOI: 10.1111/jgs.17975] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
Background Canadian long‐term care facility (LTCF) residents experienced higher death rates compared to other countries during the first wave of the COVID‐19 pandemic. This cohort study analyzes the individual, therapeutic, and institutional factors associated with death in LTCFs. Methods Institutional data for 17 LTCFs in Montreal, Canada were obtained from local administrative registries. Individual data for 1197 residents infected by SARS‐CoV‐2 between February 23 and July 11, 2020 were obtained through chart reviews. A multivariable modified Poisson regression model, which accounted for LTCF clustering, was used to identify resident and facility covariates associated with 30‐day mortality after COVID‐19 diagnosis. Results Severe shortage of licensed practical nurses (RR 2.60 95% CI 1.20–5.61) and medium‐sized facilities compared to smaller‐sized facilities (RR 2.73 95% CI 1.23–6.07) were associated with 30‐day mortality. Later COVID‐19 diagnosis (RR 0.98 95% CI 0.97–0.99 per additional day) was associated with survival. Individual risk factors for death included age (RR 1.33 95% CI 1.23–1.45 per additional 10 years), male sex (RR 1.46 95% CI 1.24–1.71), functional impairment (RR 1.08 95% CI 1.04–1.12 per unit increase of SMAF), as well as a diagnosis of congestive heart failure (RR 1.31 95% CI 1.04–1.66) and neurocognitive disorder (RR 1.31 95% CI 1.01–1.70). Among severe cases, anticoagulation was associated with survival (RR 0.70 95% CI 0.51–0.96). Conclusions This study identified practical nurse shortages and facility size as institutional risk factors for COVID‐19 death. Anticoagulation was associated with survival among severe cases.
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Affiliation(s)
- Xi Sophie Zhang
- Department of General Medicine, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.,Department of Family and Emergency Medicine, University of Montreal, Montreal, Canada
| | | | - Caroline Quach
- Department of Microbiology, Infectious Disease, and Immunology, University of Montreal, Montreal, Canada.,Clinical Department of Laboratory Medicine, Centre hospitalier universitaire de Sainte-Justine (CHUSJ), Montreal, Canada
| | - Quoc Dinh Nguyen
- Department of Geriatric Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.,Department of Medicine, University of Montreal, Montreal, Canada
| | - Kate Zinszer
- Centre de recherche en santé publique, Montreal, Canada.,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada
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8
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Verbiest MEA, Stoop A, Scheffelaar A, Janssen MM, van Boekel LC, Luijkx KG. Health impact of the first and second wave of COVID-19 and related restrictive measures among nursing home residents: a scoping review. BMC Health Serv Res 2022; 22:921. [PMID: 35841028 PMCID: PMC9286708 DOI: 10.1186/s12913-022-08186-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background and objectives COVID-19 disproportionally affects older adults living in nursing homes. The purpose of this review was to explore and map the scientific literature on the health impact of COVID-19 and related restrictive measures during the first and second wave among nursing home residents. A specific focus was placed on health data collected among nursing home residents themselves. Research design and methods In this study, best practices for scoping reviews were followed. Five databases were systematically searched for peer-reviewed empirical studies published up until December 2020 in which data were collected among nursing home residents. Articles were categorized according to the type of health impact (physical, social and/or psychological) and study focus (impact of COVID-19 virus or related restrictive measures). Findings were presented using a narrative style. Results Of 60 included studies, 57 examined the physical impact of COVID-19. All of these focused on the direct impact of the COVID-19 virus. These studies often used an observational design and quantitative data collection methods, such as swab testing or reviewing health records. Only three studies examined the psychological impact of COVID-19 of which one study focused on the impact of COVID-19-related restrictive measures. Findings were contradictory; both decreased and improved psychological wellbeing was found during the pandemic compared with before. No studies were found that examined the impact on social wellbeing and one study examined other health-related outcomes, including preference changes of nursing home residents in Advanced Care planning following the pandemic. Discussion and implications Studies into the impact of the first and second wave of the COVID-19 pandemic among nursing home residents predominantly focused on the physical impact. Future studies into the psychological and social impact that collect data among residents themselves will provide more insight into their perspectives, such as lived experiences, wishes, needs and possibilities during later phases of the pandemic. These insights can inform policy makers and healthcare professionals in providing person-centered care during the remaining COVID-19 pandemic and in future crisis periods.
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Affiliation(s)
- Marjolein E A Verbiest
- Academic Collaborative Centre Older Adults, Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.
| | - Annerieke Stoop
- Academic Collaborative Centre Older Adults, Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Aukelien Scheffelaar
- Academic Collaborative Centre Older Adults, Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Meriam M Janssen
- Academic Collaborative Centre Older Adults, Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Leonieke C van Boekel
- Academic Collaborative Centre Older Adults, Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Katrien G Luijkx
- Academic Collaborative Centre Older Adults, Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
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9
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Degarege A, Naveed Z, Kabayundo J, Brett-Major D. Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis. Pathogens 2022; 11:563. [PMID: 35631084 PMCID: PMC9147100 DOI: 10.3390/pathogens11050563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA; (Z.N.); (J.K.); (D.B.-M.)
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Rosca A, Balcaen T, Lanoix JP, Michaud A, Moyet J, Marcq I, Schmit JL, Bloch F, Deschasse G. Mortality risk and antibiotic use for COVID-19 in hospitalized patients over 80. Biomed Pharmacother 2022; 146:112481. [PMID: 35062049 PMCID: PMC8712262 DOI: 10.1016/j.biopha.2021.112481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Patients over 80 years of age are more prone to develop severe symptoms and die from COVID-19. Antibiotics were massively prescribed in the first days of the pandemic without evidence of super infection. Antibiotics may increase the risk of mortality in cases of viral pneumonia. With age and antibiotic use, the microbiota becomes altered and less protective effect against lethal viral pneumonia. Thus we assessed whether it is safe to prescribe antibiotics for COVID-19 pneumonia to patients over 80 years of age. METHOD We conducted a retrospective monocentric study in a 1240-bed university hospital. Our inclusion criteria were patients aged ≥ 80 years, hospitalized in a COVID-19 unit, with either a positive SARS-CoV-2 RT-PCR from a nasopharyngeal swab or a CT scan within 72 h after or prior to hospitalization in the unit suggestive of infection. RESULTS We included 101 patients who received antibiotics and 48 who did not. The demographics in the two groups were similar. Overall mortality was higher for the group that received antibiotics than for the other group (36.6% vs 14.6%,). According to univariate COX analysis, the risk of mortality was higher (HR = 1.98 [0.926; 4.23]) but non-significantly for the antibiotic group. In multivariate analysis, independent risk factors of mortality were an increased leukocyte count and decreased oxygen saturation (HR = 1.097 [1.022; 1.178] and HR = 0.927 [0.891; 0.964], respectively). CONCLUSION This study raises questions about the interest of antibiotic therapy, its efficacy, and its effect on COVID-19 and encourages further research.
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Affiliation(s)
- Andreea Rosca
- Service of Pharmacy, University Hospital Amiens-Picardie, France.
| | - Thibaut Balcaen
- CHU Amiens, Medical Information Department, F-80000 Amiens, France
| | - Jean-Philippe Lanoix
- Service de Maladies Infectieuses et Tropicales, CHU Amiens-Picardie – Hôpital Nord, Place Victor Pauchet, 80000 Amiens, France,UR 4294 AGIR, Université Picardie Jules Verne, CURS, Rond point Pr Cabrol, 80000 Amiens, France
| | - Audrey Michaud
- Department of Clinical Research, Amiens Picardy University Hospital, 80054 Amiens, France
| | - Julien Moyet
- Department of Geriatric medicine, University Hospital Amiens-Picardie, France
| | - Ingrid Marcq
- Groupe de Recherche sur l'Alcool et les Pharmacodépendances INSERM UMR1247, Centre Universitaire de Recherche en Santé CURS, Université de Picardie Jules Verne, CHU Sud, Amiens, France
| | - Jean-Luc Schmit
- Service de Maladies Infectieuses et Tropicales, CHU Amiens-Picardie – Hôpital Nord, Place Victor Pauchet, 80000 Amiens, France,UR 4294 AGIR, Université Picardie Jules Verne, CURS, Rond point Pr Cabrol, 80000 Amiens, France
| | - Frederic Bloch
- Department of Geriatric medicine, University Hospital Amiens-Picardie, France,Laboratory of Functional Neurosciences EA 4559, University of Picardie – Jules-Verne, Amiens, France
| | - Guillaume Deschasse
- Department of Geriatric medicine, University Hospital Amiens-Picardie, France
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Choi YR, Chang SO. Nurses' conceptualizations of managing emergencies in nursing homes. Nurs Health Sci 2021; 24:113-122. [PMID: 34741563 DOI: 10.1111/nhs.12900] [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] [Received: 08/01/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022]
Abstract
Emergencies can negatively affect the morbidity and mortality of nursing home residents. As nurses employed at nursing homes play a key role in such situations, their conceptualizations of emergency management should be considered to improve care. Accordingly, this study aimed to identify nurses' conceptualizations of managing emergencies in nursing homes. A qualitative research design was conducted using interviews with 20 nurses working in five different nursing homes in the Republic of Korea between September 2019 and August 2020. The data were analyzed using phenomenography. This study identified two main perspectives used by nurses in nursing homes to manage emergencies, depending on the resident's condition: emergency care and daily preventive care. Nurses' conceptualizations of care provided in emergencies were organized under the frames of assessment and intervention, whereas routine care carried out during daily life activities fell under the frame of prevention. This study's findings, which elucidate nurses' complex practical and experiential knowledge, provide insights for the development of emergency management training.
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Affiliation(s)
- Young-Rim Choi
- College of Nursing, Korea University, Seoul, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
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12
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García-Cabrera L, Pérez-Abascal N, Montero-Errasquín B, Rexach Cano L, Mateos-Nozal J, Cruz-Jentoft A. Characteristics, hospital referrals and 60-day mortality of older patients living in nursing homes with COVID-19 assessed by a liaison geriatric team during the first wave: a research article. BMC Geriatr 2021; 21:610. [PMID: 34715807 PMCID: PMC8553905 DOI: 10.1186/s12877-021-02565-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/12/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The infection by SARS-CoV-2 (COVID-19) has been especially serious in older patients. The aim of this study is to describe baseline and clinical characteristics, hospital referrals, 60-day mortality, factors associated with hospital referrals and mortality in older patients living in nursing homes (NH) with suspected COVID-19. METHODS A retrospective observational study was performed during March and April 2020 of institutionalized patients assessed by a liaison geriatric hospital-based team. Were collected all older patients living in 31 nursing homes of a public hospital catchment area assessed by a liaison geriatric team due to the suspicion of COVID-19 during the first wave, when the hospital system was collapsed. Sociodemographic variables, comprehensive geriatric assessment, clinical characteristics, treatment received including care setting, and 60-days mortality were recorded from electronic medical records. A logistic regression analysis was performed to analyze the factors associated with mortality. RESULTS 419 patients were included in the study (median age 89 years old, 71.6 % women, 63.7 % with moderate-severe dependence, and 43.8 % with advanced dementia). 31.1 % were referred to the emergency department in the first assessment, with a higher rate of hospital referral in those with better functional and mental status. COVID-19 atypical symptoms like functional decline, delirium, or eating disorders were frequent. 36.9% had died in the 60 days following the first call. According to multivariate logistic regression age (p 0.010), Barthel index <60 (p 0.002), presence of tachypnea (p 0.021), fever (p 0.006) and the use of ceftriaxone (p 0.004) were associated with mortality. No mortality differences were found between those referred to the hospital or cared at the nursing home. CONCLUSIONS AND IMPLICATIONS 31% of the nursing home patients assessed by a liaison geriatric hospital-based team for COVID-19 were referred to the hospital, being more frequently referred those with a better functional and cognitive situation. The 60-days mortality rate due to COVID-19 was 36.8% and was associated with older age, functional dependence, the presence of tachypnea and fever, and the use of ceftriaxone. Geriatric comprehensive assessment and coordination between NH and the hospital geriatric department teams were crucial.
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Affiliation(s)
- Lorena García-Cabrera
- Unidad de Cuidados Paliativos, Hospital Universitario Ramón y Cajal (IRYCIS), Carretera de Colmenar km 9,1, 28034, Madrid, Spain.
| | - Noelia Pérez-Abascal
- Servicio de Geriatría. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Lourdes Rexach Cano
- Unidad de Cuidados Paliativos, Hospital Universitario Ramón y Cajal (IRYCIS), Carretera de Colmenar km 9,1, 28034, Madrid, Spain
| | - Jesús Mateos-Nozal
- Servicio de Geriatría. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
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Mahamat-Saleh Y, Fiolet T, Rebeaud ME, Mulot M, Guihur A, El Fatouhi D, Laouali N, Peiffer-Smadja N, Aune D, Severi G. Diabetes, hypertension, body mass index, smoking and COVID-19-related mortality: a systematic review and meta-analysis of observational studies. BMJ Open 2021; 11:e052777. [PMID: 34697120 PMCID: PMC8557249 DOI: 10.1136/bmjopen-2021-052777] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/07/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES We conducted a systematic literature review and meta-analysis of observational studies to investigate the association between diabetes, hypertension, body mass index (BMI) or smoking with the risk of death in patients with COVID-19 and to estimate the proportion of deaths attributable to these conditions. METHODS Relevant observational studies were identified by searches in the PubMed, Cochrane library and Embase databases through 14 November 2020. Random-effects models were used to estimate summary relative risks (SRRs) and 95% CIs. Certainty of evidence was assessed using the Cochrane methods and the Grading of Recommendations, Assessment, Development and Evaluations framework. RESULTS A total of 186 studies representing 210 447 deaths among 1 304 587 patients with COVID-19 were included in this analysis. The SRR for death in patients with COVID-19 was 1.54 (95% CI 1.44 to 1.64, I2=92%, n=145, low certainty) for diabetes and 1.42 (95% CI 1.30 to 1.54, I2=90%, n=127, low certainty) for hypertension compared with patients without each of these comorbidities. Regarding obesity, the SSR was 1.45 (95% CI 1.31 to 1.61, I2=91%, n=54, high certainty) for patients with BMI ≥30 kg/m2 compared with those with BMI <30 kg/m2 and 1.12 (95% CI 1.07 to 1.17, I2=68%, n=25) per 5 kg/m2 increase in BMI. There was evidence of a J-shaped non-linear dose-response relationship between BMI and mortality from COVID-19, with the nadir of the curve at a BMI of around 22-24, and a 1.5-2-fold increase in COVID-19 mortality with extreme obesity (BMI of 40-45). The SRR was 1.28 (95% CI 1.17 to 1.40, I2=74%, n=28, low certainty) for ever, 1.29 (95% CI 1.03 to 1.62, I2=84%, n=19) for current and 1.25 (95% CI 1.11 to 1.42, I2=75%, n=14) for former smokers compared with never smokers. The absolute risk of COVID-19 death was increased by 14%, 11%, 12% and 7% for diabetes, hypertension, obesity and smoking, respectively. The proportion of deaths attributable to diabetes, hypertension, obesity and smoking was 8%, 7%, 11% and 2%, respectively. CONCLUSION Our findings suggest that diabetes, hypertension, obesity and smoking were associated with higher COVID-19 mortality, contributing to nearly 30% of COVID-19 deaths. TRIAL REGISTRATION NUMBER CRD42020218115.
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Affiliation(s)
- Yahya Mahamat-Saleh
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Thibault Fiolet
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Mathieu Edouard Rebeaud
- Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Matthieu Mulot
- Laboratory of Soil Biodiversity, Faculty of Science, University of Neuchatel, Neuchâtel, Switzerland
| | - Anthony Guihur
- Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Douae El Fatouhi
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Nasser Laouali
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Nathan Peiffer-Smadja
- Universite de Paris, IAME, INSERM, Paris, France
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gianluca Severi
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
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Benvenuti E, Rivasi G, Bulgaresi M, Barucci R, Lorini C, Balzi D, Faraone A, Fortini G, Vaccaro G, Del Lungo I, Gangemi S, Giardini S, Piga C, Barghini E, Boni S, Bulli G, Carrai P, Crociani A, Lo Forte A, Martella L, Pupo S, Marozzi I, Bandini G, Buscemi P, Cosma C, Stacchini L, Baggiani L, Ungar A, Mossello E, Bonaccorsi G, Landini G. Caring for nursing home residents with COVID-19: a "hospital-at-nursing home" intermediate care intervention. Aging Clin Exp Res 2021; 33:2917-2924. [PMID: 34417733 PMCID: PMC8378521 DOI: 10.1007/s40520-021-01959-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/09/2021] [Indexed: 01/30/2023]
Abstract
Background Nursing home (NH) residents have been dramatically affected by COVID-19, with extremely high rates of hospitalization and mortality. Aims To describe the features and impact of an assistance model involving an intermediate care mobile medical specialist team (GIROT, Gruppo Intervento Rapido Ospedale Territorio) aimed at delivering “hospital-at-nursing home” care to NH residents with COVID-19 in Florence, Italy. Methods The GIROT activity was set-up during the first wave of the pandemic (W1, March–April 2020) and became a structured healthcare model during the second (W2, October 2020–January 2021). The activity involved (1) infection transmission control among NHs residents and staff, (2) comprehensive geriatric assessment including prognostication and geriatric syndromes management, (3) on-site diagnostic assessment and protocol-based treatment of COVID-19, (4) supply of nursing personnel to understaffed NHs. To estimate the impact of the GIROT intervention, we reported hospitalization and infection lethality rates recorded in SARS-CoV-2-positive NH residents during W1 and W2. Results The GIROT activity involved 21 NHs (1159 residents) and 43 NHs (2448 residents) during W1 and W2, respectively. The percentage of infected residents was higher in W2 than in W1 (64.5% vs. 38.8%), while both hospitalization and lethality rates significantly decreased in W2 compared to W1 (10.1% vs 58.2% and 23.4% vs 31.1%, respectively). Discussion Potentiating on-site care in the NHs paralleled a decrease of hospital admissions with no increase of lethality. Conclusions An innovative “hospital-at-nursing home” patient-centred care model based on comprehensive geriatric assessment may provide a valuable contribution in fighting COVID-19 in NH residents. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01959-z.
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Affiliation(s)
- Enrico Benvenuti
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy.
| | - Matteo Bulgaresi
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Riccardo Barucci
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Chiara Lorini
- Department of Health Science, University of Florence, Florence, Italy
| | - Daniela Balzi
- Epidemiology Unit, Local Health Unit "Toscana Centro", Florence, Italy
| | - Antonio Faraone
- Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | - Giacomo Fortini
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Gabriele Vaccaro
- Department of Health Science, University of Florence, Florence, Italy
| | - Ilaria Del Lungo
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Salvatore Gangemi
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Sante Giardini
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Cecilia Piga
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Eleonora Barghini
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Serena Boni
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Giulia Bulli
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Paolo Carrai
- Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | - Andrea Crociani
- Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | - Aldo Lo Forte
- Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | - Letizia Martella
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Simone Pupo
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Irene Marozzi
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Giulia Bandini
- Division of Internal Medicine, Careggi Hospital, Florence, Italy
| | - Primo Buscemi
- Department of Health Science, University of Florence, Florence, Italy
| | - Claudia Cosma
- Department of Health Science, University of Florence, Florence, Italy
| | - Lorenzo Stacchini
- Department of Health Science, University of Florence, Florence, Italy
| | | | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Enrico Mossello
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | | | - Giancarlo Landini
- Department of Internal Medicine, Santa Maria Nuova Hospital, Local Health Unit "Toscana Centro", Florence, Italy
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Vitamin K in COVID-19—Potential Anti-COVID-19 Properties of Fermented Milk Fortified with Bee Honey as a Natural Source of Vitamin K and Probiotics. FERMENTATION 2021. [DOI: 10.3390/fermentation7040202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Vitamin K deficiency is evident in severe and fatal COVID-19 patients. It is associated with the cytokine storm, thrombotic complications, multiple organ damage, and high mortality, suggesting a key role of vitamin K in the pathology of COVID-19. To support this view, we summarized findings reported from machine learning studies, molecular simulation, and human studies on the association between vitamin K and SARS-CoV-2. We also investigated the literature for the association between vitamin K antagonists (VKA) and the prognosis of COVID-19. In addition, we speculated that fermented milk fortified with bee honey as a natural source of vitamin K and probiotics may protect against COVID-19 and its severity. The results reported by several studies emphasize vitamin K deficiency in COVID-19 and related complications. However, the literature on the role of VKA and other oral anticoagulants in COVID-19 is controversial: some studies report reductions in (intensive care unit admission, mechanical ventilation, and mortality), others report no effect on mortality, while some studies report higher mortality among patients on chronic oral anticoagulants, including VKA. Supplementing fermented milk with honey increases milk peptides, bacterial vitamin K production, and compounds that act as potent antioxidants: phenols, sulforaphane, and metabolites of lactobacilli. Lactobacilli are probiotic bacteria that are suggested to interfere with various aspects of COVID-19 infection ranging from receptor binding to metabolic pathways involved in disease prognosis. Thus, fermented milk that contains natural honey may be a dietary manipulation capable of correcting nutritional and immune deficiencies that predispose to and aggravate COVID-19. Empirical studies are warranted to investigate the benefits of these compounds.
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Ballin M, Bergman J, Kivipelto M, Nordström A, Nordström P. Excess Mortality After COVID-19 in Swedish Long-Term Care Facilities. J Am Med Dir Assoc 2021; 22:1574-1580.e8. [PMID: 34174196 PMCID: PMC8223135 DOI: 10.1016/j.jamda.2021.06.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/25/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022]
Abstract
Objective To compare 30-day mortality in long-term care facility (LTCF) residents with and without COVID-19 and to investigate the impact of 31 potential risk factors for mortality in COVID-19 cases. Design Retrospective cohort study. Setting and Participants All residents of LTCFs registered in Senior Alert, a Swedish national database of health examinations in older adults, during 2019-2020. Methods We selected residents with confirmed COVID-19 until September 15, 2020, along with time-dependent propensity score–matched controls without COVID-19. Exposures were COVID-19, age, sex, comorbidities, medications, and other patient characteristics. The outcome was all-cause 30-day mortality. Results A total of 3731 residents (median age 87 years, 64.5% female) with COVID-19 were matched to 3731 controls without COVID-19. Thirty-day mortality was 39.9% in COVID-19 cases and 5.7% in controls [relative risk 7.05, 95% confidence interval (CI) 6.10-8.14]. In COVID-19 cases, the odds ratio (OR) for 30-day mortality was 2.44 (95% CI 1.57-3.81) in cases aged 80-84 years, 2.99 (95% CI 1.93-4.65) in cases aged 85-89 years, and 3.28 (95% CI 2.11-5.10) in cases aged ≥90 years, as compared with cases aged <70 years. Other risk factors for mortality among COVID-19 cases included male sex (OR, 2.60, 95% CI 2.22-3.05), neuropsychological conditions (OR, 2.18; 95% CI 1.76-2.71), impaired walking ability (OR, 1.45, 95% CI 1.17-1.78), urinary and bowel incontinence (OR 1.51, 95% CI 1.22-1.85), diabetes (OR 1.36, 95% CI 1.14-1.62), chronic kidney disease (OR 1.37, 95% CI 1.11-1.68) and previous pneumonia (OR 1.57, 95% CI 1.32-1.85). Nutritional factors, cardiovascular diseases, and antihypertensive medications were not significantly associated with mortality. Conclusions and Implications In Swedish LTCFs, COVID-19 was associated with a large excess in mortality after controlling for an extensive number of risk factors. Beyond older age and male sex, several prevalent clinical risk factors independently contributed to higher mortality. These findings suggest that reducing transmission of COVID-19 in LTCFs will likely prevent a considerable number of deaths.
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Affiliation(s)
- Marcel Ballin
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Jonathan Bergman
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Medical Unit Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Nordström
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden; School of Sport Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden.
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Corrochano M, Acosta-Isaac R, Mojal S, Miqueleiz S, Rodriguez D, Quijada-Manuitt MÁ, Fraga E, Castillo-Ocaña M, Amaro-Hosey K, Albiol N, Soria JM, Antonijoan RM, Souto JC. Impact of pre-admission antithrombotic therapy on disease severity and mortality in patients hospitalized for COVID-19. J Thromb Thrombolysis 2021; 53:96-102. [PMID: 34138399 PMCID: PMC8210515 DOI: 10.1007/s11239-021-02507-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 12/15/2022]
Abstract
Anticoagulant therapy is a cornerstone treatment for coronavirus disease 2019 (COVID-19) due to the high rates of thromboembolic complications associated with this disease. We hypothesized that chronic antithrombotic therapy could play a protective role in patients hospitalized for COVID-19. Retrospective, observational study of all patients admitted to our hospital for ≥ 24 h from March 1 to May 31, 2020 with SARS-CoV-2. The objective was to evaluate clinical outcomes and mortality in COVID-19 patients receiving chronic anticoagulation (AC) or antiplatelet therapy (AP) prior to hospital admission. A total of 1612 patients were evaluated. The mean (standard deviation; SD) age was 66.5 (17.1) years. Patients were divided into three groups according to the use of antithrombotic therapy prior to admission (AP, AC, or no-antithrombotic treatment). At admission, 9.6% of the patients were taking anticoagulants and 19.1% antiplatelet therapy. The overall mortality rate was 19.3%. On the multivariate analysis there were no significant differences in mortality between the antithrombotic groups (AC or AP) and the no-antithrombotic group (control group). Patients on AC had lower ICU admission rates than the control group (OR: 0.41, 95% CI, 0.18–0.93). Anticoagulation therapy prior to hospitalization for COVID-19 was associated with lower ICU admission rates. However, there were no significant differences in mortality between the patients receiving chronic antithrombotic therapy and patients not taking antithrombotic medications. These findings suggest that chronic anticoagulation therapy at the time of COVID-19 infection may reduce disease severity and thus the need for ICU admission.
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Affiliation(s)
- Mariana Corrochano
- Haemostasis and Thrombosis Unit, Hospital de La Santa Creu I Sant Pau. Carrer de Sant Quintí 89, 08041, Barcelona, Spain.
| | - René Acosta-Isaac
- Haemostasis and Thrombosis Unit, Hospital de La Santa Creu I Sant Pau. Carrer de Sant Quintí 89, 08041, Barcelona, Spain
| | - Sergi Mojal
- Haemostasis and Thrombosis Unit, Hospital de La Santa Creu I Sant Pau. Carrer de Sant Quintí 89, 08041, Barcelona, Spain
| | - Sara Miqueleiz
- Clinical Trials Unit (AGDAC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Diana Rodriguez
- Clinical Trials Unit (AGDAC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Marta Castillo-Ocaña
- Clinical Pharmacology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Nil Albiol
- Haemostasis and Thrombosis Unit, Hospital de La Santa Creu I Sant Pau. Carrer de Sant Quintí 89, 08041, Barcelona, Spain
| | - José Manuel Soria
- Unit of Genomics of Complex Diseases, Institut d'Investigació Biomèdica Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Rosa Maria Antonijoan
- Clinical Pharmacology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Drug Research Center, Institut d'Investigació Biomèdica Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Joan Carles Souto
- Haemostasis and Thrombosis Unit, Hospital de La Santa Creu I Sant Pau. Carrer de Sant Quintí 89, 08041, Barcelona, Spain
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18
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Alexander PE, Armstrong R, Fareed G, Lotus J, Oskoui R, Prodromos C, Risch HA, Tenenbaum HC, Wax CM, Dara P, McCullough PA, Gill KK. Early multidrug treatment of SARS-CoV-2 infection (COVID-19) and reduced mortality among nursing home (or outpatient/ambulatory) residents. Med Hypotheses 2021; 153:110622. [PMID: 34130113 PMCID: PMC8178530 DOI: 10.1016/j.mehy.2021.110622] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/25/2021] [Accepted: 06/02/2021] [Indexed: 12/18/2022]
Abstract
The outbreak of COVID-19 from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world with tremendous morbidity and mortality in the elderly. In-hospital treatment addresses the multifaceted nature of the illness including initial viral replication, cytokine storm, and endothelial injury with thrombosis. We identified nine reports of early treatment outcomes in COVID-19 nursing home patients. Multi-drug therapy including hydroxychloroquine with one or more anti-infectives, corticosteroids, and antithrombotic anti-blood clotting agents can be extended to seniors in the nursing home setting without hospitalization. Data from nine studies found hydroxychloroquine-based multidrug regimens were associated with a statistically significant > 60% reduction in mortality. Going forward, we conclude that early empiric treatment for the elderly with COVID-19 in the nursing home setting (or similar congregated settings with elderly residents/patients e.g. LTF or ALF) has a reasonable probability of success and acceptable safety. This group remains our highest at-risk group and warrants acute treatment focus prior to symptoms worsening. Given the rapidity and severity of SARS-CoV-2 outbreaks in nursing homes, in-center treatment of acute COVID-19 patients is a reasonable strategy to reduce the risks of hospitalization and death. If elderly high-risk patients in such congregated nursing home type settings are allowed to worsen with no early treatment, they may be too sick and fragile to benefit from in-hospital therapeutics and are at risk for pulmonary failure, life-ending micro-thrombi of the lungs, kidneys etc. The issue is timing of therapeutics, and we argue that early treatment before hospitalization, is the right time and can potentially save lives, especially among our higher-risk elderly populations hit hardest by severe illness and death from COVID-19. We must reiterate, we are talking about ‘early’ treatment before the disease is far along in the disease sequelae where the patient then needs hospitalization and aggressive interventions. We are referring to the initial days e.g. day one, post infection when symptoms emerge or there is strong clinical suspicion. This early therapeutic option deserves serious and urgent consideration by the medical establishment and respective decision-makers. Doctors must be allowed their clinical discretion in how they optimally treat their patients. Doctors must be brave and trust their skilled judgements and do all to save the lives of their patients. We therefore hypothesize that early outpatient ambulatory treatment, once initiated as soon as symptoms begin in high-risk positive persons, would significantly reduce hospitalizations and prevent deaths. Specifically, the provision of early multi-drug sequenced therapy with repurposed drugs will reduce hospitalization and death in elderly patients being cared for in long-term-care facilities. The most important implications of our hypothesis are: 1) hospitalizations and deaths would be reduced 2) transmission would be reduced due to the mitigation of symptoms and 3) recovery following infection and treatment provides for natural exposure immunity that is broad based, durable, and robust (helping towards natural immunity within the population). The end result is reduced strain on hospitals and systems that would allow for other non-COVID illnesses to receive care.
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Affiliation(s)
- Paul E Alexander
- McMaster University and GUIDE Research Methods Group, Hamilton, Ontario, Canada.
| | | | | | - John Lotus
- The Foundation for Orthopaedics and Regenerative Medicine (FOReM), Chicago, IL, USA.
| | - Ramin Oskoui
- CEO, Foxhall Cardiology, PC, Washington, DC, USA
| | - Chad Prodromos
- The Foundation for Orthopaedics and Regenerative Medicine (FOReM), Chicago, IL, USA
| | | | - Howard C Tenenbaum
- Centre for Advanced Dental Research and Care, Mount Sinai Hospital, and Faculties of Medicine and Dentistry, University of Toronto, Toronto, ON, Canada.
| | - Craig M Wax
- Family Physician, Independent Physicians for Patient Independence, AAPS Board of Directors, NJ, USA.
| | - Parvez Dara
- Consultant, Medical Hematologist and Oncologist, USA
| | - Peter A McCullough
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA.
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19
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Russo V, Bottino R, D'Andrea A, Silverio A, Di Maio M, Golino P, Nigro G, Valsecchi O, Attena E, Canonico ME, Galasso G, Parodi G, Scudiero F. Chronic Oral Anticoagulation and Clinical Outcome in Hospitalized COVID-19 Patients. Cardiovasc Drugs Ther 2021; 36:705-712. [PMID: 33988835 PMCID: PMC8120255 DOI: 10.1007/s10557-021-07194-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE The clinical course of COVID-19 may be complicated by acute respiratory distress syndrome (ARDS) and thromboembolic events, which are associated with high risk of mortality. Although previous studies reported a lower rate of death in patients treated with heparin, the potential benefit of chronic oral anticoagulation therapy (OAT) remains unknown. We aimed to investigate the association between OAT with the risk of ARDS and mortality in hospitalized patients with COVID-19. METHODS This is a multicenter retrospective Italian study including consecutive patients hospitalized for COVID-19 from March 1 to April 22, 2020, at six Italian hospitals. Patients were divided into two groups according to the chronic assumption of oral anticoagulants. RESULTS Overall, 427 patients were included; 87 patients (19%) were in the OAT group. Of them, 54 patients (13%) were on treatment with non-vitamin k oral anticoagulants (NOACs) and 33 (8%) with vitamin-K antagonists (VKAs). OAT patients were older and had a higher rate of hypertension, diabetes, and coronary artery disease compared to No-OAT group. The rate of ARDS at admission (26% vs 28%, P=0.834), or developed during the hospitalization (9% vs 10%, P=0.915), was similar between study groups; in-hospital mortality (22% vs 26%, P=0.395) was also comparable. After balancing for potential confounders by using the propensity score matching technique, no differences were found in term of clinical outcome between OAT and No-OAT patients CONCLUSION: Oral anticoagulation therapy, either NOACs or VKAs, did not influence the risk of ARDS or death in patients hospitalized with COVID-19.
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Affiliation(s)
- Vincenzo Russo
- Cardiology Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Via. Bianchi, 80131, Naples, Italy
| | - Roberta Bottino
- Cardiology Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Via. Bianchi, 80131, Naples, Italy.
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, 84014, Nocera Inferiore, Italy
| | - Angelo Silverio
- Cardiovascolar and Thoracic Department, Division of Cardiology, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Marco Di Maio
- Cardiovascolar and Thoracic Department, Division of Cardiology, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy.,Division of Cardiology, Maria SS. Addolorata Hospital, Eboli, Salerno, Italy
| | - Paolo Golino
- Cardiology Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Via. Bianchi, 80131, Naples, Italy
| | - Gerardo Nigro
- Cardiology Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Via. Bianchi, 80131, Naples, Italy
| | - Orazio Valsecchi
- Division of Cardiology, "Bolognini" Hospital, ASST Bergamo Est, Seriate, BG, Italy
| | - Emilio Attena
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | | | - Gennaro Galasso
- Cardiovascolar and Thoracic Department, Division of Cardiology, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Fernando Scudiero
- Division of Cardiology, "Bolognini" Hospital, ASST Bergamo Est, Seriate, BG, Italy
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20
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Ten Cate H. Thrombosis: Grand Challenges Ahead! Front Cardiovasc Med 2021; 8:637005. [PMID: 34017864 PMCID: PMC8129168 DOI: 10.3389/fcvm.2021.637005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/29/2021] [Indexed: 12/22/2022] Open
Affiliation(s)
- Hugo Ten Cate
- Thrombosis Expertise Center, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands.,Center for Thrombosis and Haemostasis, University Medical Center of Gutenberg University, Mainz, Germany
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21
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Takeuchi T, Kitamura T, Hirayama A, Katayama Y, Shimazu T, Sobue T. Characteristics of patients with novel coronavirus disease (COVID-19) during the first surge versus the second surge of infections in Osaka Prefecture, Japan. Glob Health Med 2021; 3:82-89. [PMID: 33937570 DOI: 10.35772/ghm.2020.01102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 12/18/2022]
Abstract
In Japan, the differences in characteristics, severity, and mortality of novel coronavirus disease (COVID-19) patients between the first and second surges of infections have not been fully understood. This study is a retrospective cohort study of COVID-19 patients confirmed between February 1 and August 31, 2020 in Osaka Prefecture, Japan. Publicly available information on patients was collected from the website of Osaka Prefecture. Patients were divided into two groups according to the date of the positive laboratory test result: the first surge (February 1 to May 22) and the second surge (May 23 to August 31). Patients' characteristics were compared between the two groups. A multivariable Cox proportional-hazards model was applied to compare severity and mortality between the two groups, where sex, age group at the onset date, city of residence, and days to test positive were adjusted. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. A total of 8,541 patients included 1,780 and 6,761 patients in the first and second surges, respectively. Age at the onset date was younger in the second surge (p < 0.001), and median of days from the onset date to the positive test date shortened from 7 to 6 days (p < 0.001). The multivariable Cox proportional-hazards model revealed that both severity and mortality were lower in the second surge than in the first surge (severity: HR: 0.51 [0.39-0.67]; mortality: HR: 0.37 [0.25-0.56]). In conclusion, severity and mortality were lower in the second surge than in the first surge among COVID-19 patients in Osaka Prefecture, Japan.
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Affiliation(s)
- Taro Takeuchi
- Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Atsushi Hirayama
- Department of Public Health, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomotaka Sobue
- Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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22
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Patel NG, Bhasin A, Feinglass JM, Angarone MP, Cohen ER, Barsuk JH. Mortality, critical illness, and mechanical ventilation among hospitalized patients with COVID-19 on therapeutic anticoagulants. THROMBOSIS UPDATE 2021; 2:100027. [PMID: 38620459 PMCID: PMC7732225 DOI: 10.1016/j.tru.2020.100027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/22/2022] Open
Abstract
Background COVID-19 is associated with hypercoagulability and increased incidence of thrombosis. We compared the clinical outcomes of adults hospitalized with COVID-19 who were on therapeutic anticoagulants to those on prophylactic anticoagulation. Materials and methods We performed an observational study of adult inpatients' with COVID-19 from March 9 to June 26, 2020. We compared patients who were continued on their outpatient prescribed therapeutic anticoagulation and those who were newly started on therapeutic anticoagulation for COVID-19 (without other indication) to those who were on prophylactic doses. The primary outcome was overall death while secondary outcomes were critical illness (World Health Organization Ordinal Scale for Clinical Improvement score ≥5), mechanical ventilation, and death among patients who first had critical illness. We adjusted for age, sex, race, body mass index (BMI), Charlson score, glucose on admission, and use of antiplatelet agents. Results Of 1716 inpatients with COVID-19, 171 patients were continued on their therapeutic anticoagulation and 78 were started on new therapeutic anticoagulation for COVID-19. In patients continued on home therapeutic anticoagulation, there were no differences in overall death, critical illness, mechanical ventilation, or death among patients with critical illness compared to patients on prophylactic anticoagulation. In patients receiving new therapeutic anticoagulation for COVID-19, there was increased death (OR 5.93; 95% CI 3.71-9.47), critical illness (OR 14.51; 95% CI 7.43-28.31), need mechanical ventilation (OR 11.22; 95% CI 6.67-18.86), and death after first having critical illness (OR 5.51; 95% CI 2.80-10.87). Conclusions Therapeutic anticoagulation for inpatients with COVID-19 was not associated with improved outcomes.
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Affiliation(s)
- Niti G Patel
- Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, IL, USA
| | - Ajay Bhasin
- Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, IL, USA
| | - Joseph M Feinglass
- Northwestern University Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, IL, USA
| | - Michael P Angarone
- Northwestern University Feinberg School of Medicine, Division of Infectious Diseases, Department of Medicine, Chicago, IL, USA
| | - Elaine R Cohen
- Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, IL, USA
| | - Jeffrey H Barsuk
- Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, IL, USA
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23
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Berning MJ, Palmer E, Tsai T, Mitchell SL, Berry SD. An advance care planning long-term care initiative in response to COVID-19. J Am Geriatr Soc 2021; 69:861-867. [PMID: 33577704 PMCID: PMC8013602 DOI: 10.1111/jgs.17051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/03/2022]
Abstract
Objective Describe a systematic approach to address advance care planning (ACP) during a COVID‐19 outbreak and its impact on the incidence of new do‐not‐hospitalize (DNH) directives among long‐term care (LTC) residents. Design Prospective quality improvement initiative. Setting Two long‐term chronic care campuses within a large academic healthcare organization. Participants LTC residents with activated healthcare proxies who lacked DNH directives based on documentation in the electronic medical record (EMR) as of April 13, 2020. Intervention Using a structured discussion guide, trained healthcare staff from various disciplines contacted the residents' proxies to conduct COVID‐19 focused ACP discussions. Residents without DNH directives with COVID‐19 were prioritized. Preferences ascertained in the discussion were communicated to the residents' primary care teams and directives were updated in the EMR accordingly. Measurements Residents who acquired a new DNH directive during the study initiative were determined using the EMR. Subsequent changes in DNH orders, hospitalizations, and deaths were ascertained by retrospective chart review from the date of new DNH through August 5, 2020. Results At baseline, 315/581 (54%) of LTC residents did not have a DNH directive. Their mean age was 87 (±9) years and 70% were female. Following ACP discussions, 124/315 (39%) of residents acquired a new DNH directive. Among residents with new DNH directives, 65/124 (52%) were diagnosed with COVID‐19 from April 2, 2020 to May 21, 2020. During follow‐up, only 6/124 (4.8%) residents had their DNH order reversed, 2/124 (1.6%) residents were hospitalized with illnesses unrelated to COVID‐19, and 29/124 (23%) died. Conclusions There was substantial opportunity to increase the proportion of LTC residents with DNH orders during the COVID‐19 pandemic through a systematic ACP initiative which utilized real‐time EMR data. New directives to avoid hospitalizations were sustained among the majority of residents beyond the peak of the pandemic.
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Affiliation(s)
| | - Emily Palmer
- Department of Medicine, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Timothy Tsai
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Susan L Mitchell
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah D Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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24
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Flam B, Wintzell V, Ludvigsson JF, Mårtensson J, Pasternak B. Direct oral anticoagulant use and risk of severe COVID-19. J Intern Med 2021; 289:411-419. [PMID: 33258156 PMCID: PMC7753564 DOI: 10.1111/joim.13205] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hypercoagulability and thromboembolism are prominent features of severe COVID-19, and ongoing anticoagulant use might be protective. METHODS We conducted a nationwide register-based cohort study in Sweden, February through May, 2020, to assess whether ongoing direct oral anticoagulant (DOAC) use was associated with reduced risk of hospital admission for laboratory-confirmed COVID-19, or a composite of intensive care unit (ICU) admission or death due to laboratory-confirmed COVID-19. RESULTS DOAC use (n = 103 703) was not associated with reduced risk of hospital admission for COVID-19 (adjusted hazard ratio [aHR] [95% confidence interval] 1.00 [0.75-1.33] vs. nonuse atrial fibrillation comparator [n = 36 875]; and aHR 0.94 [0.80-1.10] vs. nonuse cardiovascular disease comparator [n = 355 699]), or ICU admission or death due to COVID-19 (aHRs 0.76 [0.51-1.12], and 0.90 [0.71-1.15], respectively). CONCLUSION Ongoing DOAC use was not associated with reduced risk of severe COVID-19, indicating that prognosis would not be modified by early outpatient DOAC initiation.
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Affiliation(s)
- B Flam
- From the, Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - V Wintzell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - J F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J Mårtensson
- From the, Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - B Pasternak
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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25
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Kumar A, Dey AD, Behl T, Chadha S, Aggarwal V. Exploring the multifocal therapeutic approaches in COVID-19: A ray of hope. Int Immunopharmacol 2021; 90:107156. [PMID: 33189613 PMCID: PMC7608010 DOI: 10.1016/j.intimp.2020.107156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/24/2020] [Accepted: 10/21/2020] [Indexed: 12/28/2022]
Abstract
The ongoing global pandemic of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is marked as one of the most challenging infectious diseases in the history of mankind with affliction of ~29,737,453 confirmed cases globally. Looking at the present scenario where there is a parallel increment in curve with time, there is an utmost emergency to discover a perennial solution to this life-threatening virus which has led the Human race in an unusual state of affair. The entire health care fraternity is engaged in endeavouring an ultimate way out to hit this pandemic but no such research made till now has been approved yet, to have the potential to bring an end to this fatal situation. Although a few possible treatment choices exist at the moment yet the requirement to search for a still better therapeutic option remains persistent. Global laboratories are working day and night in search for an effective vaccine, many are undergoing clinical trials but their commercialization is no less than a year away. The present review highlights the current potential therapies viz., vaccines, immunotherapies, convulsant plasma therapies, corticosteroids, antithrombotic, intravenous immunoglobulins, nocturnal oxygen therapy etc. that may prove beneficial in attenuating the pandemic situation. However, comparison and presentation of collective data on the therapeutic advancements in mitigating the pandemic situation needs further clinical investigations in order to prove boon to mankind.
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Affiliation(s)
- Arun Kumar
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
| | - Asmita Deka Dey
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Swati Chadha
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Vishal Aggarwal
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
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26
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Clinical Presentation, Course, and Risk Factors Associated with Mortality in a Severe Outbreak of COVID-19 in Rhode Island, USA, April-June 2020. Pathogens 2020; 10:pathogens10010008. [PMID: 33374131 PMCID: PMC7824344 DOI: 10.3390/pathogens10010008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 01/25/2023] Open
Abstract
Long-term care facilities (LTCFs) have had a disproportionally high mortality rate due to COVID-19. We describe a rapidly escalating COVID-19 outbreak among 116 LTCF residents in Rhode Island, USA. Overall, 111 (95.6%) residents tested positive and, of these, 48 (43.2%) died. The most common comorbidities were hypertension (84.7%) and cardiovascular disease (84.7%). A small percentage (9%) of residents were asymptomatic, while 33.3% of residents were pre-symptomatic, with progression to symptoms within a median of three days following the positive test. While typical symptoms of fever (80.2%) and cough (43.2%) were prevalent, shortness of breath (14.4%) was rarely found despite common hypoxemia (95.5%). The majority of patients demonstrated atypical symptoms with the most common being loss of appetite (61.3%), lethargy (42.3%), diarrhea (37.8%), and fatigue (32.4%). Many residents had increased agitation (38.7%) and anxiety (5.4%), potentially due to the restriction measures or the underlying mental illness. The fever curve was characterized by an intermittent low-grade fever, often the first presenting symptom. Mortality was associated with a disease course beginning with a loss of appetite and lethargy, as well as one more often involving fever greater than 38 °C, loss of appetite, altered mental status, diarrhea, and respiratory distress. Interestingly, no differences in age or comorbidities were noted between survivors and non-survivors. Taking demographic factors into account, treatment with anticoagulation was still associated with reduced mortality (adjusted OR 0.16; 95% C.I. 0.06–0.39; p < 0.001). Overall, the clinical features of the disease in this population can be subtle and the symptoms are commonly atypical. However, clinical decline among those who did not survive was often rapid with patients expiring within 10 days from disease detection. Further studies are needed to better explain the variability in clinical course of COVID-19 among LTCF residents, specifically the factors affecting mortality, the differences observed in symptom presentation, and rate of clinical decline.
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Vrillon A, Hourregue C, Azuar J, Grosset L, Boutelier A, Tan S, Roger M, Mourman V, Mouly S, Sène D, François V, Dumurgier J, Paquet C. COVID-19 in Older Adults: A Series of 76 Patients Aged 85 Years and Older with COVID-19. J Am Geriatr Soc 2020; 68:2735-2743. [PMID: 33045106 PMCID: PMC7675559 DOI: 10.1111/jgs.16894] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Clinical presentation and risk factors of death in COVID-19 in oldest adults have not been well characterized. OBJECTIVES To describe clinical features and outcome of COVID-19 in patients older than 85 years and study risk factors for mortality. DESIGN Prospective cohort. PARTICIPANTS AND SETTING Patients aged 85 years and older, admitted in noncritical care units at the University Hospital Lariboisière Fernand-Widal (Paris, France) for confirmed severe acute respiratory syndrome coronavirus 2 infection were included and followed up for 21 days. MEASUREMENTS Clinical and laboratory findings were collected. Cox survival analysis was performed to explore factors associated with death. RESULTS From March 14 to April 11, 2020, 76 patients (median age = 90 (86-92) years; women = 55.3%) were admitted for confirmed COVID-19. Of the patients, 64.5% presented with three or more comorbidities. Most common symptoms were asthenia (76.3%), fever (75.0%) and confusion and delirium (71.1%). An initial fall was reported in 25.0% of cases, and digestive symptoms were reported in 22.4% of cases. COVID-19 was severe in 51.3% of cases, moderate in 32.9%, and mild in 15.8%. Complications included acute respiratory syndrome (28.9%), cardiac decompensation (14.5%), and hypotensive shock (9.0%). Fatality at 21 days was 28.9%, after a median course of disease of 13 (8-17) days. Males were overrepresented in nonsurvivors (68.2%). In survivors, median length of stay was 12 (9-19.5) days. Independent predictive factors of death were C-reactive protein level at admission and lymphocyte count at nadir. CONCLUSION Specific clinical features, multiorgan injury, and high case fatality rate are observed in older adults with COVID-19. However, rapid diagnosis, appropriate care, and monitoring seem to improve prognosis.
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Affiliation(s)
- Agathe Vrillon
- Université de Paris, INSERM U1144 Optimisation Thérapeutique en NeuropsychopharmacologieParisFrance
- Centre de Neurologie Cognitive, AP‐HPGroupe Hospitalier Saint‐Louis Lariboisière Fernand‐WidalParisFrance
- COVID Unit Féréol, AP‐HPGroupe Hospitalier Saint‐Louis Lariboisière Fernand‐WidalParisFrance
| | - Claire Hourregue
- Centre de Neurologie Cognitive, AP‐HPGroupe Hospitalier Saint‐Louis Lariboisière Fernand‐WidalParisFrance
- COVID Unit Féréol, AP‐HPGroupe Hospitalier Saint‐Louis Lariboisière Fernand‐WidalParisFrance
| | - Julien Azuar
- Université de Paris, INSERM U1144 Optimisation Thérapeutique en NeuropsychopharmacologieParisFrance
- COVID Unit Féréol, AP‐HPGroupe Hospitalier Saint‐Louis Lariboisière Fernand‐WidalParisFrance
- Département de Psychiatrie et de Médecine AddictologiqueAP‐HP, Groupe Hospitalier Saint‐Louis Lariboisière Fernand‐Widal, Hôpital Fernand WidalParisFrance
| | - Lina Grosset
- Centre de Neurologie Cognitive, AP‐HPGroupe Hospitalier Saint‐Louis Lariboisière Fernand‐WidalParisFrance
- COVID Unit Féréol, AP‐HPGroupe Hospitalier Saint‐Louis Lariboisière Fernand‐WidalParisFrance
| | - Ada Boutelier
- COVID Unit Féréol, AP‐HPGroupe Hospitalier Saint‐Louis Lariboisière Fernand‐WidalParisFrance
| | - Sophie Tan
- COVID Unit Féréol, AP‐HPGroupe Hospitalier Saint‐Louis Lariboisière Fernand‐WidalParisFrance
- Département de Psychiatrie et de Médecine AddictologiqueAP‐HP, Groupe Hospitalier Saint‐Louis Lariboisière Fernand‐Widal, Hôpital Fernand WidalParisFrance
| | - Michael Roger
- COVID Unit Féréol, AP‐HPGroupe Hospitalier Saint‐Louis Lariboisière Fernand‐WidalParisFrance
| | - Vianney Mourman
- Médecine de la Douleur et Médecine PalliativeAP‐HP, Groupe Hospitalier Saint‐Louis Lariboisière Fernand‐Widal, Hôpital Fernand WidalParisFrance
| | - Stéphane Mouly
- Département de Médecine Interne, AP‐HPGroupe Hospitalier Lariboisière Fernand‐Widal, Hôpital LariboisièreParisFrance
- Université de Paris, Faculté de MédecineParisFrance
| | - Damien Sène
- Département de Médecine Interne, AP‐HPGroupe Hospitalier Lariboisière Fernand‐Widal, Hôpital LariboisièreParisFrance
- Université de Paris, Faculté de MédecineParisFrance
| | - Véronique François
- Gériatrie, AP‐HPGroupe Hospitalier Saint‐Louis Lariboisière Fernand‐Widal, Hôpital Fernand WidalParisFrance
| | - Julien Dumurgier
- Centre de Neurologie Cognitive, AP‐HPGroupe Hospitalier Saint‐Louis Lariboisière Fernand‐WidalParisFrance
- COVID Unit Féréol, AP‐HPGroupe Hospitalier Saint‐Louis Lariboisière Fernand‐WidalParisFrance
- Université de Paris, Faculté de MédecineParisFrance
- Université de Paris, INSERM U1153 Epidemiology of Ageing and Neurodegenerative DiseasesParisFrance
| | - Claire Paquet
- Université de Paris, INSERM U1144 Optimisation Thérapeutique en NeuropsychopharmacologieParisFrance
- Centre de Neurologie Cognitive, AP‐HPGroupe Hospitalier Saint‐Louis Lariboisière Fernand‐WidalParisFrance
- Université de Paris, Faculté de MédecineParisFrance
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Burkett E, Carpenter CR, Hullick C, Arendts G, Ouslander JG. It's time: Delivering optimal emergency care of residents of aged care facilities in the era of COVID-19. Emerg Med Australas 2020; 33:131-137. [PMID: 33131219 DOI: 10.1111/1742-6723.13683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Ellen Burkett
- Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Healthcare Improvement Unit, Clinical Excellence Queensland, Brisbane, Queensland, Australia
| | | | - Carolyn Hullick
- Belmont Hospital, Belmont, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Glenn Arendts
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Joseph G Ouslander
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
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Cai Z, Greene MI, Zhu Z, Zhang H. Structural Features and PF4 Functions that Occur in Heparin-Induced Thrombocytopenia (HIT) Complicated by COVID-19. Antibodies (Basel) 2020; 9:E52. [PMID: 33050376 PMCID: PMC7709132 DOI: 10.3390/antib9040052] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/10/2020] [Accepted: 09/29/2020] [Indexed: 01/08/2023] Open
Abstract
Platelet factor 4 (PF4, CXCL4) is a small chemokine protein released by activated platelets. Although a major physiological function of PF4 is to promote blood coagulation, this cytokine is involved in innate and adaptive immunity in events when platelets are activated in response to infections. Coronavirus disease 2019 (COVID-19) patients have abnormal coagulation activities, and severe patients develop higher D-dimer levels. D-dimers are small protein products present in the blood after blood clots are degraded by fibrinolysis. To prevent clotting, heparin is often clinically used in COVID-19 patients. Some clinical procedures for the management of COVID-19 patients may include extracorporeal membrane oxygenation (ECMO) and renal replacement therapy (CRRT), which also require the use of heparin. Anti-PF4 antibodies are frequently detected in severe patients and heparin-induced thrombocytopenia (HIT) can also be observed. PF4 and its role in HIT as well as in pathologies seen in COVID-19 patients define a potential therapeutic option of using blocking antibodies in the treatment of COVID-19.
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Affiliation(s)
| | | | | | - Hongtao Zhang
- Departments of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19301, USA; (Z.C.); (M.I.G.); (Z.Z.)
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Ouslander JG, Grabowski DC. COVID-19 in Nursing Homes: Calming the Perfect Storm. J Am Geriatr Soc 2020; 68:2153-2162. [PMID: 32735036 DOI: 10.1111/jgs.16784] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 01/31/2023]
Abstract
The pandemic of viral infection with the severe acute respiratory syndrome coronavirus-2 that causes COVID-19 disease has put the nursing home industry in crisis. The combination of a vulnerable population that manifests nonspecific and atypical presentations of COVID-19, staffing shortages due to viral infection, inadequate resources for and availability of rapid, accurate testing and personal protective equipment, and lack of effective treatments for COVID-19 among nursing home residents have created a "perfect storm" in our country's nursing homes. This perfect storm will continue as society begins to reopen, resulting in more infections among nursing home staff and clinicians who acquire the virus outside of work, remain asymptomatic, and unknowingly perpetuate the spread of the virus in their workplaces. Because of the elements of the perfect storm, nursing homes are like a tinderbox, and it only takes one person to start a fire that could cause many deaths in a single facility. Several public health interventions and health policy strategies, adequate resources, and focused clinical quality improvement initiatives can help calm the storm. The saddest part of this perfect storm is that many years of inaction on the part of policy makers contributed to its impact. We now have an opportunity to improve nursing homes to protect residents and their caregivers ahead of the next storm. It is time to reimagine how we pay for and regulate nursing home care to achieve this goal. J Am Geriatr Soc 68:2153-2162, 2020.
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Affiliation(s)
- Joseph G Ouslander
- Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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31
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Spaetgens B, Brouns SH, Schols JMGA. The Post-Acute and Long-Term Care Crisis in the Aftermath of COVID-19: A Dutch Perspective. J Am Med Dir Assoc 2020; 21:1171-1172. [PMID: 32736846 PMCID: PMC7323634 DOI: 10.1016/j.jamda.2020.06.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Bart Spaetgens
- Section Geriatric Medicine, Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Steffie H Brouns
- Section Geriatric Medicine, Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jos M G A Schols
- Care and Public Health Research Institute (CAPHRI), Department of Health Services Research and Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
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