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Balik M, Waldauf P, Jurisinova I, Svobodova E, Diblickova M, Tencer T, Zavora J, Smela G, Kupidlovska L, Adamkova V, Fridrichova M, Jerabkova K, Mikes J, Duska F, Dusek L. SARS-CoV-2 viral load is linked to remdesivir efficacy in severe Covid-19 admitted to intensive care. Sci Rep 2024; 14:20825. [PMID: 39242658 PMCID: PMC11379941 DOI: 10.1038/s41598-024-71588-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/29/2024] [Indexed: 09/09/2024] Open
Abstract
Remdesivir therapy has been declared as efficient in the early stages of Covid-19. Of the 339 patients (males 55.8%, age 71(59;77) years) with a detectable viral load, 140 were treated with remdesivir (of those 103 in the ICU and 57 immunosuppressed) and retrospectively compared with 199 patients (of those 82 in the ICU and 28 immunosuppressed) who were denied therapy due to advanced Covid-19. The viral load was estimated by detecting nucleocapsid antigen in serum (n = 155, median 217(28;1524)pg/ml), antigen in sputum (n = 18, COI 18(4.6;32)), nasopharyngeal antigen (n = 44, COI 17(8;35)) and the real-time PCR (n = 122, Ct 21(18;27)). After adjustment for confounders, patients on remdesivir had better 12-month survival (HR 0.66 (0.44;0.98), p = 0.039), particularly when admitted to the ICU (HR 0.49 (0.29;0.81), p = 0.006). For the immunocompromised patients, the difference did not reach statistical significance (HR 0.55 (0.18;1.69), p = 0.3). The other most significant confounders were age, ICU admission, mechanical ventilation, leukocyte/lymphocyte ratio, admission creatinine and immunosuppression. The impact of monoclonal antibodies or previous vaccinations was not significant. Despite frequent immune suppression including haemato-oncology diseases, lymphopenia, and higher inflammatory markers in the remdesivir group, the results support remdesivir administration with respect to widely available estimates of viral load in patients with high illness severity.
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Affiliation(s)
- M Balik
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague 2, Prague, 12800, Czech Republic.
| | - P Waldauf
- Department of Anaesthesiology and Intensive Care, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital in Prague, Prague, Czech Republic
| | - I Jurisinova
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague 2, Prague, 12800, Czech Republic
| | - E Svobodova
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague 2, Prague, 12800, Czech Republic
| | - M Diblickova
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague 2, Prague, 12800, Czech Republic
| | - T Tencer
- Department of Anaesthesiology and Intensive Care, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital in Prague, Prague, Czech Republic
| | - J Zavora
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - G Smela
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - L Kupidlovska
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - V Adamkova
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - M Fridrichova
- Department of Laboratory Diagnostics, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital in Prague, Prague, Czech Republic
| | - K Jerabkova
- Department of Anaesthesiology and Intensive Care, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital in Prague, Prague, Czech Republic
| | - J Mikes
- Department of Anaesthesiology and Intensive Care, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital in Prague, Prague, Czech Republic
| | - F Duska
- Department of Anaesthesiology and Intensive Care, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital in Prague, Prague, Czech Republic
| | - L Dusek
- Faculty of Medicine, Institute of Health Information and Statistics of the Czech Republic, Masaryk University, Brno, Czech Republic
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Feng J, Chen J, Li X, Ren X, Chen J, Li Z, Wu Y, Zhang Z, Yang R, Li J, Lu Y, Liu Y. Mendelian randomization and Bayesian model averaging of autoimmune diseases and Long COVID. Front Genet 2024; 15:1383162. [PMID: 39005628 PMCID: PMC11240141 DOI: 10.3389/fgene.2024.1383162] [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: 02/19/2024] [Accepted: 05/27/2024] [Indexed: 07/16/2024] Open
Abstract
Background Following COVID-19, reports suggest Long COVID and autoimmune diseases (AIDs) in infected individuals. However, bidirectional causal effects between Long COVID and AIDs, which may help to prevent diseases, have not been fully investigated. Methods Summary-level data from genome-wide association studies (GWAS) of Long COVID (N = 52615) and AIDs including inflammatory bowel disease (IBD) (N = 377277), Crohn's disease (CD) (N = 361508), ulcerative colitis (UC) (N = 376564), etc. were employed. Bidirectional causal effects were gauged between AIDs and Long COVID by exploiting Mendelian randomization (MR) and Bayesian model averaging (BMA). Results The evidence of causal effects of IBD (OR = 1.06, 95% CI = 1.00-1.11, p = 3.13E-02), CD (OR = 1.10, 95% CI = 1.01-1.19, p = 2.21E-02) and UC (OR = 1.08, 95% CI = 1.03-1.13, p = 2.35E-03) on Long COVID was found. In MR-BMA, UC was estimated as the highest-ranked causal factor (MIP = 0.488, MACE = 0.035), followed by IBD and CD. Conclusion This MR study found that IBD, CD and UC had causal effects on Long COVID, which suggests a necessity to screen high-risk populations.
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Affiliation(s)
- Jieni Feng
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiankun Chen
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Emerging Infectious Diseases, Guangzhou, China
| | - Xiaoya Li
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaolei Ren
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junxu Chen
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zuming Li
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuan Wu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhongde Zhang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, China
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Rongyuan Yang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Emerging Infectious Diseases, Guangzhou, China
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiqiang Li
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Emerging Infectious Diseases, Guangzhou, China
| | - Yue Lu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuntao Liu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Emerging Infectious Diseases, Guangzhou, China
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Dey D, Katso B, Amoako E, Manu A, Bediako Y. Clinical disease activity in autoimmune rheumatic patients receiving COVID-19 vaccines. BMC Rheumatol 2024; 8:25. [PMID: 38880913 PMCID: PMC11181637 DOI: 10.1186/s41927-024-00396-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Vaccines are a crucial component of the global efforts to control the spread of COVID-19. Very little is known about COVID-19 vaccine responses in patients living with autoimmune rheumatic conditions in Africa. We examined the clinical reaction to COVID-19 vaccinations in Ghanaians diagnosed with autoimmune rheumatic disease. METHODS This was a hospital-based interventional cohort study of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients recruited via regular face-to-face clinic visits. The systemic lupus erythematosus disease activity index Selena modification (SELENA-SLEDAI) and the disease activity score 28-joint count-erythrocyte sedimentation rate (DAS28-ESR) were used to measure changes in disease activity levels. RESULTS Thirty-eight (38) patients of which 21 (55.3%) were diagnosed with SLE and 17 (44.7%) with RA contributed data for analyses. Most (89.5%) of the patients were females, with a mean age of 37.4 years. The SLE patients experienced a notable increase in severe flares during weeks three and six, as well as the third and sixth months, followed by subsequent decreases in the twelfth month, while remission levels increased throughout the same period. Among RA patients, high disease activity decreased during weeks three and six, as well as the third, sixth, and twelfth months, with remission levels increasing during the same time. A low dose (≥ 50 < 75 mg) dose of azathioprine was at some point associated with having a severe flare among SLE patients. After both vaccine doses, SLE patients were the majority having experienced both local and systemic reactions, all resolving within 24 h. Approximately 73.7% of the patients were COVID-19 negative at baseline. During post-vaccination visits, this increased to 100% by week six, with no positives thereafter. CONCLUSION This study explores COVID-19 vaccine responses in Ghanaian autoimmune rheumatic disease patients, revealing disease activity levels in RA patients improved after vaccination compared to SLE patients. Our findings identify a potential link between low-dose azathioprine and severe flares in SLE patients, particularly evident in the third-week post-vaccination. Further research is warranted to clarify these findings and guide tailored treatment approaches in this medically significant population during pandemics and vaccination efforts.
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Affiliation(s)
- Dzifa Dey
- Department of Medicine and Therapeutics, University of Ghana Medical School, Legon, Accra, Ghana.
- Rheumatology Unit, Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana.
| | - Bright Katso
- Rheumatology Unit, Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
| | | | - Aida Manu
- Yemaachi Biotechnology Ltd, Accra, Ghana
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Camacho-Moll ME, Mata-Tijerina VL, Gutiérrez-Salazar CC, Silva-Ramírez B, Peñuelas-Urquides K, González-Escalante L, Escobedo-Guajardo BL, Cruz-Luna JE, Corrales-Pérez R, Gómez-García S, Bermúdez-de León M. The impact of comorbidity status in COVID-19 vaccines effectiveness before and after SARS-CoV-2 omicron variant in northeastern Mexico: a retrospective multi-hospital study. Front Public Health 2024; 12:1402527. [PMID: 38932780 PMCID: PMC11199416 DOI: 10.3389/fpubh.2024.1402527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction The end of the coronavirus disease 2019 (COVID-19) pandemic has been declared by the World Health Organization on May 5, 2023. Several vaccines were developed, and new data is being published about their effectiveness. However, the clinical trials for the vaccines were performed before the Omicron variant appeared and there are population groups where vaccine effectiveness still needs to be tested. The overarching goal of the present study was to analyze the effects of COVID-19 vaccination before and after the Omicron variant in patients considering comorbidities in a population from Nuevo Leon, Mexico. Methods Epidemiological COVID-19 data from the Mexican Social Security Institute were collected from 67 hospitals located in northeastern Mexico, from July 2020 to May 2023, and a total of 669,393 cases were compiled, 255,819 reported a SARS-CoV-2 positive reverse transcription quantitative polymerase chain reaction (RT-qPCR) test or a positive COVID-19 antigen rapid test. Results Before Omicron (BO, 2020-2021), after 14 days of two doses of COVID-19 vaccine, BNT162b2 and ChAdOx1 vaccines were effective against infection in non-comorbid and all comorbid subgroups, whereas after Omicron (AO, 2022- 2023) there was no significant effectiveness against infection with none of the vaccines. Regarding hospitalization BO, BNT162b2, ChAdOx1, CoronaVac and mRNA-1273 significantly protected non-comorbid patients whereas BNT162b2, ChAdOx1, and mRNA-1273, protected all comorbid subgroups against hospitalization. AO, BNT162b2, ChAdOx1, CoronaVac and mRNA-1273 were effective against hospitalization in non-comorbid patients whereas for most comorbid subgroups BNT162b2, ChAdOx1 and CoronaVac were effective against hospitalization. Non-comorbid patients were protected against death as an outcome of COVID-19 during the BO period with most vaccines whereas a reduction in effectiveness was observed AO with mRNA-1273 vaccines in patients with hypertension, and diabetes mellitus. Discussion BO, COVID-19 vaccines were effective against infection, hospitalization, and death whereas AO, COVID-19 vaccines failed to protect the population from COVID-19 infection. A varying effectiveness against hospitalization and death is observed AO.
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Affiliation(s)
- Maria Elena Camacho-Moll
- Laboratory of Molecular Biology, Northeast Biomedical Research Center, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Viviana Leticia Mata-Tijerina
- Laboratory of Immunogenetics, Northeast Biomedical Research Center, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | | | - Beatriz Silva-Ramírez
- Laboratory of Immunogenetics, Northeast Biomedical Research Center, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Katia Peñuelas-Urquides
- Laboratory of Molecular Microbiology, Northeast Biomedical Research Center, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Laura González-Escalante
- Laboratory of Molecular Microbiology, Northeast Biomedical Research Center, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Brenda Leticia Escobedo-Guajardo
- Laboratory of Molecular Research of Diseases, Northeast Biomedical Research Center, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Jorge Eleazar Cruz-Luna
- Medical Epidemiological Assistance Coordination of the State of Nuevo Leon, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Roberto Corrales-Pérez
- Medical Epidemiological Assistance Coordination of the State of Nuevo Leon, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Salvador Gómez-García
- Medical Epidemiological Assistance Coordination of the State of Nuevo Leon, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Mario Bermúdez-de León
- Laboratory of Molecular Biology, Northeast Biomedical Research Center, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
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Cano-García L, Manrique-Arija S, Redondo-Rodríguez R, Vera-Ruiz M, Lisbona-Montañez JM, Mucientes-Ruiz A, García-Studer A, Ortiz-Marquez F, Mena-Vázquez N, Fernández-Nebro A. Impact of the COVID-19 pandemic on psychosocial health in rheumatic patients: A longitudinal study. REUMATOLOGIA CLINICA 2024; 20:297-304. [PMID: 38991823 DOI: 10.1016/j.reumae.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 07/13/2024]
Abstract
AIM To describe the impact of the COVID-19 on the psychosocial health of patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), and systemic lupus erythematosus (SLE). DESIGN Longitudinal observational study of a series of patients with rheumatic disease. METHODS The main outcome measure was impairment of the ability to participate in social activities, as measured using the PROMIS-APS instrument Short Form-8a. We evaluated social activities in various settings and performed a multivariate analysis to study the association between worsening of social participation during the COVID-19 pandemic and implicated factors. RESULTS One hundred and twenty-five patients had completed the prospective follow-up: 40 with AR (32%), 42 with SpA (33.6%), and 43 with SLE (34.4%). Overall, poorer mean PROMIS scores were recorded after the COVID-19 pandemic for: satisfaction with social roles (p=0.029), depression (p=0.039), and ability to participate in social activities (p=0.024). The factors associated with ability to participate in social activities after the COVID-19 pandemic were older age (β=-0.215; p=0.012), diagnosis of SLE (β=-0.203; p=0.015), depression (β=-0.295; p=0.003) and satisfaction with social roles (β=0.211; p=0.037). CONCLUSION The ability to participate in social activities after the COVID-19 pandemic is affected in patients with rheumatic disease, especially in SLE.
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Affiliation(s)
- Laura Cano-García
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain; Departamento de Medicina y Dermatología, Universidad de Málaga, Spain.
| | - Rocío Redondo-Rodríguez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Marta Vera-Ruiz
- Departamento de Medicina y Dermatología, Universidad de Málaga, Spain
| | - Jose Manuel Lisbona-Montañez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain; Departamento de Medicina y Dermatología, Universidad de Málaga, Spain
| | - Arkaitz Mucientes-Ruiz
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Aimara García-Studer
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Fernando Ortiz-Marquez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain; Departamento de Medicina y Dermatología, Universidad de Málaga, Spain
| | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain; Departamento de Medicina y Dermatología, Universidad de Málaga, Spain
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Safar Alsofyani I, Samman BS, Alhubayshi SS, Ellahi AT, Alsaedi AB, Almansour M. Impact of COVID-19 Pandemic on Patients With Rheumatic Diseases in Medina, Saudi Arabia: An Observational Cross-Sectional Study. Cureus 2024; 16:e60128. [PMID: 38864060 PMCID: PMC11165667 DOI: 10.7759/cureus.60128] [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] [Accepted: 05/12/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION The Coronavirus disease of 2019 (COVID-19) pandemic undoubtedly ranks among the most health-impacting pandemics throughout medical history. Although the COVID-19 global public health emergency has ended, lessons need to be learned to be more ready to face similar pandemics in the future. Few studies in Saudi Arabia discuss the impact of the COVID-19 pandemic on autoimmune rheumatic disease (AIRD) patients. Thus, this study was conducted to elaborate on the effects of the COVID-19 pandemic on AIRD patients and rheumatology practices in Saudi Arabia. Methods: This observational cross-sectional study was conducted among patients aged over 14 with AIRD using a pre-designed validated survey questionnaire. Data were collected from AIRD patients who were following up between November 2021 to April 2022 at the Rheumatology Clinic of King Fahad General Hospital in Madinah City, Saudi Arabia. This center was chosen as being the main hospital in the city following patients of AIRD. RESULTS A total of 324 patients were included in our study, with the majority (n=264, 81.5%) being females. The mean age was 44.42±14.4 years. Clinical data revealed that 115 (35.5%) of our patients experienced mild COVID-19 infection, 19 (5.9%) suffered from respiratory insufficiency, and seven (2.2%) required admission to the intensive care unit (ICU). Non-compliance to medication was recorded at 25.2%. There were 115 (35.5%) patients who had an AIRD flare that was significantly higher among those who were not adherent to the medications (p<0.001). Disease flare was also significantly seen among patients who were not on prednisone or were on low doses of prednisone (p<0.001). The majority (n=33, 97.1%) of the 34 infected patients who had an AIRD flare had their flare-up at the same time as their COVID-19 infection (p<0.001). COVID-19 vaccination rate was 87.7% (n=284). The most common reason for non-vaccination in 40 (12.3%) patients was the patients' concern about disease flare-ups by the vaccine or interference of the vaccine with their medication (n=16, 4.9%). CONCLUSION Our study showed a 35.5% (n=115) COVID-19 infection rate. The majority of our AIRD patients sustained minor infections that did not require hospitalization or ICU admission. The majority of the patients who underwent a severe COVID-19 infection course were not on prednisolone or were on low-dose prednisone. Due to COVID-19 restrictions and drug shortages, one in four patients (25.3%) stopped taking their medications and was significantly found to have a high prevalence of underlying AIRD flare. Despite the high vaccination rate, disease flare was the biggest concern for those who were not immunized. Although the COVID-19 pandemic has ended, doctors should be aware of risk factors associated with severe AIRD outcomes that should be balanced based on the infection severity, underlying disease flares, and patient-centered education about medication adherence and vaccination.
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Affiliation(s)
| | - Basim S Samman
- Internal Medicine, Ministry of National Guard - Health Affairs, Prince Mohammed Bin Abdulaziz Hospital, Medina, SAU
| | | | - Amjad T Ellahi
- Internal Medicine, King Fahad General Hospital, Medina, SAU
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Golzardi M, Hromić-Jahjefendić A, Šutković J, Aydin O, Ünal-Aydın P, Bećirević T, Redwan EM, Rubio-Casillas A, Uversky VN. The Aftermath of COVID-19: Exploring the Long-Term Effects on Organ Systems. Biomedicines 2024; 12:913. [PMID: 38672267 PMCID: PMC11048001 DOI: 10.3390/biomedicines12040913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Post-acute sequelae of SARS-CoV-2 infection (PASC) is a complicated disease that affects millions of people all over the world. Previous studies have shown that PASC impacts 10% of SARS-CoV-2 infected patients of which 50-70% are hospitalised. It has also been shown that 10-12% of those vaccinated against COVID-19 were affected by PASC and its complications. The severity and the later development of PASC symptoms are positively associated with the early intensity of the infection. RESULTS The generated health complications caused by PASC involve a vast variety of organ systems. Patients affected by PASC have been diagnosed with neuropsychiatric and neurological symptoms. The cardiovascular system also has been involved and several diseases such as myocarditis, pericarditis, and coronary artery diseases were reported. Chronic hematological problems such as thrombotic endothelialitis and hypercoagulability were described as conditions that could increase the risk of clotting disorders and coagulopathy in PASC patients. Chest pain, breathlessness, and cough in PASC patients were associated with the respiratory system in long-COVID causing respiratory distress syndrome. The observed immune complications were notable, involving several diseases. The renal system also was impacted, which resulted in raising the risk of diseases such as thrombotic issues, fibrosis, and sepsis. Endocrine gland malfunction can lead to diabetes, thyroiditis, and male infertility. Symptoms such as diarrhea, nausea, loss of appetite, and taste were also among reported observations due to several gastrointestinal disorders. Skin abnormalities might be an indication of infection and long-term implications such as persistent cutaneous complaints linked to PASC. CONCLUSIONS Long-COVID is a multidimensional syndrome with considerable public health implications, affecting several physiological systems and demanding thorough medical therapy, and more study to address its underlying causes and long-term effects is needed.
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Affiliation(s)
- Maryam Golzardi
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (M.G.); (J.Š.)
| | - Altijana Hromić-Jahjefendić
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (M.G.); (J.Š.)
| | - Jasmin Šutković
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (M.G.); (J.Š.)
| | - Orkun Aydin
- Department of Psychology, Faculty of Arts and Social Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (O.A.); (P.Ü.-A.)
| | - Pinar Ünal-Aydın
- Department of Psychology, Faculty of Arts and Social Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (O.A.); (P.Ü.-A.)
| | - Tea Bećirević
- Atrijum Polyclinic, 71000 Sarajevo, Bosnia and Herzegovina;
| | - Elrashdy M. Redwan
- Department of Biological Science, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Centre of Excellence in Bionanoscience Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Therapeutic and Protective Proteins Laboratory, Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City of Scientific Research and Technological Applications (SRTA-City), New Borg EL-Arab, Alexandria 21934, Egypt
| | - Alberto Rubio-Casillas
- Autlan Regional Hospital, Health Secretariat, Autlan 48900, Jalisco, Mexico;
- Biology Laboratory, Autlan Regional Preparatory School, University of Guadalajara, Autlan 48900, Jalisco, Mexico
| | - Vladimir N. Uversky
- Department of Molecular Medicine and USF Health Byrd Alzheimer’s Research Institute, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
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Leston M, Elson W, Ordóñez-Mena JM, Kar D, Whitaker H, Joy M, Roberts N, Hobbs FDR, de Lusignan S. Disparities in COVID-19 mortality amongst the immunosuppressed: A systematic review and meta-analysis for enhanced disease surveillance. J Infect 2024; 88:106110. [PMID: 38302061 PMCID: PMC10943183 DOI: 10.1016/j.jinf.2024.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Effective disease surveillance, including that for COVID-19, is compromised without a standardised method for categorising the immunosuppressed as a clinical risk group. METHODS We conducted a systematic review and meta-analysis to evaluate whether excess COVID-associated mortality compared to the immunocompetent could meaningfully subdivide the immunosuppressed. Our study adhered to UK Immunisation against infectious disease (Green Book) criteria for defining and categorising immunosuppression. Using OVID (EMBASE, MEDLINE, Transplant Library, and Global Health), PubMed, and Google Scholar, we examined relevant literature between the entirety of 2020 and 2022. We selected for cohort studies that provided mortality data for immunosuppressed subgroups and immunocompetent comparators. Meta-analyses, grey literature and any original works that failed to provide comparator data or reported all-cause or paediatric outcomes were excluded. Odds Ratios (OR) and 95% confidence intervals (CI) of COVID-19 mortality were meta-analysed by immunosuppressed category and subcategory. Subgroup analyses differentiated estimates by effect measure, country income, study setting, level of adjustment, use of matching and publication year. Study screening, extraction and bias assessment were performed blinded and independently by two researchers; conflicts were resolved with the oversight of a third researcher. PROSPERO registration number is CRD42022360755. FINDINGS We identified 99 unique studies, incorporating data from 1,542,097 and 56,248,181 unique immunosuppressed and immunocompetent patients with COVID-19 infection, respectively. Compared to immunocompetent people (pooled OR, 95%CI), solid organ transplants (2.12, 1.50-2.99) and malignancy (2.02, 1.69-2.42) patients had a very high risk of COVID-19 mortality. Patients with rheumatological conditions (1.28, 1.13-1.45) and HIV (1.20, 1.05-1.36) had just slightly higher risks than the immunocompetent baseline. Case type, setting income and mortality data matching and adjustment were significant modifiers of excess immunosuppressed mortality for some immunosuppressed subgroups. INTERPRETATION Excess COVID-associated mortality among the immunosuppressed compared to the immunocompetent was seen to vary significantly across subgroups. This novel means of subdivision has prospective benefit for targeting patient triage, shielding and vaccination policies during periods of high disease transmission.
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Affiliation(s)
- Meredith Leston
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom.
| | - Willam Elson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Jose M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Debasish Kar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Heather Whitaker
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Old Campus Road, Old Campus Research Building, Headington, Oxford OX3 7DQ, United Kingdom
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
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9
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Çimen Güneş E, Çolak S, Şenlik ZB, Tekgöz E, Altunay K, Özdemirkan T, Aytaç BC, Şimşek AÇ, Çınar M, Yılmaz S. Look after the COVID-19 pandemic: Mortality rates among patients with rheumatic diseases. Int J Rheum Dis 2024; 27:e15129. [PMID: 38514928 DOI: 10.1111/1756-185x.15129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/18/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024]
Abstract
AIM Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection may have a more severe course in patients with underlying disease or who have had immunosuppression. In this study, it was aimed to determine the frequency of coronavirus disease 2019 (COVID-19) and the mortality rates related to COVID-19 among patients with rheumatic disease. METHODS The patients who were followed up with rheumatic disease in the rheumatology outpatient clinic in a tertiary hospital were retrospectively assessed if they had COVID-19 infection or not between March 2020 and January 2022. RESULTS A total of 10 682 patients were evaluated. There were 2928 (27.4%) COVID-19-positive and 7754 (72.6%) COVID-19-negative patients. The mean age of COVID-19-positive patients was 46.2 ± 14.6 years, and 65.8% were female. Forty-two (1.4%) patients died due to COVID-19. Among COVID-19-negative patients, 192 patients died. The most common rheumatic disease among patients with COVID-19 was spondyloarthritis (SpA) (30.4%). Corticosteroids were the most common treatment agent in COVID-19-positive patients regardless of mortality. Thirty-one (73.8%) patients were receiving corticosteroids, and 35 (83.3%) patients were receiving immunosuppressive agents among patients with mortality. According to the logistic regression analysis, older age, male gender, and receiving corticosteroid, hydroxychloroquine, mycophenolate mofetil, tofacitinib, rituximab, and cyclophosphamide were found to be related to increased mortality. CONCLUSION COVID-19 is a serious infection and the current study emphasized that patients with rheumatic diseases had increased mortality rates, particularly in patients who were old, male, and on immunosuppressive treatments.
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Affiliation(s)
- Ezgi Çimen Güneş
- Department of Internal Medicine, Division of Rheumatology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Seda Çolak
- Department of Internal Medicine, Division of Rheumatology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | | | - Emre Tekgöz
- Department of Internal Medicine, Division of Rheumatology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | | | | | - Baran C Aytaç
- Department of Internal Medicine, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Asiye Ç Şimşek
- Department of Public Health, Gulhane School of Medicine, University of Health Science, Ankara, Turkey
| | - Muhammet Çınar
- Department of Internal Medicine, Division of Rheumatology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sedat Yılmaz
- Department of Internal Medicine, Division of Rheumatology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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10
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Krishna N, K P S, G K R. Identifying diseases associated with Post-COVID syndrome through an integrated network biology approach. J Biomol Struct Dyn 2024; 42:652-671. [PMID: 36995291 DOI: 10.1080/07391102.2023.2195003] [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: 12/04/2022] [Accepted: 03/17/2023] [Indexed: 03/31/2023]
Abstract
A growing body of research shows that COVID-19 is now recognized as a multi-organ disease with a wide range of manifestations that can have long-lasting repercussions, referred to as post-COVID-19 syndrome. It is unknown why the vast majority of COVID-19 patients develop post-COVID-19 syndrome, or why patients with pre-existing disorders are more likely to experience severe COVID-19. This study used an integrated network biology approach to obtain a comprehensive understanding of the relationship between COVID-19 and other disorders. The approach involved building a PPI network with COVID-19 genes and identifying highly interconnected regions. The molecular information contained within these subnetworks, as well as the pathway annotations, were used to reveal the link between COVID-19 and other disorders. Using Fisher's exact test and disease-specific gene information, significant COVID-19-disease associations were discovered. The study discovered diseases that affect multiple organs and organ systems, thus proving the theory of multiple organ damage caused by COVID-19. Cancers, neurological disorders, hepatic diseases, cardiac disorders, pulmonary diseases, and hypertensive diseases are just a few of the conditions linked to COVID-19. Pathway enrichment analysis of shared proteins revealed the shared molecular mechanism of COVID-19 and these diseases. The findings of the study shed new light on the major COVID-19-associated disease conditions and how their molecular mechanisms interact with COVID-19. The novelty of studying disease associations in the context of COVID-19 provides new insights into the management of rapidly evolving long-COVID and post-COVID syndromes, which have significant global implications.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Navami Krishna
- School of Biotechnology, National Institute of Technology Calicut, Calicut, Kerala, India
| | - Sijina K P
- School of Biotechnology, National Institute of Technology Calicut, Calicut, Kerala, India
| | - Rajanikant G K
- School of Biotechnology, National Institute of Technology Calicut, Calicut, Kerala, India
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11
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Boteanu A, Leon L, Pérez Esteban S, Rabadán Rubio E, Pavía Pascual M, Bonilla G, Bonilla González-Laganá C, García Fernandez A, Recuero Diaz S, Ruiz Gutierrez L, Sanmartín Martínez JJ, de la Torre-Rubio N, Nuño L, Sánchez Pernaute O, Del Bosque I, Lojo Oliveira L, Rodríguez Heredia JM, Clemente D, Abasolo L, Bachiller-Corral J. Severe COVID-19 in patients with immune-mediated rheumatic diseases: A stratified analysis from the SORCOM multicentre registry. Mod Rheumatol 2023; 34:97-105. [PMID: 36516217 DOI: 10.1093/mr/roac148] [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: 09/29/2022] [Revised: 11/11/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate risk factors for severe coronavirus disease 2019 (COVID-19) in patients with immune-mediated rheumatic diseases, stratified by systemic autoimmune conditions and chronic inflammatory arthritis. METHODS An observational, cross-sectional multicentre study was performed. Patients from 10 rheumatology departments in Madrid who presented with severe acute respiratory syndrome coronavirus-2 infection between February 2020 and May 2021 were included. The main outcome was COVID-19 severity (hospital admission or mortality). Risk factors for severity were estimated, adjusting for covariates (socio-demographic, clinical, and treatments), using logistic regression analyses. RESULTS In total, 523 patients with COVID-19 were included, among whom 192 (35.6%) patients required hospital admission and 38 (7.3%) died. Male gender, older age, and comorbidities such as diabetes mellitus, hypertension, and obesity were associated with severe COVID-19. Corticosteroid doses >10 mg/day, rituximab, sulfasalazine, and mycophenolate use, were independently associated with worse outcomes. COVID-19 severity decreased over the different pandemic waves. Mortality was higher in the systemic autoimmune conditions (univariate analysis, P < .001), although there were no differences in the overall severity in the multivariate analysis. CONCLUSIONS This study confirms and provides new insights regarding the harmful effects of corticosteroids, rituximab, and other therapies (mycophenolate and sulfasalazine) in COVID-19. Methotrexate and anti-tumour necrosis factor therapy were not associated with worse outcomes.
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Affiliation(s)
- Alina Boteanu
- Rheumatology Department and IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Leticia Leon
- Rheumatology Department and IDISSC, Hospital Clínico San Carlos, Madrid, Spain
- Health Sciences, Universidad Camilo José Cela, Madrid, Spain
| | - Silvia Pérez Esteban
- Rheumatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Elena Rabadán Rubio
- Rheumatology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Marina Pavía Pascual
- Rheumatology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Gema Bonilla
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Sheila Recuero Diaz
- Rheumatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Lucia Ruiz Gutierrez
- Rheumatology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | | | - Laura Nuño
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Olga Sánchez Pernaute
- Rheumatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Iván Del Bosque
- Rheumatology Department and IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Daniel Clemente
- Rheumatology Department, Hospital Universitario Infantil Niño Jesus, Madrid, Spain
| | - Lydia Abasolo
- Rheumatology Department and IDISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Bachiller-Corral
- Rheumatology Department and IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
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12
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Fedorchenko Y, Mahmudov K, Abenov Z, Zimba O, Yessirkepov M. Diabetes mellitus in rheumatic diseases: clinical characteristics and treatment considerations. Rheumatol Int 2023; 43:2167-2174. [PMID: 37718369 DOI: 10.1007/s00296-023-05453-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
New pathophysiological insights are now available on comorbidities in rheumatic diseases (RDs). Several nationwide studies point to the fact that comorbid diabetes mellitus (DM) increases the risk of adverse outcomes in patients with various RDs. Genetic factors, intensity of systemic inflammation, anti-inflammatory potential of therapeutic agents, and duration of RDs have been insufficiently explored in the context of comorbidities. Some disease-modifying antirheumatic drugs (DMARDs) have demonstrated a potential to improve the glycemic control while glucocorticoids (GCs) have worsened it, particularly in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Anti-TNFalpha agents in combination with hydroxychloroquine (HCQ) have been associated with a reduced risk of DM in patients with RA, ankylosing spondylitis (AS), Sjögren syndrome (SS), and SLE. Better understanding of confounding factor of currently available antirheumatic therapies in patients with DM and RDs will pave the way for a tailored approach, limiting the severity of clinical manifestations and reducing the mortality risk.
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Affiliation(s)
- Yuliya Fedorchenko
- Department of Pathophysiology, Ivano-Frankivsk National Medical University, Halytska Str. 2, Ivano-Frankivsk, 76018, Ukraine.
| | - Khaiyom Mahmudov
- Department of Propaedeutics of Internal Diseases, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
| | - Zhumabek Abenov
- Student Polyclinic, Shymkent, Kazakhstan
- South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Krakow, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
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13
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Batu ED, Demirkan FG, Sag E, Lamot L, Faleye A, Marrani E, Ziv A, Ardalan K, Gmuca S, Swart JF, Uziel Y. The impact of the COVID-19 pandemic on pediatric rheumatology practice: an international, cross-sectional survey study. Semin Arthritis Rheum 2023; 63:152289. [PMID: 37918050 PMCID: PMC11089463 DOI: 10.1016/j.semarthrit.2023.152289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/22/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has affected patient care in general. We aimed to analyze the impact of the pandemic on pediatric rheumatology practice. METHODS An online survey including 22 questions was created by the representatives of the Emerging RheumatoloGists and rEsearchers (EMERGE) group of the Pediatric Rheumatology European Society (PReS) on SurveyMonkey. The descriptive analysis of the responses was performed on SurveyMonkey. RESULTS Overall, 469 pediatric rheumatologists (F/M: 2.9) from 70 countries completed the survey. The practice of drug prescription is not affected by the pandemic, according to 65.3 % of the respondents, while 24.3 % and 16.5 % are prescribing biologic drugs and corticosteroids less often, respectively. Over 40 % of the respondents have seen an increased number of patients with vasculitis or chilblains during the pandemic. One-third of the respondents stated no adjustments in their clinical practice after 2.5 years of COVID-19 pandemic. The rest indicated implementing various changes, with an emphasis on incorporating telemedicine. Telemedicine constitutes ≥10 % of the clinical practice for one-third of the participants. Nonetheless, 35.5 % agree that there are still delays in patient care due to the pandemic. However, most (∼90 %) think our practice is returning to the pre-pandemic routine. CONCLUSION The findings of our study indicate a significant alteration in pediatric rheumatology practice due to the pandemic. This includes increased caution when prescribing anti-rheumatic drugs, a transition towards telemedicine utilization, delays in routine care, and a rise in COVID-19-related inflammatory conditions. It is imperative to address these aspects in order to improve patient care in pediatric rheumatology.
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Affiliation(s)
- Ezgi D Batu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Ankara, Turkey
| | - Fatma Gül Demirkan
- Department of Pediatric Rheumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Erdal Sag
- Ankara Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Lovro Lamot
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia; Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ayodele Faleye
- Paediatric Rheumatology Unit, Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Edoardo Marrani
- Pediatric Rheumatology Unit, AOU Meyer IRCCS, Firenze, Italy
| | - Amit Ziv
- Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel
| | - Kaveh Ardalan
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Sabrina Gmuca
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, UMC Utrecht, Netherlands
| | - Yosef Uziel
- Tel Aviv University School of Medicine, Israel and Pediatric Rheumatology Unit, Meir Medical Center, Department of Pediatrics, Kfar Saba, Tel Aviv, Israel
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14
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Picchianti-Diamanti A, Navarra A, Aiello A, Laganà B, Cuzzi G, Salmi A, Vanini V, Maggi F, Meschi S, Matusali G, Notari S, Agrati C, Salemi S, Di Rosa R, Passarini D, Di Gioia V, Sesti G, Conti F, Spinelli FR, Corpolongo A, Chimenti MS, Ferraioli M, Sebastiani GD, Benucci M, Li Gobbi F, Santoro AP, Capri A, Puro V, Nicastri E, Goletti D. Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine. Vaccines (Basel) 2023; 11:1684. [PMID: 38006015 PMCID: PMC10675674 DOI: 10.3390/vaccines11111684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Objectives: We aimed to analyse the incidence and severity of breakthrough infections (BIs) in rheumatoid arthritis (RA) patients after a COronaVIrus Disease 2019 (COVID-19) vaccination booster dose. Methods: We enrolled 194 RA patients and 1002 healthcare workers (HCWs) as controls. Clinical, lifestyle and demographic factors were collected at the time of the third dose, and immunogenicity analyses were carried out in a subgroup of patients at 4-6 weeks after the third dose. Results: BIs were experienced by 42% patients (82/194) with a median time since the last vaccination of 176 days. Older age (>50 years; aHR 0.38, 95% CI: 0.20-0.74), receiving conventional synthetic disease modifying antirheumatic drugs (csDMARDs) (aHR 0.52, 95%CI: 0.30-0.90) and having a titre of neutralising antibodies >20 (aHR 0.36, 95% CI: 0.12-1.07) were identified as protective factors. Conversely, anti-IL6R treatment and anti-CD20 therapy increased BI probability. BIs were mostly pauci-symptomatic, but the hospitalisation incidence was significantly higher than in HCWs (8.5% vs. 0.19%); the main risk factor was anti-CD20 therapy. Conclusions: Being older than 50 years and receiving csDMARDs were shown to be protective factors for BI, whereas anti-IL6R or anti-CD20 therapy increased the risk. Higher neutralising antibody titres were associated with a lower probability of BI. If confirmed in a larger population, the identification of a protective cut-off would allow a personalised risk-benefit therapeutic management of RA patients.
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Affiliation(s)
- Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Assunta Navarra
- Epidemiology Department, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy;
| | - Alessandra Aiello
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Gilda Cuzzi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
| | - Andrea Salmi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
| | - Valentina Vanini
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
- Unità Operativa Semplice (UOS) Professioni Sanitarie Tecniche, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (F.M.); (S.M.); (G.M.)
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (F.M.); (S.M.); (G.M.)
| | - Giulia Matusali
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (F.M.); (S.M.); (G.M.)
| | - Stefania Notari
- Laboratory of Cellular Immunology and Clinical Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (S.N.); (C.A.)
| | - Chiara Agrati
- Laboratory of Cellular Immunology and Clinical Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (S.N.); (C.A.)
- Department of Pediatric Hematology and Oncology, Bambino Gesù Pediatric Hospital, 00152 Rome, Italy
| | - Simonetta Salemi
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Roberta Di Rosa
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Damiano Passarini
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Valeria Di Gioia
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Fabrizio Conti
- Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza” Università di Roma, 00161 Rome, Italy; (F.C.); (F.R.S.)
| | - Francesca Romana Spinelli
- Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza” Università di Roma, 00161 Rome, Italy; (F.C.); (F.R.S.)
| | - Angela Corpolongo
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.C.); (E.N.)
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of ‘Medicina dei Sistemi’, University of Rome ‘Tor Vergata’, 00133 Rome, Italy;
| | - Mario Ferraioli
- Department of Rheumatology, San Camillo Hospital, 00152 Rome, Italy; (M.F.); (G.D.S.)
| | | | - Maurizio Benucci
- Rheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL—Toscana Centro, 50122 Florence, Italy; (M.B.); (F.L.G.)
| | - Francesca Li Gobbi
- Rheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL—Toscana Centro, 50122 Florence, Italy; (M.B.); (F.L.G.)
| | - Anna Paola Santoro
- UOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.P.S.); (A.C.); (V.P.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Andrea Capri
- UOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.P.S.); (A.C.); (V.P.)
| | - Vincenzo Puro
- UOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.P.S.); (A.C.); (V.P.)
| | - Emanuele Nicastri
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.C.); (E.N.)
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
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15
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Ngaosuwan K, Soonklang K, Warakul C, Auewarakul C, Mahanonda N. Protection of inactivated vaccine against SARS-CoV-2 infections in patients with comorbidities: a prospective cohort study. Front Med 2023; 17:867-877. [PMID: 37434065 DOI: 10.1007/s11684-023-0995-9] [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: 10/23/2022] [Accepted: 03/06/2023] [Indexed: 07/13/2023]
Abstract
Protection against severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection of inactivated vaccines is not well characterized in people with comorbidities, who are at high risk of severe infection. We compared the risk of SARS-CoV-2 infection after complete vaccination with Sinopharm/BBIBP in people with comorbidities (e.g., autoimmune diseases, cardiovascular disease, chronic lung disease, and diabetes) with healthy individuals using a Cox-proportional hazard model. In July-September 2021, a total of 10 548 people (comorbidities, 2143; healthy, 8405) receiving the complete primary series of vaccination with Sinopharm/BBIBP in Bangkok, Thailand were prospectively followed for SARS-CoV-2 infection through text messaging and telephone interviewing for 6 months. A total of 295 infections from 284 participants were found. HRs (95% CI) of individuals with any comorbidities did not increase (unadjusted, 1.02 (0.77-1.36), P = 0.89; adjusted, 1.04 (0.78-1.38), P = 0.81). HRs significantly increased in the subgroup of autoimmune diseases (unadjusted, 2.64 (1.09-6.38), P = 0.032; adjusted, 4.45 (1.83-10.83), P = 0.001) but not in cardiovascular disease, chronic lung disease, or diabetes. The protection against SARS-CoV-2 infection of the Sinopharm vaccine was similar in participants with any comorbidities vs. healthy individuals. However, the protection appeared lower in the subgroup of autoimmune diseases, which may reflect suboptimal immune responses among these people.
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Affiliation(s)
- Kanchana Ngaosuwan
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, 10210, Thailand.
| | - Kamonwan Soonklang
- Data Management Unit, Centre of Learning and Research in Celebration of HRH Princess Chulabhorn's 60th Birthday Anniversary, Chulabhorn Royal Academy, Bangkok, 10210, Thailand
| | - Chawin Warakul
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, 10210, Thailand
| | - Chirayu Auewarakul
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, 10210, Thailand
| | - Nithi Mahanonda
- Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, 10210, Thailand
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16
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Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, Cardenas-de la Garza JA, Gonzalez-Gonzalez V, Beltran-Aguilar VM, Arias-Peralta AG, De Avila-Gonzalez N, Guajardo-Jauregui N. Cardiovascular health worsening in patients with autoimmune rheumatological diseases during the COVID-19 pandemic. Clin Rheumatol 2023; 42:2677-2690. [PMID: 36627529 PMCID: PMC9838353 DOI: 10.1007/s10067-022-06486-4] [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: 09/17/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023]
Abstract
Rheumatic autoimmune diseases are associated with a myriad of comorbidities. Of particular importance due to their morbimortality are cardiovascular diseases. COVID-19 greatly impacted the world population in many different areas. Patients with rheumatic diseases had to face changes in their healthcare, in addition to unemployment, a decrease in physical activity, social isolation, and lack of access to certain medications. This review summarizes the impact of COVID-19 pandemic on cardiovascular risk factors, comorbidities, and unhealthy behaviors in patients with rheumatic inflammatory autoimmune diseases, particularly focused on rheumatoid arthritis and systemic lupus erythematosus. Searches were carried out in MEDLINE/PubMed and Scopus from August to December 2022. Four reviewers screened the title and abstract of retrieved records. Potentially eligible reports were then reviewed in full text. Differences were reconciled by either consensus or discussion with an external reviewer. During the COVID-19 pandemic, patients with rheumatic diseases showed an increase in the prevalence of mental health disorders (43.2-57.7%), reduced physical activity (56.8%), and a worsening in eating behaviors. Alcohol intake increased (18.2%), especially in early phases of the pandemic. Smoking prevalence decreased (28.2%). Dyslipidemia and hypertension showed no changes. The pandemic and lockdown affected rheumatic patients not only in disease-related characteristics but in the prevalence of their cardiovascular comorbidities and risk factors. Lifestyle changes, such as healthy eating, physical activity, and optimal management of their rheumatic diseases and comorbidities, are essential to manage the long-lasting consequences of the COVID-19 outbreak. Key Points • During the COVID-19 pandemic, anxiety, depression, sedentarism, obesity, and a worsening in eating behaviors increased. •Patients with rheumatic diseases and comorbidities have worse clinical outcomes and a higher cardiovascular disease burden than those without them. •Comparative studies are necessary to precisely elucidate the pandemic's impact on the prevalence of cardiovascular disease, risk factors, and comorbidities in patients with rheumatoid arthritis and systemic lupus erythematosus.
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Affiliation(s)
- Dionicio A Galarza-Delgado
- Division of Rheumatology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Jose R Azpiri-Lopez
- Division of Cardiology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero y Gonzalitos S/N, 64460, Monterrey, Nuevo León, Mexico.
| | - Iris J Colunga-Pedraza
- Division of Rheumatology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Jesus Alberto Cardenas-de la Garza
- Division of Rheumatology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Valeria Gonzalez-Gonzalez
- Division of Rheumatology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Victor M Beltran-Aguilar
- Division of Rheumatology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Angel G Arias-Peralta
- Division of Cardiology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero y Gonzalitos S/N, 64460, Monterrey, Nuevo León, Mexico
| | - Natalia De Avila-Gonzalez
- Division of Rheumatology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Natalia Guajardo-Jauregui
- Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
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17
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Conway R, Nikiphorou E, Demetriou CA, Low C, Leamy K, Ryan JG, Kavanagh R, Fraser AD, Carey JJ, O'Connell P, Flood RM, Mullan RH, Kane DJ, Stafford F, Robinson PC, Liew JW, Grainger R, McCarthy GM. Outcomes of COVID-19 in people with rheumatic and musculoskeletal disease in Ireland over the first 2 years of the pandemic. Ir J Med Sci 2023; 192:2495-2500. [PMID: 36622628 PMCID: PMC9827440 DOI: 10.1007/s11845-022-03265-7] [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: 07/07/2022] [Accepted: 12/28/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Poor COVID-19 outcomes occur with higher frequency in people with rheumatic and musculoskeletal diseases (RMD). Better understanding of the factors involved is crucial to informing patients and clinicians regarding risk mitigation. AIM To describe COVID-19 outcomes for people with RMD in Ireland over the first 2 years of the pandemic. METHODS Data entered into the C19-GRA provider registry from Ireland between 24th March 2020 and 31st March 2022 were analysed. Differences in the likelihood of hospitalisation and mortality according to demographic and clinical variables were investigated. RESULTS Of 237 cases included, 59.9% were female, 95 (41.3%) were hospitalised, and 22 (9.3%) died. Hospitalisation was more common with increasing age, gout, smoking, long-term glucocorticoid use, comorbidities, and specific comorbidities of cardiovascular and pulmonary disease, and cancer. Hospitalisation was less frequent in people with inflammatory arthritis and conventional synthetic or biologic disease-modifying antirheumatic drug use. Hospitalisation had a U-shaped relationship with disease activity, being more common in both high disease activity and remission. Mortality was more common with increasing age, gout, smoking, long-term glucocorticoid use, comorbidities, and specific comorbidities of cardiovascular disease, pulmonary disease, and obesity. Inflammatory arthritis was less frequent in those who died. CONCLUSION Hospitalisation or death were more frequently experienced by RMD patients with increasing age, certain comorbidities including potentially modifiable ones, and certain medications and diagnoses amongst other factors. These are important 'indicators' that can help risk-stratify and inform the management of RMD patients.
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Affiliation(s)
- Richard Conway
- Department of Rheumatology, St. James's Hospital, James Street, Dublin 8, Ireland.
- Trinity College Dublin, Dublin, Ireland.
| | - Elena Nikiphorou
- Department of Rheumatology, King's College Hospital, London, UK
- Centre for RMDs, King's College London, London, UK
| | - Christiana A Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Candice Low
- Department of Rheumatology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Kelly Leamy
- Department of Rheumatology, Mater Misericordiae Hospital, Dublin 1, Ireland
| | - John G Ryan
- Department of Rheumatology, Cork University Hospital, Wilton, Cork, Ireland
| | | | - Alexander D Fraser
- Department of Rheumatology, University Hospitals Limerick, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - John J Carey
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
- National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connell
- Department of Rheumatology, Beaumont Hospital, Dublin 9, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rachael M Flood
- Trinity College Dublin, Dublin, Ireland
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - Ronan H Mullan
- Trinity College Dublin, Dublin, Ireland
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - David J Kane
- Trinity College Dublin, Dublin, Ireland
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | | | - Philip C Robinson
- Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Jean W Liew
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
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18
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Wang W, Sun X, Fan R, Xu LX, Tang JP. Clinical characteristics of moderate or severe COVID-19 infection in patients with rheumatic diseases and analysis of risk factors leading to severe disease. Int J Rheum Dis 2023; 26:1951-1959. [PMID: 37550949 DOI: 10.1111/1756-185x.14844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/03/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To explore the clinical characteristics of rheumatic disease (RD) patients who suffered from moderate or severe coronavirus disease 2019 (COVID-19) infection and to evaluate risk factors of COVID-19 infection in RD patients. METHODS A retrospective analysis was conducted on 148 moderate or severe COVID-19 patients admitted to the First People's Hospital of Suqian Affiliated to Nanjing Medical University, including 74 RD patients and 74 non-RD patients. Clinical data were collected including clinical characteristics and laboratory tests. RESULTS The RD group showed a higher proportion of females with a higher incidence of interstitial lung disease and kidney disease than the non-RD group. Also, the incidence of fatigue, olfactory dysfunction and musculoskeletal pain was higher in the RD group, but the incidence of cough, wheezing, and fever was lower compared with non-RD patients. The hospitalized course of the RD group (12.7 days ± 6.55) was significantly longer than that in the non-RD group (8.07 days ± 3.40). Also, patients in the RD group had higher levels of erythrocyte sedimentation rate, interleukin (IL)-2, and IL-4 than the non-RD group. The logistic regression analysis showed that dizziness and headache, C-reactive protein (CRP) > 8 mg/L and lactate dehydrogenase (LDH) > 248 μ/L were independent risk factors for severe COVID-19 infections of RD patients. CONCLUSION RD patients who suffered from moderate or severe COVID-19 infections have a higher risk of comorbidities, higher levels of inflammation, and longer hospitalized course. Dizziness and headache, CRP > 8 mg/L and LDH > 248 μ/L are risk factors for severe COVID-19 infections in RD patients.
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Affiliation(s)
- Wen Wang
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Xiang Sun
- Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Ran Fan
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Ling-Xiao Xu
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Jian-Ping Tang
- Division of Rheumatology and Immunology, Tongji Hospital of Tongji University School of Medicine, Shanghai, China
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19
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Fukihara J, Kondoh Y. COVID-19 and interstitial lung diseases: A multifaceted look at the relationship between the two diseases. Respir Investig 2023; 61:601-617. [PMID: 37429073 PMCID: PMC10281233 DOI: 10.1016/j.resinv.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/09/2023] [Accepted: 05/22/2023] [Indexed: 07/12/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although it has been a fatal disease for many patients, the development of treatment strategies and vaccines have progressed over the past 3 years, and our society has become able to accept COVID-19 as a manageable common disease. However, as COVID-19 sometimes causes pneumonia, post-COVID pulmonary fibrosis (PCPF), and worsening of preexisting interstitial lung diseases (ILDs), it is still a concern for pulmonary physicians. In this review, we have selected several topics regarding the relationships between ILDs and COVID-19. The pathogenesis of COVID-19-induced ILD is currently assumed based mainly on the evidence of other ILDs and has not been well elucidated specifically in the context of COVID-19. We have summarized what has been clarified to date and constructed a coherent story about the establishment and progress of the disease. We have also reviewed clinical information regarding ILDs newly induced or worsened by COVID-19 or anti-SARS-CoV-2 vaccines. Inflammatory and profibrotic responses induced by COVID-19 or vaccines have been thought to be a risk for de novo induction or worsening of ILDs, and this has been supported by the evidence obtained through clinical experience over the past 3 years. Although COVID-19 has become a mild disease in most cases, it is still worth looking back on the above-reviewed information to broaden our perspectives regarding the relationship between viral infection and ILD. As a representative etiology for severe viral pneumonia, further studies in this area are expected.
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Affiliation(s)
- Jun Fukihara
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan.
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20
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Alhowaish TS, Alhamadh MS, Mathkour A, Alamoudi M, Alqahtani HA, Alrashid A. Clinical Course and Outcomes of COVID-19 Infection in Patients Treated with Rituximab: A Tertiary Care Center Experience. Open Access Rheumatol 2023; 15:145-159. [PMID: 37663367 PMCID: PMC10473421 DOI: 10.2147/oarrr.s424316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Patients receiving rituximab (RTX) may be at increased risk for severe Coronavirus infections and worse outcomes compared with the general population. Because of the conflicting results concerning the effect of RTX on the clinical course and outcomes of COVID-19 infection, we aimed to share our experience with 35 patients infected with COVID-19 while treated with RTX for a variety of clinical indications. Methods This was a single-centre retrospective cohort study that included 35 patients. All patients aged ≥14 years who were treated with RTX for various conditions and were found to have COVID-19 infection were included. Patients with poor outcomes or patients with suspected COVID-19 infection were excluded. Results The patients' mean age was 42.8 ± 16.3 years with an average BMI of 29.9 ± 11.4 kg/m2. Over half (51.4%, n = 18) of the patients received RTX at a dose of 375 mg/m2 with a median frequency of 4 doses. More than a third (37.1%, n = 13) of the patients had hypogammaglobulinemia and 25.7% had low CD19. Over a third (42.9%, n= 15) of the patients required hospitalization and almost a third (25.7%, n = 9) required treatment in the intensive care unit. There was a statistically significant association between intensive care unit admission and age, steroid use, and low CD19. The mortality rate was 25.7%, and it was significantly higher in elderly, diabetics, corticosteroid users, patients who were hospitalized, treated in the intensive care unit, and had low immunoglobin or CD19. Conclusion Treatment with RTX seems to be a potential risk factor for unfavorable outcomes in COVID-19 patients. RTX should be used with caution or avoided unless the benefit clearly outweighs the risk.
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Affiliation(s)
- Thamer S Alhowaish
- Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
| | - Moustafa S Alhamadh
- King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAUHS), Ministry of the National Guard-Health Affairs, Riyadh, 14611, Kingdom of Saudi Arabia
| | - Alaa Mathkour
- Ministry of Health, Riyadh, 12613, Kingdom of Saudi Arabia
| | - Marwan Alamoudi
- King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- Department of Medicine, Division of Rheumatology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Hossam Ali Alqahtani
- Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
| | - Abdulrahman Alrashid
- King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAUHS), Ministry of the National Guard-Health Affairs, Riyadh, 14611, Kingdom of Saudi Arabia
- Department of Medicine, Division of Rheumatology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
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21
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Geng Y, Fan Y, Deng X, Wang Y, Zhao J, Ji L, Song Z, Li G, Zhang X, Sun X, Huang H, Xie W, Zhang Z. The Recent Outbreak of COVID-19 in China During the Omicron Variant Predominance: Clinical Features and Outcomes in Patients with Autoimmune Inflammatory Rheumatic Diseases. Rheumatol Ther 2023; 10:1039-1053. [PMID: 37335431 PMCID: PMC10326221 DOI: 10.1007/s40744-023-00569-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION The impact of coronavirus disease 2019 (COVID-19) on vulnerable populations with autoimmune inflammatory rheumatic diseases (AIIRDs) has been variable with variants and of great concern. Here we report the clinical features, outcomes, and risk factors for infection and hospitalization in patients with AIIRDs in the first wave of infection in China in December 2022. METHODS A real-world survey was conducted in Chinese patients with AIIRDs from 8 December 2022 to 13 January 2023. The survey was distributed via internet nationwide, clinic consultation, and to inpatients at a tertiary hospital in Beijing. Clinical features, outcomes, and vaccination status were collected. RESULTS A total of 2005 patients with AIIRDs completed the survey. There were 1690 (84.3%) patients infected and only 48.2% of patients received COVID-19 vaccination. Most of the fully vaccinated patients received inactivated COVID-19 vaccines, including Sinovac (55.6%) and Sinopharm (27.2%), followed by recombinant subunit vaccine from Zhifei Longcom (2.0%). The independent protecting factors for infection were a time interval of less than 3 months from last vaccination (OR 0.53, p = 0.037) and rheumatoid arthritis (RA) as the underlying AIIRD (OR 0.62, p = 0.041). A total of 57 out of 1690 patients (3.4%) were hospitalized for COVID, with 46 (2.7%) experiencing severe/critical course and 6 deaths (0.4%). In multivariable logistic regression analysis, independent risk factors for hospitalization were age over 60 years (OR 11.52, p < 0.001), with comorbidity (OR 1.83, p = 0.045) and systemic lupus erythematosus (SLE) as the AIIRDs (OR 2.59, p = 0.036). Receiving booster vaccine was an independent protective factor for hospitalization (OR 0.53, 95% CI 0.30-0.98; p = 0.018). CONCLUSION Hesitation for vaccination is common among Chinese patients with AIIRDs. The time from last vaccination of less than 3 months and having RA decreased the risk of COVID infection. Older age and having comorbidity or SLE increased the risk of hospitalization, while booster vaccination reduced the risk.
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Affiliation(s)
- Yan Geng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Yong Fan
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Xuerong Deng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Yu Wang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Juan Zhao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Lanlan Ji
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Zhibo Song
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Guangtao Li
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Xiaohui Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Xiaoying Sun
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Hong Huang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Wenhui Xie
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China.
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22
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Batu ED, Erden A. The outcome of COVID-19 in patients with autoimmune rheumatic diseases: Comparable to the general population or worse? Int J Rheum Dis 2023; 26:1435-1439. [PMID: 37527023 DOI: 10.1111/1756-185x.14766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Ezgi Deniz Batu
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Abdulsamet Erden
- Division of Rheumatology, Department of Internal Sciences, Gazi University Faculty of Medicine, Ankara, Turkey
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23
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Ekin A, Coskun BN, Dalkilic E, Pehlivan Y. The effects of COVID-19 infection on the mortality of patients receiving rituximab therapy. Ir J Med Sci 2023; 192:1959-1973. [PMID: 36258064 PMCID: PMC9579651 DOI: 10.1007/s11845-022-03193-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Rituximab (RTX) is an important immunosuppressive agent used for many rheumatologic diseases. This study investigated the factors affecting mortality and mortality due to COVID-19 infection in patients receiving RTX. METHODS From March 2020 to November 2021, 111 patients who were followed up at a tertiary center with a diagnosis of any rheumatologic disease and who were diagnosed with COVID-19 were enrolled out of 336 patients who received at least one dose of RTX. Age, COVID-19 vaccination status, comorbidities, and some laboratory parameters were determined. The association between them and COVID-19 infection was investigated. In addition, patients were divided into two groups: those with rheumatoid arthritis (RA) and those without RA, and factors affecting mortality were studied. RESULTS Thirty (27.0%) of the total 111 patients treated with RTX who tested positive for COVID-19 died. Among these patients, 19 (32.7%) of 58 patients diagnosed with RA died. Of the 53 patients diagnosed with non RA disease, 11 (20.7%) died. Age (p = 0.003, OR: 1.058, 95% CI: 1.025-1.097) and age at diagnosis (p = 0.047, OR: 1.032, 95% CI: 1.000-1.064) were the lowest against COVID-19 infection. Rate of vaccination of at least two doses (p = 0.000, OR: 0.170, 95% CI: 0.065-0.491), number of comorbid conditions (p = 0.001, OR: 1.530, 95% CI: 1.202-1.949), CKD (p = 0.003, significance was found between OR: 7.000, 95% CI: 1.926-25.439) and DM (p = 0.000, OR: 6.978, 95% CI: 2.499-19.483) and death. CONCLUSION As a result of the study, it was found that RTX treatment in particular increased the risk of death from COVID-19 infection. However, vaccination against COVID-19 has a very important place in this patient group. It is important that vaccination is administered at the full dose and adjusted according to the RTX treatment time, and that the dose and timing of RTX treatment are regulated.
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Affiliation(s)
- Ali Ekin
- Division of Rheumatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Belkıs Nihan Coskun
- Division of Rheumatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ediz Dalkilic
- Division of Rheumatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Yavuz Pehlivan
- Division of Rheumatology, Faculty of Medicine, Uludag University, Bursa, Turkey
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Ughi N, Bernasconi DP, Gagliardi C, Del Gaudio F, Dicuonzo A, Maloberti A, Giannattasio C, Rossetti C, Valsecchi MG, Epis OM. Trends in severe outcomes in SARS-CoV-2-positive hospitalized patients with rheumatic diseases: a monocentric observational and case-control study in northern Italy. Reumatismo 2023; 75. [PMID: 37462130 DOI: 10.4081/reumatismo.2023.1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/18/2023] [Indexed: 07/20/2023] Open
Abstract
Rheumatic disease patients are at greater risk of infection due to their disease, comorbidities, and immunosuppressive therapy. COVID-19 outcomes in this patient setting appeared to be similar to those of the general population. However, data on this topic were mainly related to small studies on a limited number of patients. Consequently, to date, this field remains poorly explored, particularly in the pre-vaccine era. This monocentric study aimed to describe the intrahospital mortality in rheumatic patients with SARS-CoV-2 consecutively hospitalized from 21 February to 31 December 2020, before anti-SARS-CoV-2 vaccine administration spread, compared with non-rheumatic patients. Of 2491 included patients, 65 [3%, median (interquartile range) age 75 (64.76-82.239 years, 65% women] were suffering from rheumatic diseases. A total of 20 deaths were reported [case fatality rate 31%, 95% confidence interval (CI): 19-42] compared with 433 deaths (19%, 95% CI: 17-20) in patients without rheumatic diseases (p=0.024). However, the rheumatic disease was not associated with a significant increase in univariate mortality hazards (hazard ratio 1.374, 95% CI: 0.876-2.154), and after adjustment (hazard ratio 1.199, 95% CI: 0.759-1.894) by age, sex and Charlson comorbidity index. The incidence of intensive care unit admission, death, and discharge in the case-control study was comparable between rheumatic and non-rheumatic patients. The presence of rheumatic diseases in SARS-CoV-2-hospitalized patients did not represent an independent risk factor for severe disease or mortality.
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Affiliation(s)
- N Ughi
- Division of Rheumatology, Multispecialist Medical Department, Niguarda Hospital, Milan.
| | - D P Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center-B4, School of Medicine and Surgery, Milano-Bicocca University, Milan.
| | - C Gagliardi
- Division of Rheumatology, Multispecialist Medical Department, Niguarda Hospital, Milan.
| | - F Del Gaudio
- Functional Department for Higher Education, Research, and Development, Niguarda Hospital, Milan.
| | - A Dicuonzo
- Functional Department for Higher Education, Research, and Development, Niguarda Hospital, Milan.
| | - A Maloberti
- Division of Cardiology 4, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan; School of Medicine and Surgery, Milano-Bicocca University, Milan .
| | - C Giannattasio
- Division of Cardiology 4, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan; School of Medicine and Surgery, Milano-Bicocca University, Milan .
| | - C Rossetti
- Functional Department for Higher Education, Research, and Development, Niguarda Hospital, Milan.
| | - M G Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center-B4, School of Medicine and Surgery, Milano-Bicocca University, Milan.
| | - O M Epis
- Division of Rheumatology, Multispecialist Medical Department, Niguarda Hospital, Milan.
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25
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Tanaka H, Chubachi S, Namkoong H, Sato Y, Asakura T, Lee H, Azekawa S, Otake S, Nakagawara K, Fukushima T, Watase M, Sakurai K, Kusumoto T, Kondo Y, Masaki K, Kamata H, Ishii M, Kaneko Y, Hasegawa N, Ueda S, Sasaki M, Izumo T, Inomata M, Miyazawa N, Kimura Y, Suzuki Y, Harada N, Ichikawa M, Takata T, Ishikura H, Yoshiyama T, Kokuto H, Murakami K, Sano H, Ueda T, Kuwahara N, Fujiwara A, Ogura T, Inoue T, Asami T, Mutoh Y, Nakachi I, Baba R, Nishi K, Tani M, Kagyo J, Hashiguchi M, Oguma T, Asano K, Nishikawa M, Watanabe H, Okada Y, Koike R, Kitagawa Y, Kimura A, Imoto S, Miyano S, Ogawa S, Kanai T, Fukunaga K. Propensity-Score Matched Analysis of the Effectiveness of Baricitinib in Patients With Coronavirus Disease 2019 (COVID-19) Using Nationwide Real-World Data: An Observational Matched Cohort Study From the Japan COVID-19 Task Force. Open Forum Infect Dis 2023; 10:ofad311. [PMID: 37441355 PMCID: PMC10334380 DOI: 10.1093/ofid/ofad311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/07/2023] [Indexed: 07/15/2023] Open
Abstract
Background To determine the effectiveness of baricitinib in patients with coronavirus disease 2019 (COVID-19), investigate whether baricitinib prevents the need for invasive mechanical ventilation and identify patient subgroups that would benefit from baricitinib. Methods This observational matched-cohort study was conducted by the Japan COVID-19 Task Force, a nationwide multicenter consortium. Patients with COVID-19 aged ≥18 years were identified from 70 hospitals in Japan. Among patients with confirmed COVID-19 from February 2020 to September 2021, those receiving baricitinib were propensity-score matched with controls. Results Among 3309 patients, 144 propensity score-matched pairs were identified. Thirteen (9.0%) patients in the baricitinib group and 27 (18.8%) in the control group required invasive mechanical ventilation during the disease course (odds ratio, 0.43). Although the baricitinib group had more severe disease, there were no significant differences in the intensive care unit admission rates (odds ratio, 1.16) and mortality rates (odds ratio, 0.74) between groups. In subgroup analyses, baricitinib was associated with a significant reduction in the need for invasive mechanical ventilation in patients requiring oxygen support (odds ratio, 0.28), with rapid shadow spread on chest radiography (odds ratio, 0.11), or treated with remdesivir (odds ratio, 0.27), systemic corticosteroids (odds ratio, 0.31), or anticoagulants (odds ratio, 0.17). Conclusions Baricitinib is effective at preventing the need for invasive mechanical ventilation in patients with COVID-19.
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Affiliation(s)
- Hiromu Tanaka
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shotaro Chubachi
- Correspondence: Shotaro Chubachi, MD, PhD, Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (); Ho Namkoong, MD, PhD, Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan ()
| | - Ho Namkoong
- Correspondence: Shotaro Chubachi, MD, PhD, Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (); Ho Namkoong, MD, PhD, Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan ()
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ho Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shuhei Azekawa
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shiro Otake
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kensuke Nakagawara
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Fukushima
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mayuko Watase
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Sakurai
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuya Kusumoto
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasushi Kondo
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsunori Masaki
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Soichiro Ueda
- JCHO (Japan Community Health Care Organization) Saitama Medical Center, Internal Medicine, Saitama, Japan
| | - Mamoru Sasaki
- JCHO (Japan Community Health Care Organization) Saitama Medical Center, Internal Medicine, Saitama, Japan
| | | | | | - Naoki Miyazawa
- Department of Respiratory Medicine, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Yasuhiro Kimura
- Department of Respiratory Medicine, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Yusuke Suzuki
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Masako Ichikawa
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Tohru Takata
- Department of Infection Control, Fukuoka University Hospital, Fukuoka, Japan
| | - Hiroyasu Ishikura
- Department of Emergency and Critical Care Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | | | | | - Koji Murakami
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirohito Sano
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuya Ueda
- Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Naota Kuwahara
- Internal Medicine, Internal Medicine Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Akiko Fujiwara
- Internal Medicine, Internal Medicine Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Takashi Ogura
- Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Takashi Inoue
- Internal Medicine, Sano Kosei General Hospital, Sano, Japan
| | - Takahiro Asami
- Internal Medicine, Sano Kosei General Hospital, Sano, Japan
| | - Yoshikazu Mutoh
- Department of Infectious Diseases, Tosei General Hospital, Seto, Japan
| | | | - Rie Baba
- Department of Infectious Diseases, Tosei General Hospital, Seto, Japan
| | - Koichi Nishi
- Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Mayuko Tani
- Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | | | | | - Tsuyoshi Oguma
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Masanori Nishikawa
- Department of Respiratory Medicine, Fujisawa City Hospital, Fujisawa, Japan
| | - Hiroki Watanabe
- Department of Respiratory Medicine, Fujisawa City Hospital, Fujisawa, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Genome Informatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Ryuji Koike
- Medical Innovation Promotion Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akinori Kimura
- Institute of Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seiya Imoto
- Division of Health Medical Intelligence, Human Genome Center, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
| | - Satoru Miyano
- M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Candel FJ, Barreiro P, Salavert M, Cabello A, Fernández-Ruiz M, Pérez-Segura P, San Román J, Berenguer J, Córdoba R, Delgado R, España PP, Gómez-Centurión IA, González Del Castillo JM, Heili SB, Martínez-Peromingo FJ, Menéndez R, Moreno S, Pablos JL, Pasquau J, Piñana JL, On Behalf Of The Modus Investigators Adenda. Expert Consensus: Main Risk Factors for Poor Prognosis in COVID-19 and the Implications for Targeted Measures against SARS-CoV-2. Viruses 2023; 15:1449. [PMID: 37515137 PMCID: PMC10383267 DOI: 10.3390/v15071449] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
The clinical evolution of patients infected with the Severe Acute Respiratory Coronavirus type 2 (SARS-CoV-2) depends on the complex interplay between viral and host factors. The evolution to less aggressive but better-transmitted viral variants, and the presence of immune memory responses in a growing number of vaccinated and/or virus-exposed individuals, has caused the pandemic to slowly wane in virulence. However, there are still patients with risk factors or comorbidities that put them at risk of poor outcomes in the event of having the coronavirus infectious disease 2019 (COVID-19). Among the different treatment options for patients with COVID-19, virus-targeted measures include antiviral drugs or monoclonal antibodies that may be provided in the early days of infection. The present expert consensus is based on a review of all the literature published between 1 July 2021 and 15 February 2022 that was carried out to establish the characteristics of patients, in terms of presence of risk factors or comorbidities, that may make them candidates for receiving any of the virus-targeted measures available in order to prevent a fatal outcome, such as severe disease or death. A total of 119 studies were included from the review of the literature and 159 were from the additional independent review carried out by the panelists a posteriori. Conditions found related to strong recommendation of the use of virus-targeted measures in the first days of COVID-19 were age above 80 years, or above 65 years with another risk factor; antineoplastic chemotherapy or active malignancy; HIV infection with CD4+ cell counts < 200/mm3; and treatment with anti-CD20 immunosuppressive drugs. There is also a strong recommendation against using the studied interventions in HIV-infected patients with a CD4+ nadir <200/mm3 or treatment with other immunosuppressants. Indications of therapies against SARS-CoV-2, regardless of vaccination status or history of infection, may still exist for some populations, even after COVID-19 has been declared to no longer be a global health emergency by the WHO.
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Affiliation(s)
- Francisco Javier Candel
- Clinical Microbiology & Infectious Diseases, Transplant Coordination, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Pablo Barreiro
- Regional Public Health Laboratory, Infectious Diseases, Internal Medicine, Hospital General Universitario La Paz, 28055 Madrid, Spain
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Miguel Salavert
- Infectious Diseases, Internal Medicine, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Alfonso Cabello
- Internal Medicine, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), 28041 Madrid, Spain
| | - Pedro Pérez-Segura
- Medical Oncology, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Jesús San Román
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Juan Berenguer
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28007 Madrid, Spain
| | - Raúl Córdoba
- Haematology and Haemotherapy, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Rafael Delgado
- Clinical Microbiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), 28041 Madrid, Spain
| | - Pedro Pablo España
- Pneumology, Hospital Universitario de Galdakao-Usansolo, 48960 Vizcaya, Spain
| | | | | | - Sarah Béatrice Heili
- Intermediate Respiratory Care Unit, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Francisco Javier Martínez-Peromingo
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Geriatrics, Hospital Universitario Rey Juan Carlos, 28933 Madrid, Spain
| | - Rosario Menéndez
- Pneumology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Santiago Moreno
- Infectious Diseases, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - José Luís Pablos
- Rheumatology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), 28041 Madrid, Spain
| | - Juan Pasquau
- Infectious Diseases, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | - José Luis Piñana
- Haematology and Haemotherapy, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
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Zeng H, Zhuang Y, Li X, Yin Z, Huang X, Peng H. Exploring the potential common denominator pathogenesis of system lupus erythematosus with COVID-19 based on comprehensive bioinformatics analysis. Front Immunol 2023; 14:1179664. [PMID: 37426642 PMCID: PMC10325730 DOI: 10.3389/fimmu.2023.1179664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Objective Evidences show that there may be a link between SLE and COVID-19. The purpose of this study is to screen out the diagnostic biomarkers of systemic lupus erythematosus (SLE) with COVID-19 and explore the possible related mechanisms by the bioinformatics approach. Methods SLE and COVID-19 datasets were extracted separately from the NCBI Gene Expression Omnibus (GEO) database. The limma package in R was used to obtain the differential genes (DEGs). The protein interaction network information (PPI) and core functional modules were constructed in the STRING database using Cytoscape software. The hub genes were identified by the Cytohubba plugin, and TF-gene together with TF-miRNA regulatory networks were constructed via utilizing the Networkanalyst platform. Subsequently, we generated subject operating characteristic curves (ROC) to verify the diagnostic capabilities of these hub genes to predict the risk of SLE with COVID-19 infection. Finally, a single-sample gene set enrichment (ssGSEA) algorithm was used to analyze immune cell infiltration. Results A total of 6 common hub genes (CDC6, PLCG1, KIF15, LCK, CDC25C, and RASGRP1) were identified with high diagnostic validity. These gene functional enrichments were mainly involved in cell cycle, and inflammation-related pathways. Compared to the healthy controls, abnormal infiltration of immune cells was found in SLE and COVID-19, and the proportion of immune cells linked to the 6 hub genes. Conclusion Our research logically identified 6 candidate hub genes that could predict SLE complicated with COVID-19. This work provides a foothold for further study of potential pathogenesis in SLE and COVID-19.
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Affiliation(s)
- Huiqiong Zeng
- Department of Rheumatology, Shenzhen Futian Hospital for Rheumatic Diseases, Futian District, Shenzhen, Guangdong, China
| | - Yu Zhuang
- Department of Rheumatology and Immunology, Huizhou Central People’s Hospital, Huizhou, Guangdong, China
| | - Xiaojuan Li
- Department of Public Health, Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Zhihua Yin
- Department of Rheumatology, Shenzhen Futian Hospital for Rheumatic Diseases, Futian District, Shenzhen, Guangdong, China
| | - Xia Huang
- Department of Xi Yuan Community Health Service Center, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Haiyan Peng
- Department of Rheumatology, Shenzhen Futian Hospital for Rheumatic Diseases, Futian District, Shenzhen, Guangdong, China
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Tadayon Najafabadi B, Rayner DG, Shokraee K, Shokraie K, Panahi P, Rastgou P, Seirafianpour F, Momeni Landi F, Alinia P, Parnianfard N, Hemmati N, Banivaheb B, Radmanesh R, Alvand S, Shahbazi P, Dehghanbanadaki H, Shaker E, Same K, Mohammadi E, Malik A, Srivastava A, Nejat P, Tamara A, Chi Y, Yuan Y, Hajizadeh N, Chan C, Zhen J, Tahapary D, Anderson L, Apatu E, Schoonees A, Naude CE, Thabane L, Foroutan F. Obesity as an independent risk factor for COVID-19 severity and mortality. Cochrane Database Syst Rev 2023; 5:CD015201. [PMID: 37222292 PMCID: PMC10207996 DOI: 10.1002/14651858.cd015201] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Since December 2019, the world has struggled with the COVID-19 pandemic. Even after the introduction of various vaccines, this disease still takes a considerable toll. In order to improve the optimal allocation of resources and communication of prognosis, healthcare providers and patients need an accurate understanding of factors (such as obesity) that are associated with a higher risk of adverse outcomes from the COVID-19 infection. OBJECTIVES To evaluate obesity as an independent prognostic factor for COVID-19 severity and mortality among adult patients in whom infection with the COVID-19 virus is confirmed. SEARCH METHODS MEDLINE, Embase, two COVID-19 reference collections, and four Chinese biomedical databases were searched up to April 2021. SELECTION CRITERIA We included case-control, case-series, prospective and retrospective cohort studies, and secondary analyses of randomised controlled trials if they evaluated associations between obesity and COVID-19 adverse outcomes including mortality, mechanical ventilation, intensive care unit (ICU) admission, hospitalisation, severe COVID, and COVID pneumonia. Given our interest in ascertaining the independent association between obesity and these outcomes, we selected studies that adjusted for at least one factor other than obesity. Studies were evaluated for inclusion by two independent reviewers working in duplicate. DATA COLLECTION AND ANALYSIS: Using standardised data extraction forms, we extracted relevant information from the included studies. When appropriate, we pooled the estimates of association across studies with the use of random-effects meta-analyses. The Quality in Prognostic Studies (QUIPS) tool provided the platform for assessing the risk of bias across each included study. In our main comparison, we conducted meta-analyses for each obesity class separately. We also meta-analysed unclassified obesity and obesity as a continuous variable (5 kg/m2 increase in BMI (body mass index)). We used the GRADE framework to rate our certainty in the importance of the association observed between obesity and each outcome. As obesity is closely associated with other comorbidities, we decided to prespecify the minimum adjustment set of variables including age, sex, diabetes, hypertension, and cardiovascular disease for subgroup analysis. MAIN RESULTS: We identified 171 studies, 149 of which were included in meta-analyses. As compared to 'normal' BMI (18.5 to 24.9 kg/m2) or patients without obesity, those with obesity classes I (BMI 30 to 35 kg/m2), and II (BMI 35 to 40 kg/m2) were not at increased odds for mortality (Class I: odds ratio [OR] 1.04, 95% confidence interval [CI] 0.94 to 1.16, high certainty (15 studies, 335,209 participants); Class II: OR 1.16, 95% CI 0.99 to 1.36, high certainty (11 studies, 317,925 participants)). However, those with class III obesity (BMI 40 kg/m2 and above) may be at increased odds for mortality (Class III: OR 1.67, 95% CI 1.39 to 2.00, low certainty, (19 studies, 354,967 participants)) compared to normal BMI or patients without obesity. For mechanical ventilation, we observed increasing odds with higher classes of obesity in comparison to normal BMI or patients without obesity (class I: OR 1.38, 95% CI 1.20 to 1.59, 10 studies, 187,895 participants, moderate certainty; class II: OR 1.67, 95% CI 1.42 to 1.96, 6 studies, 171,149 participants, high certainty; class III: OR 2.17, 95% CI 1.59 to 2.97, 12 studies, 174,520 participants, high certainty). However, we did not observe a dose-response relationship across increasing obesity classifications for ICU admission and hospitalisation. AUTHORS' CONCLUSIONS Our findings suggest that obesity is an important independent prognostic factor in the setting of COVID-19. Consideration of obesity may inform the optimal management and allocation of limited resources in the care of COVID-19 patients.
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Affiliation(s)
| | - Daniel G Rayner
- Faculty Health Sciences, McMaster University, Hamilton, Canada
| | - Kamyar Shokraee
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Shokraie
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parsa Panahi
- Student Research Committee, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Paravaneh Rastgou
- School of Medicine, Tabriz University of Medical Sciences, Tehran, Iran
| | | | - Feryal Momeni Landi
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pariya Alinia
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Parnianfard
- Research Center for Evidence-Based Medicine, Iranian Evidence-Based Medicine (EBM) Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nima Hemmati
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Banivaheb
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ramin Radmanesh
- Society of Clinical Research Associates, Toronto, Canada
- Graduate division, Master of Advanced Studies in Clinical Research, University of California, San Diego, California, USA
| | - Saba Alvand
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parmida Shahbazi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Elaheh Shaker
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Same
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdullah Malik
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Peyman Nejat
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alice Tamara
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic, Cardiovascular and Aging Cluster, The Indonesian Medical Education and Research Institute, Jakarta, Indonesia
| | - Yuan Chi
- Yealth Network, Beijing Yealth Technology Co., Ltd, Beijing, China
- Cochrane Campbell Global Ageing Partnership, London, UK
| | - Yuhong Yuan
- Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Canada
| | - Nima Hajizadeh
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Cynthia Chan
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Jamie Zhen
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Dicky Tahapary
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Ontario, Canada
| | - Laura Anderson
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Emma Apatu
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Anel Schoonees
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Celeste E Naude
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lehana Thabane
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - Farid Foroutan
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
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Stepanova N, Driianska V, Korol L, Snisar L, Savchenko S. Pre-existing serum indoxyl sulfate and COVID-19 outcomes in patients undergoing hemodialysis: A retrospective cohort study. UKRAINIAN JOURNAL OF NEPHROLOGY AND DIALYSIS 2023:61-68. [DOI: 10.31450/ukrjnd.2(78).2023.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Patients undergoing hemodialysis (HD) are at increased risk of severe complications from COVID-19 due to compromised immune function and comorbidities. This retrospective study aimed to investigate the association between pre-existing serum indoxyl sulfate (IS) concentrations and COVID-19 outcomes in HD patients.
Methods. Data on pre-existing IS and proinflammatory cytokines, such as interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and tumor necrosis factor-alpha (TNF-α) were extracted from an existing patient database. The patients were followed up for 1.5 years and compared according to median serum IS concentration: low-IS (< 22.2 μg/mL) and high-IS (≥22.2 μg/mL) groups. The primary outcomes focused on assessing the risk and severity of COVID-19 infection.
Results. A total of 56 patients aged 62 (56-67) years with a dialysis vintage of 37.5 (30-168) months were included in the analysis. Serum levels of IS were significantly correlated with Kt/V values (p = 0.043), arterial hypertension (p = 0.001), IL-6 (p = 0.023), MCP-1 (p = 0.023), and TNF-α (p = 0.033) concentrations. Elevated serum IS levels were significantly associated with an increased risk of COVID-19 infection (p < 0.0001) and a higher likelihood of hospitalization (p = 0.03). Patients with higher IS levels exhibited more severe lung involvement (p < 0.0001) and a greater need for respiratory support (p = 0.004). A serum IS concentration of 21.5 μg/mL was the optimal threshold for predicting COVID-19 infection in HD patients (sensitivity of 83.4% and specificity of 92.3%, p < 0.0001).
Conclusion: Our study highlights the detrimental impact of serum IS on COVID-19 infection and its clinical outcomes in patients undergoing HD. Further research is warranted to elucidate the underlying mechanisms and explore potential therapeutic strategies targeting IS in this population.
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Abdulnaby NK, Gamal SM, Alkemary A, Abdo M, Sabry IM, Belita MI, Mohamed SS. COVID-19 outcomes in patients with and without autoimmune rheumatic diseases: A multicenter comparative study. Int J Rheum Dis 2023; 26:870-877. [PMID: 36929695 DOI: 10.1111/1756-185x.14662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/10/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND AND OBJECTIVE People with rheumatic diseases are particularly concerned with the coronavirus disease 2019 (COVID-19) pandemic. Our work aimed to study the impact of pre-existing autoimmune rheumatic disease (AIRD) and its immunosuppressive drugs on COVID-19 severity and outcome. PATIENTS AND METHODS This is a multicenter case-control study performed between September 2020 and February 2021 on 130 adults with COVID-19, including 66 patients with AIRD and 64 without AIRD, who served as a control group. RESULTS Regarding COVID-19 clinical manifestations; diarrhea, fatigue, and headache were found with significantly higher frequency in the AIRD group while a higher frequency of cough was found in the control group. Comparing COVID-19 complications, only septic shock was significantly higher in the AIRD group (P = 0.013). Both groups were treated with similar COVID-19 drugs except for tocilizumab and anticoagulants, which were statistically significantly more frequently used in the control group (P < 0.001 for both). No statistically significant difference was found between the groups in the outcome or severity of COVID-19. There was no impact of previous immunosuppressive drugs before COVID-19 on the severity of the disease except for a longer duration of recovery in patients on steroids (P < 0.001). Patients with hypertension had severe COVID-19 compared with those without (odds ratio 2.8, 95% confidence interval 1.2-6.9; P = 0.020). CONCLUSION AIRD may not affect COVID-19 severity and outcome. Similarly, immunosuppressive medications had no effect; except that patients on systemic steroids had longer duration for recovery. Comorbid conditions, such as hypertension, may be associated with more severe COVID-19 disease course.
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Affiliation(s)
- Nasser K Abdulnaby
- Chest Diseases and Tuberculosis Department Faculty of Medicine Cairo University, Cairo, Egypt
| | - Sherif M Gamal
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alkhateeb Alkemary
- Internal Medicine and Nephrology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa Abdo
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Irene M Sabry
- Chest Diseases and Tuberculosis Department Faculty of Medicine Cairo University, Cairo, Egypt
| | - Mohamed I Belita
- Department of Anesthesia and Surgical ICU, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sally S Mohamed
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Salas Jarque J, Moreno Díaz J, Bustos Morell C, Pereira Boan J, Durán Portella A, Ruiz Montes F, Velilla Marco J. [Corticoid treatment and SARS-CoV-2 variants: two independent factors associated with COVID-19 mortality in a Spanish regional hospital]. An Sist Sanit Navar 2023; 46:e1017. [PMID: 37203319 PMCID: PMC10205026 DOI: 10.23938/assn.1017] [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: 07/12/2022] [Revised: 08/08/2022] [Accepted: 10/26/2022] [Indexed: 05/20/2023]
Abstract
BACKGROUND Pandemic inter-wave hospital admissions and COVID-19-related mortality rates vary greatly. Some of the factors that may be playing part in this are the profile of the patients, viral variants, pharmacological treatments, or preventive measures. This work aimed to analyze the factors associated with mortality in COVID-19 patients admitted to hospital during 2020-2021. METHODS Retrospective cohort study with COVID-19 patients admitted to Hospital de Barbastro (Spain) during 2020-2021. Data were collected from the Spanish Conjunto Mínimo Básico de Datos and microbiology and electronic prescription records. RESULTS During the study period, 908 patients were consecutively admitted for COVID-19 (median age 70 years, 57.2% males); 162 (17.8%) patients died. We identified seven successive epidemiological waves. The following variables significantly associated to higher mortality: age, arterial hypertension, chronic renal failure, dementia, chronic obstructive pulmonary disease, heart failure, prior stroke, Charlson index, and wave 2; wave 4 was associated to greater survival. The multivariate analysis showed that age (OR=1.11; 95% CI: 1.09-1.14), chronic obstructive pulmonary disease (OR=2.33; 95% CI: 1.18-4.57), wave 2 (OR=2.57; 95% CI: 1.10-6.00), and wave 3 (OR=2.94; 95% CI: 1.17-7.38) associated with higher mortality. Glucocorticoid treatment was the only protective factor (OR=0.29; 95%CI: 0.14-0.62). CONCLUSIONS This study confirms the therapeutic utility of glucocorticoids to reduce in-hospital mortality due to COVID-19. Heterogeneous mortality rates between the different COVID-19 waves suggest a direct role of viral variants as determinants of lethality, regardless of the patient's history.
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Camacho Moll ME, Mata Tijerina VL, Silva Ramírez B, Peñuelas Urquides K, González Escalante LA, Escobedo Guajardo BL, Cruz Luna JE, Corrales Pérez R, Gómez García S, Bermúdez de León M. Sex, Age, and Comorbidities Are Associated with SARS-CoV-2 Infection, COVID-19 Severity, and Fatal Outcome in a Mexican Population: A Retrospective Multi-Hospital Study. J Clin Med 2023; 12:jcm12072676. [PMID: 37048758 PMCID: PMC10095205 DOI: 10.3390/jcm12072676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
People with comorbidities and the male sex are at a higher risk of developing severe COVID-19. In the present study, we aim to investigate the associated factors for infection, severity, and death due to COVID-19 in a population from Nuevo León, México. Epidemiological COVID-19 data were collected from 65 hospitals from December 2020 to May 2022. A total of 75,232 cases were compiled from which 25,722 cases were positive for SARS-CoV-2. Male sex, older age, diabetes, obesity, and hypertension were associated with infection. In addition to the above-mentioned factors, renal disease, cardiovascular disease, and immunosuppression were found to be associated with increased COVID-19 severity. These factors, as well as neurological diseases, are also associated with death due to COVID-19. When comparing the different variants of SARs-CoV-2, the variant B1.1.519 increased the probability of death by 2.23 times compared to the AY.20 variant. Male sex, older age, diabetes, obesity, and hypertension are associated with SARS-CoV-2 infection, severity, and death. Along with the aforementioned comorbidities, renal disease, cardiovascular disease, and immunosuppression are also associated with severity and death. Another factor associated with death is the presence of neurological disease. The SARS-CoV-2 B1.1.519 variant increases the odds of death compared to the SARS-CoV-2 AY.20 variant.
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Affiliation(s)
- Maria Elena Camacho Moll
- Laboratory of Molecular Biology, Northeast Biomedical Research Centre, Mexican Social Security Institute, Monterrey 64720, Mexico
| | - Viviana Leticia Mata Tijerina
- Laboratory of Immunogenetics, Northeast Biomedical Research Centre, Mexican Social Security Institute, Monterrey 64720, Mexico
| | - Beatriz Silva Ramírez
- Laboratory of Immunogenetics, Northeast Biomedical Research Centre, Mexican Social Security Institute, Monterrey 64720, Mexico
| | - Katia Peñuelas Urquides
- Laboratory of Molecular Microbiology, Northeast Biomedical Research Centre, Mexican Social Security Institute, Monterrey 64720, Mexico
| | - Laura Adiene González Escalante
- Laboratory of Molecular Microbiology, Northeast Biomedical Research Centre, Mexican Social Security Institute, Monterrey 64720, Mexico
| | - Brenda Leticia Escobedo Guajardo
- Laboratory of Molecular Research of Diseases, Northeast Biomedical Research Centre, Mexican Social Security Institute, Monterrey 64720, Mexico
| | - Jorge Eleazar Cruz Luna
- Medical Epidemiological Assistance Coordination of the State of Nuevo León, Mexican Social Security Institute, Monterrey 64000, Mexico
| | - Roberto Corrales Pérez
- Medical Epidemiological Assistance Coordination of the State of Nuevo León, Mexican Social Security Institute, Monterrey 64000, Mexico
| | - Salvador Gómez García
- Medical Epidemiological Assistance Coordination of the State of Nuevo León, Mexican Social Security Institute, Monterrey 64000, Mexico
| | - Mario Bermúdez de León
- Laboratory of Molecular Biology, Northeast Biomedical Research Centre, Mexican Social Security Institute, Monterrey 64720, Mexico
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Chevalier K, Genin M, Jean TP, Avouac J, Flipo RM, Georgin-Lavialle S, El Mahou S, Pertuiset E, Pham T, Servettaz A, Marotte H, Domont F, Chazerain P, Devaux M, Mekinian A, Sellam J, Fautrel B, Rouzaud D, Ebstein E, Costedoat-Chalumeau N, Richez C, Hachulla E, Mariette X, Seror R. CovAID: Identification of factors associated with severe COVID-19 in patients with inflammatory rheumatism or autoimmune diseases. Front Med (Lausanne) 2023; 10:1152587. [PMID: 37035330 PMCID: PMC10075312 DOI: 10.3389/fmed.2023.1152587] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Autoimmune/inflammatory rheumatic diseases (AIRDs) patients might be at-risk of severe COVID-19. However, whether this is linked to the disease or to its treatment is difficult to determine. This study aimed to identify factors associated with occurrence of severe COVID-19 in AIRD patients and to evaluate whether having an AIRD was associated with increased risk of severe COVID-19 or death. Materials and methods Two databases were analyzed: the EDS (Entrepôt des Données de Santé, Clinical Data Warehouse), including all patients followed in Paris university hospitals and the French multi-center COVID-19 cohort [French rheumatic and musculoskeletal diseases (RMD)]. First, in a combined analysis we compared patients with severe and non-severe COVID-19 to identify factors associated with severity. Then, we performed a propensity matched score case-control study within the EDS database to compare AIRD cases and non-AIRD controls. Results Among 1,213 patients, 195 (16.1%) experienced severe COVID-19. In multivariate analysis, older age, interstitial lung disease (ILD), arterial hypertension, obesity, sarcoidosis, vasculitis, auto-inflammatory diseases, and treatment with corticosteroids or rituximab were associated with increased risk of severe COVID-19. Among 35,741 COVID-19 patients in EDS, 316 having AIRDs were compared to 1,264 Propensity score-matched controls. AIRD patients had a higher risk of severe COVID-19 [aOR = 1.43 (1.08-1.87), p = 0.01] but analysis restricted to rheumatoid arthritis and spondyloarthritis found no increased risk of severe COVID-19 [aOR = 1.11 (0.68-1.81)]. Conclusion In this multicenter study, we confirmed that AIRD patients treated with rituximab or corticosteroids and/or having vasculitis, auto-inflammatory disease, and sarcoidosis had increased risk of severe COVID-19. Also, AIRD patients had, overall, an increased risk of severe COVID-19 compares general population.
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Affiliation(s)
- Kevin Chevalier
- Department of Rheumatology, Université Paris-Saclay, INSERM UMR 1184: Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Michaël Genin
- University of Lille, CHU Lille, ULR 2694–METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | | | | | | | | | | | | | - Thao Pham
- Hospital Sainte Marguerite, Rheumatology, Marseille, France
| | - Amelie Servettaz
- Hospital Robert Debré, Internal Medicine, Infectious Diseases and Clinical Immunology, Reims, France
| | - Hubert Marotte
- University Hospital of Saint-Étienne, Rheumatology, Saint-Priest-en-Jarez, France
| | - Fanny Domont
- University Hospitals Pitié Salpêtrière - Charles Foix, Internal Medicine and Clinical Immunology, Paris, France
| | - Pascal Chazerain
- Hopital de la Croix Saint-Simon, Rheumatology and Internal Medicine, Paris, France
| | - Mathilde Devaux
- Saint-Germain-en-Laye Intercommunal Hospital Center, Internal Medicine, Poissy, France
| | - Arsene Mekinian
- Hospital Saint-Antoine AP-HP, Internal Medicine, Paris, France
| | - Jérémie Sellam
- Hospital Saint-Antoine AP-HP, Rheumatology, Paris, France
| | - Bruno Fautrel
- Sorbonne Universite – APHP, Pitie Salpetriere Hospital, Department of Rheumatology, Pierre Louis Institute of Epidemiology and Public Health, INSERM UMRS 1136, Paris, France
| | - Diane Rouzaud
- Bichat-Claude Bernard Hospital, Internal Medicine, Paris, France
| | - Esther Ebstein
- Bichat-Claude Bernard Hospital, Rheumatology, Paris, France
| | | | | | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for Rare Systemic Autoimmune Diseases North and North-West of France (CeRAINO), CHU Lille, University of Lille, INSERM, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Xavier Mariette
- Department of Rheumatology, Université Paris-Saclay, INSERM UMR 1184: Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Raphaèle Seror
- Department of Rheumatology, Université Paris-Saclay, INSERM UMR 1184: Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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Sherif ZA, Gomez CR, Connors TJ, Henrich TJ, Reeves WB. Pathogenic mechanisms of post-acute sequelae of SARS-CoV-2 infection (PASC). eLife 2023; 12:e86002. [PMID: 36947108 DOI: 10.7554/elife.86002:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/10/2023] [Indexed: 08/28/2024] Open
Abstract
COVID-19, with persistent and new onset of symptoms such as fatigue, post-exertional malaise, and cognitive dysfunction that last for months and impact everyday functioning, is referred to as Long COVID under the general category of post-acute sequelae of SARS-CoV-2 infection (PASC). PASC is highly heterogenous and may be associated with multisystem tissue damage/dysfunction including acute encephalitis, cardiopulmonary syndromes, fibrosis, hepatobiliary damages, gastrointestinal dysregulation, myocardial infarction, neuromuscular syndromes, neuropsychiatric disorders, pulmonary damage, renal failure, stroke, and vascular endothelial dysregulation. A better understanding of the pathophysiologic mechanisms underlying PASC is essential to guide prevention and treatment. This review addresses potential mechanisms and hypotheses that connect SARS-CoV-2 infection to long-term health consequences. Comparisons between PASC and other virus-initiated chronic syndromes such as myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome will be addressed. Aligning symptoms with other chronic syndromes and identifying potentially regulated common underlining pathways may be necessary for understanding the true nature of PASC. The discussed contributors to PASC symptoms include sequelae from acute SARS-CoV-2 injury to one or more organs, persistent reservoirs of the replicating virus or its remnants in several tissues, re-activation of latent pathogens such as Epstein-Barr and herpes viruses in COVID-19 immune-dysregulated tissue environment, SARS-CoV-2 interactions with host microbiome/virome communities, clotting/coagulation dysregulation, dysfunctional brainstem/vagus nerve signaling, dysautonomia or autonomic dysfunction, ongoing activity of primed immune cells, and autoimmunity due to molecular mimicry between pathogen and host proteins. The individualized nature of PASC symptoms suggests that different therapeutic approaches may be required to best manage specific patients.
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Affiliation(s)
- Zaki A Sherif
- Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, District of Columbia, United States
| | - Christian R Gomez
- Division of Lung Diseases, National Institutes of Health (NIH), National Heart, Lung and Blood Institute (NHLBI), Bethesda, United States
| | - Thomas J Connors
- Department of Pediatrics, Division of Critical Care, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, New York, United States
| | - Timothy J Henrich
- Division of Experimental Medicine, University of California, San Francisco, United States
| | - William Brian Reeves
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas, San Antonio, United States
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Sherif ZA, Gomez CR, Connors TJ, Henrich TJ, Reeves WB. Pathogenic mechanisms of post-acute sequelae of SARS-CoV-2 infection (PASC). eLife 2023; 12:e86002. [PMID: 36947108 PMCID: PMC10032659 DOI: 10.7554/elife.86002] [Citation(s) in RCA: 70] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/10/2023] [Indexed: 03/23/2023] Open
Abstract
COVID-19, with persistent and new onset of symptoms such as fatigue, post-exertional malaise, and cognitive dysfunction that last for months and impact everyday functioning, is referred to as Long COVID under the general category of post-acute sequelae of SARS-CoV-2 infection (PASC). PASC is highly heterogenous and may be associated with multisystem tissue damage/dysfunction including acute encephalitis, cardiopulmonary syndromes, fibrosis, hepatobiliary damages, gastrointestinal dysregulation, myocardial infarction, neuromuscular syndromes, neuropsychiatric disorders, pulmonary damage, renal failure, stroke, and vascular endothelial dysregulation. A better understanding of the pathophysiologic mechanisms underlying PASC is essential to guide prevention and treatment. This review addresses potential mechanisms and hypotheses that connect SARS-CoV-2 infection to long-term health consequences. Comparisons between PASC and other virus-initiated chronic syndromes such as myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome will be addressed. Aligning symptoms with other chronic syndromes and identifying potentially regulated common underlining pathways may be necessary for understanding the true nature of PASC. The discussed contributors to PASC symptoms include sequelae from acute SARS-CoV-2 injury to one or more organs, persistent reservoirs of the replicating virus or its remnants in several tissues, re-activation of latent pathogens such as Epstein-Barr and herpes viruses in COVID-19 immune-dysregulated tissue environment, SARS-CoV-2 interactions with host microbiome/virome communities, clotting/coagulation dysregulation, dysfunctional brainstem/vagus nerve signaling, dysautonomia or autonomic dysfunction, ongoing activity of primed immune cells, and autoimmunity due to molecular mimicry between pathogen and host proteins. The individualized nature of PASC symptoms suggests that different therapeutic approaches may be required to best manage specific patients.
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Affiliation(s)
- Zaki A Sherif
- Department of Biochemistry & Molecular Biology, Howard University College of MedicineWashington, District of ColumbiaUnited States
| | - Christian R Gomez
- Division of Lung Diseases, National Institutes of Health (NIH), National Heart, Lung and Blood Institute (NHLBI)BethesdaUnited States
| | - Thomas J Connors
- Department of Pediatrics, Division of Critical Care, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's HospitalNew YorkUnited States
| | - Timothy J Henrich
- Division of Experimental Medicine, University of CaliforniaSan FranciscoUnited States
| | - William Brian Reeves
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of TexasSan AntonioUnited States
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36
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Fedorchenko Y, Zimba O. Comorbidities in the COVID-19 Pandemic: Scopus-Based Bibliometric Analysis. J Korean Med Sci 2023; 38:e93. [PMID: 36942396 PMCID: PMC10027540 DOI: 10.3346/jkms.2023.38.e93] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/16/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Comorbidities attract enormous attention amid the coronavirus disease 2019 (COVID-19) pandemic. Mapping knowledge based on these clinical conditions is increasingly important since the pandemic is still raging and primarily affecting subjects with chronic diseases and comorbidities. Clinical presentation and complications of COVID-19 are still hot topics which are explored in numerous evidence-based publications. The aim of this study was to analyze Scopus-indexed COVID-19 papers covering comorbidities. METHODS Searches through the Scopus database were performed on September 19, 2022 using the following keywords: "Diabetes mellitus" OR "Cardiovascular Diseases" OR "Rheumatic Diseases" OR "Obesity" OR "Malignancies" AND "COVID-19." All retrieved articles were analyzed using the following categories: document type, authorship, keywords, journal, citation score, country of origin, and language. Using the software tool VOSviewer version 1.6.18, we visualized the network of authors and keywords co-occurrence of the most prevalent comorbidities reported in connection with COVID-19. RESULTS Reports on COVID-19 and diabetes mellitus (DM) were most frequently published (n = 12,282). The US was the most productive country (n = 3,005) in the field of COVID-19 and comorbidities. There were 1,314 documents on COVID-19 and rheumatic diseases which is the least number in comparison with other comorbidities (COVID-19 and DM: 12,282, COVID-19 and cardiovascular disease: 9,911, COVID-19 and obesity: 7,070, and COVID-19 and malignancies: 1,758). CONCLUSION This mapping of COVID-19-related documents in connection with comorbidities may prioritize future research directions.
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Affiliation(s)
- Yuliya Fedorchenko
- Department of Pathophysiology, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Krakow, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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Nas K, Güçlü E, Keskin Y, Dilek G, Kalçık Unan M, Can N, Tekeoğlu İ, Kamanlı A. Clinical course and prognostic factors of COVID-19 infection in patients with chronic inflammatory-rheumatic disease: A retrospective, case-control study. Arch Rheumatol 2023; 38:44-55. [PMID: 37235113 PMCID: PMC10208609 DOI: 10.46497/archrheumatol.2023.9289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/07/2022] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES This study aims to investigate the prognosis of novel coronavirus disease-2019 (COVID-19) infection in patients with the chronic inflammatory-rheumatic disease and evaluate the effects of immunosuppressive drugs on the prognosis, clinical characteristics, laboratory findings and hospitalization periods of the rheumatic patients with COVID-19 infection. PATIENTS AND METHODS Between April 2020 and March 2021, a total of 101 patients (30 males, 71 females; mean age: 48±14.4 years; range, 46 to 48 years) with the rheumatic diseases diagnosed with COVID-19 infection were included. A total of 102 age- and sex-matched patients (35 males, 67 females; mean age: 44±14.4 years; range, 28 to 44 years) who were diagnosed with COVID-19 infection and had no history of rheumatic disease in the same period were included as the control group. Data including demographic characteristics of the patients, presence of any symptoms of COVID-19 disease, laboratory data at the time of diagnosis, and treatments administered were collected. RESULTS The rate of hospitalization was higher in 38 (37%) patients without rheumatic diseases than in 31 (31%) patients with rheumatic diseases (p=0.324). The rate of lung infiltration on radiographic examination was higher in patients without rheumatic diseases (40% vs. 49%) (p=0.177). COVID-19 infection symptoms such as anosmia 45 (45%), ageusia 51 (50%), shortness of breath 45(45%), nausea 29 (29%), vomiting 16 (16%), diarrhea 25 (25%) and myalgia-arthralgia 81 (80%) were higher in patients with rheumatic diseases. In terms of laboratory values, lymphocyte count (p=0.031) was statistically higher in patients without rheumatic diseases. Hydroxychloroquine (35%), oseltamivir 10 (10%), antibiotics 27 (26%), acetylsalicylic acid 52 (51%), and supplementary oxygen 25 (25%) treatments which used to cure COVID 19 infection were administered more in patients without rheumatic diseases. The number of treatments administered was higher in patients without rheumatic diseases (p<0.001). CONCLUSION Patients with the chronic inflammatory-rheumatic disease have more symptoms due to COVID-19 infection, but the disease course is not poor and hospitalization rates are lower.
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Affiliation(s)
- Kemal Nas
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology and Immunology, Sakarya University School of Medicine, Sakarya, Türkiye
| | - Ertuğrul Güçlü
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
| | - Yaşar Keskin
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Türkiye
| | - Gamze Dilek
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology and Immunology, Sakarya University School of Medicine, Sakarya, Türkiye
| | - Mehtap Kalçık Unan
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology and Immunology, Sakarya University School of Medicine, Sakarya, Türkiye
| | - Nurselin Can
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
| | - İbrahim Tekeoğlu
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology and Immunology, Sakarya University School of Medicine, Sakarya, Türkiye
| | - Ayhan Kamanlı
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology and Immunology, Sakarya University School of Medicine, Sakarya, Türkiye
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Gragnani L, Visentini M, Lorini S, Santini SA, Lauletta G, Mazzaro C, Urraro T, Quartuccio L, Cacciapaglia F, Ruscitti P, Tavoni A, Marri S, Cusano G, Petraccia L, Naclerio C, Treppo E, del Frate G, Di Cola I, Raimondo V, Scorpiniti D, Monti M, Puccetti L, Elia G, Fallahi P, Basili S, Scarpato S, Iannone F, Casato M, Antonelli A, Zignego AL, Ferri C. COVID-19 and Mixed Cryoglobulinemia Syndrome: Long-Term Survey Study on the Prevalence and Outcome, Vaccine Safety, and Immunogenicity. J Clin Immunol 2023; 43:680-691. [PMID: 36795264 PMCID: PMC9933006 DOI: 10.1007/s10875-023-01444-4] [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: 09/14/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Mixed cryoglobulinemia syndrome (MCs) is a rare immunoproliferative systemic disorder with cutaneous and multiple organ involvement. Our multicenter survey study aimed to investigate the prevalence and outcome of COVID-19 and the safety and immunogenicity of COVID-19 vaccines in a large MCs series. METHODS The survey included 430 unselected MCs patients (130 M, 300 F; mean age 70 ± 10.96 years) consecutively collected at 11 Italian referral centers. Disease classification, clinico-serological assessment, COVID-19 tests, and vaccination immunogenicity were carried out according to current methodologies. RESULTS A significantly higher prevalence of COVID-19 was found in MCs patients compared to Italian general population (11.9% vs 8.0%, p < 0.005), and the use of immunomodulators was associated to a higher risk to get infected (p = 0.0166). Moreover, higher mortality rate was recorded in MCs with COVID-19 compared to those without (p < 0.01). Patients' older age (≥ 60 years) correlated with worse COVID-19 outcomes. The 87% of patients underwent vaccination and 50% a booster dose. Of note, vaccine-related disease flares/worsening were significantly less frequent than those associated to COVID-19 (p = 0.0012). Impaired vaccination immunogenicity was observed in MCs patients compared to controls either after the first vaccination (p = 0.0039) and also after the booster dose (p = 0.05). Finally, some immunomodulators, namely, rituximab and glucocorticoids, hampered the vaccine-induced immunogenicity (p = 0.029). CONCLUSIONS The present survey revealed an increased prevalence and morbidity of COVID-19 in MCs patients, as well an impaired immunogenicity even after booster vaccination with high rate of no response. Therefore, MCs can be included among frail populations at high risk of infection and severe COVID-19 manifestations, suggesting the need of a close monitoring and specific preventive/therapeutical measures during the ongoing pandemic.
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Affiliation(s)
- Laura Gragnani
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
| | - Marcella Visentini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Serena Lorini
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
| | - Stefano Angelo Santini
- Department of Basic, Clinical, Intensive and Perioperative Biotechnological Sciences, Catholic University School of Medicine, Rome, Italy ,Synlab Lazio, Roma, Italy
| | - Gianfranco Lauletta
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro” Medical School, Bari, Italy
| | - Cesare Mazzaro
- Clinical Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Teresa Urraro
- Rheumatology Unit, “M. Scarlato” Hospital, Scafati (SA), Italy
| | - Luca Quartuccio
- Rheumatology Clinic Department of Medicine (DAME), ASUFC, University of Udine, Udine, Italy
| | - Fabio Cacciapaglia
- UO Reumatologia – Department of Precision and Regenerative Medicine-Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological & Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Silvia Marri
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
| | - Giuseppina Cusano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Luisa Petraccia
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
| | | | - Elena Treppo
- Rheumatology Clinic Department of Medicine (DAME), ASUFC, University of Udine, Udine, Italy
| | - Giulia del Frate
- Rheumatology Clinic Department of Medicine (DAME), ASUFC, University of Udine, Udine, Italy
| | - Ilenia Di Cola
- Rheumatology Unit, Department of Biotechnological & Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Vincenzo Raimondo
- Rheumatology Clinic ‘Madonna dello Scoglio’ Cotronei, Crotone, Italy
| | | | - Monica Monti
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
| | | | - Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research & New Technologies in Medicine and Surgery, University of Pisa, School of Medicine, Pisa, Italy
| | - Stefania Basili
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Florenzo Iannone
- UO Reumatologia – Department of Precision and Regenerative Medicine-Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Milvia Casato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
| | - Anna Linda Zignego
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
| | - Clodoveo Ferri
- Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy. .,Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy.
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Comarmond C, Drumez E, Labreuche J, Hachulla E, Thomas T, Flipo RM, Seror R, Avouac J, Balandraud N, Desbarbieux R, Felten R, Gilson M, Guyot MH, Hittinger-Roux A, Pham T, Renard M, Roux N, Sobanski V, Tournadre A, Richez C, Cacoub P. COVID-19 presentation and outcomes in patients with inflammatory rheumatic and musculoskeletal diseases receiving IL6-receptor antagonists prior to SARS-CoV-2 infection. J Transl Autoimmun 2023; 6:100190. [PMID: 36684808 PMCID: PMC9839461 DOI: 10.1016/j.jtauto.2023.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Objective COVID-19 outcome may be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases (RMD) receiving immunosuppressive therapy. We aimed to investigate whether RMD patients on anti-IL6 therapy prior to SARS-CoV-2 infection have less severe disease and better outcomes of COVID-19. Methods We conducted a retrospective national, multicentre cohort study using data from the French RMD COVID-19 cohort. We compared the severity and outcome of highly suspected or confirmed COVID-19 infection in RMD patients previously treated with tocilizumab or sarilumab (anti-IL6 group) with patients who did not receive anti-IL6 therapy (no anti-IL6 group). Results Data were collected for 1883 patients with mean age of 55.2 years [SD 16.7] and 1256 (66.7%) female. Two hundred ten (11.1%) developed severe COVID-19 and 115 (6.4%) died. After adjusting for potential confounding factors, severe COVID-19 was less frequent in the anti-IL6 group compared with the no anti-IL6 group (aOR for moderate vs. mild severity, 0.23 [95% CI, 0.10 to 0.54], p ≤ 0.01 and aOR for severe vs. mild, 0.29 [95% CI, 0.10 to 0.81], p ≤ 0.01). No significant differences were found for the evolution of COVID-19 between the anti-IL6 group and the no anti-IL6 group (aOR for recovery with sequelae vs recovery without sequelae, 0.78 [95% CI, 0.41 to 1.48] and aOR for death vs recovery without sequelae, 0.29 [95% CI, 0.07 to 1.30]). Conclusion RMD patients receiving anti-IL6 therapy prior to SARS-CoV-2 infection have less severe forms of COVID-19. No difference was observed in COVID-19 evolution, i.e., sequelae or death, between the groups.
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Affiliation(s)
- Cloé Comarmond
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université de Paris, 75010, Paris, France,Corresponding author.
| | - Elodie Drumez
- ULR 2694 METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, CHU Lille, Lille, France
| | - Julien Labreuche
- ULR 2694 METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, CHU Lille, Lille, France
| | - Eric Hachulla
- Université de Lille, INSERM, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Autoimmunes Systémiques Rares Du Nord et Nord-Ouest de France, U1286—INFINITE: Institute for Translational Research in Inflammation, France
| | - Thierry Thomas
- Rheumatology, CHU de Saint-Etienne - Hôpital Nord, France
| | | | - Raphaëlle Seror
- Rheumatology, APHP - Hôpital Bicêtre, Kremlin-Bicêtre, France
| | - Jérôme Avouac
- Rheumatology, APHP - Hôpital Cochin, Université de, Paris, France
| | | | | | - Renaud Felten
- Rheumatology, CHRU de Strasbourg - Hôpital de Hautepierre, France
| | | | | | | | - Thao Pham
- Rheumatology, APHM - Hôpital Sainte-Marguerite, Marseille, France
| | - Myriam Renard
- Rheumatology, CH Métropole-Savoie - Hôpital Reine Hortense, France
| | - Nicolas Roux
- Rheumatology, Hôpitaux Privés de Metz - Hôpital Belle-Isle, France
| | - Vincent Sobanski
- Université de Lille, INSERM, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Autoimmunes Systémiques Rares Du Nord et Nord-Ouest de France, U1286—INFINITE: Institute for Translational Research in Inflammation, France
| | - Anne Tournadre
- Rheumatology, CHU de Clermont-Ferrand - Hôpital Gabriel Montpied, France
| | | | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière Hospital, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Sorbonne Université, UMR 959, 75013, Paris, France,Corresponding author.
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Wang S, Li J, Wang S, Ye Y, Li M, Liu Y, Chen B, Lai Y, Li L, Zhuang L, Peng S, Yang N, Zhang H, Xiao H. Impacts of delta and omicron variants on inactivated SARS-CoV-2 vaccine-induced T cell responses in patients with autoimmune diseases and healthy controls. Clin Transl Med 2023; 13:e1171. [PMID: 36639826 PMCID: PMC9839884 DOI: 10.1002/ctm2.1171] [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: 08/16/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes coronavirus disease 2019 (COVID-19), which is still devastating economies and communities globally. The increasing infections of variants of concern (VOCs) in vaccinated population have raised concerns about the effectiveness of current vaccines. Patients with autoimmune diseases (PAD) under immunosuppressant treatments are facing higher risk of infection and potentially lower immune responses to SARS-CoV-2 vaccination. METHODS Blood samples were collected from PAD or healthy controls (HC) who finished two or three doses of inactivated vaccines. Spike peptides derived from wild-type strain, delta, omicron BA.1 were utilised to evaluate T cell responses and their cross-recognition of delta and omicron in HC and PAD by flow cytometry and ex vivo IFNγ-ELISpot. RESULTS We found that inactivated vaccine-induced spike-specific memory T cells were long-lasting in both PAD and HC. These spike-specific T cells were highly conserved and cross-recognized delta and omicron. Moreover, a third inactivated vaccine expanded spike-specific T cells that responded to delta and omicron spike peptides substantially in both PAD and HC. Importantly, the polyfunctionality of spike-specific memory T cells was preserved in terms of cytokine and cytotoxic responses. Although the extent of T cell responses was lower in PAD after two-dose, T cell responses were boosted to a greater magnitude in PAD by the third dose, bringing comparable spike-specific T cell immunity after the third dose. CONCLUSION Inactivated vaccine-induced spike-specific T cells remain largely intact against delta and omicron variants. This study expands our understanding of inactivated vaccine-induced T cell responses in PAD and HC, which could have important indications for vaccination strategy.
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Affiliation(s)
- Shuyi Wang
- Department of Rheumatologythe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jin Li
- Department of Rheumatologythe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Shuang Wang
- Department of Rheumatologythe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yujin Ye
- Department of Rheumatologythe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Mengyuan Li
- Department of Rheumatologythe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yihao Liu
- Clinical Trials Unitthe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Binfeng Chen
- Department of Rheumatologythe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yimei Lai
- Department of Rheumatologythe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Liubing Li
- Department of Laboratory MedicineThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Lili Zhuang
- Department of Rheumatologythe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Sui Peng
- Clinical Trials Unitthe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Niansheng Yang
- Department of Rheumatologythe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Hui Zhang
- Department of Rheumatologythe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Institue of Precision Medicinethe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Haipeng Xiao
- Department of Endocrinologythe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
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Zsichla L, Müller V. Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors. Viruses 2023; 15:175. [PMID: 36680215 PMCID: PMC9863423 DOI: 10.3390/v15010175] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.
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Affiliation(s)
- Levente Zsichla
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
| | - Viktor Müller
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
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Mathew J, Jain S, Susngi T, Naidu S, Dhir V, Sharma A, Jain S, Sharma SK. Predictors of COVID-19 severity and outcomes in Indian patients with rheumatic diseases: a prospective cohort study. Rheumatol Adv Pract 2023; 7:rkad025. [PMID: 36908302 PMCID: PMC9995091 DOI: 10.1093/rap/rkad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/17/2022] [Indexed: 03/06/2023] Open
Abstract
Objective There is dearth of data regarding the outcomes of coronavirus disease 2019 (COVID-19) among rheumatic and musculoskeletal disease (RMD) patients from Southeast Asia. We report the clinicodemographic profile and identify predictors of COVID-19 outcomes in a large cohort of Indian RMD patients. Methods This prospective cohort study, carried out at the Postgraduate Institute of Medical Education and Research, Chandigarh (a tertiary care centre in India), included RMD patients affected with COVID-19 between April 2020 and October 2021. Demographic and clinical and laboratory details of COVID-19 and underlying RMD were noted. Predictors of mortality, hospitalization and severe COVID-19 were identified using stepwise multivariable logistic regression. Results A total of 64 severe acute respiratory syndrome coronavirus-2-infected RMD patients [age 41.5 (19-85) years; 46 (72%) females] were included. Eighteen (28%) patients had severe COVID-19. Twenty-three (36%) required respiratory support [11 (17%) required mechanical ventilation]. Thirty-six (56%) patients required hospitalization [median duration of stay 10 (1-42) days]; 17 (27%) required intensive care unit admission. Presence of co-morbidities [odds ratio (OR) = 4.5 (95% CI: 1.4, 14.7)] was found to be an independent predictor of COVID-19 severity. Co-morbidities [OR = 10.7 (95% CI: 2.5, 45.4)] and underlying lupus [OR = 7.0 (95% CI: 1.2, 40.8)] were independently associated with COVID-19 hospitalization. Ongoing rheumatic disease activity [OR = 6.8 (95% CI: 1.3, 35.4)] and underlying diagnosis of lupus [OR = 7.1 (95% CI: 1.2, 42.4)] and SSc [OR = 9.5 (95% CI: 1.5, 61.8)] were found to be strong independent predictors of mortality. Age, sex, underlying RMD-associated interstitial lung disease and choice of immunosuppressive therapy were not associated with COVID-19 severity or adverse outcomes. Conclusion The presence of co-morbidities was independently associated with COVID-19 severity and hospitalization. Ongoing rheumatic disease activity and the presence of lupus or SSc independently predicted mortality. Age, sex, type of immunosuppressive therapy and presence of RMD-associated interstitial lung disease did not affect COVID-19 severity or outcomes in Indian RMD patients.
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Affiliation(s)
- Jithin Mathew
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddharth Jain
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Terence Susngi
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research,Chandigarh, India
| | - Shankar Naidu
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Dhir
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shefali Khanna Sharma
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Zhou X, Wang Y, Huang B, Feng R, Zhou X, Li C, Zhang X, Shao M, Gan Y, Jin Y, An Y, Xiao X, Wang S, Liu Q, Cheng G, Zhu F, Zhang K, Wang N, Xing X, Li R, Li Y, Liu Y, Lu D, Sun X, Li Z, Liu Y, He J. Dynamics of T follicular helper cells in patients with rheumatic diseases and subsequent antibody responses in a three-dose immunization regimen of CoronaVac. Immunology 2023; 168:184-197. [PMID: 36057099 DOI: 10.1111/imm.13572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/28/2022] [Indexed: 12/30/2022] Open
Abstract
Given increased acceptance of the CoronaVac, there is an unmet need to assess the safety and immunogenic changes of CoronaVac in patients with rheumatic diseases (RD). Here we comprehensively analysed humoral and cellular responses in patient with RD after a three-dose immunization regimen of CoronaVac. RD patients with stable condition and/or low disease activity (n = 40) or healthy controls (n = 40) were assigned in a 1:1 ratio to receive CoronaVac (Sinovac). The prevalence of anti-receptor binding domain (RBD) antibodies and neutralizing antibodies was similar between healthy control (HC) and RD patients after the second and the third vaccination. However, the titers of anti-RBD IgG and neutralizing antibodies were significantly lower in RD patients compared to HCs (p < 0.05), which was associated with an impaired T follicular helper (Tfh) cell response. Among RD patients, those who generated an antibody response displayed a significantly higher Tfh cells compared to those who failed after the first and the second vaccination (p < 0.05). Interestingly, subjects with a negative serological response displayed a similar Tfh memory response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-derived peptides as their anti-RBD IgG positive counterpart, and all (4/4) of the non-responders in HCs, and 62.5% (5/8) of the non-responders in patients with RD displayed a positive serological response following the third dose. No serious adverse events were observed. In conclusion, our findings support SARS-CoV-2 vaccination in patients with RD with stable and/or low disease activity. The impaired ability in generating vaccine-specific antibodies in patients with RD was associated with a reduction in Tfh cells induction. The window of vaccination times still needs to be explored in future studies. Clinical trial registration: This trial was registered with ChiCTR2100049138.
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Affiliation(s)
- Xingyu Zhou
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Yifan Wang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Bo Huang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Ruiling Feng
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Xinyao Zhou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chun Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Xia Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Miao Shao
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Yuzhou Gan
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Yuebo Jin
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Yuan An
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Xian Xiao
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Shiyang Wang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Qinghong Liu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Gong Cheng
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Fengyunzhi Zhu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Kai Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Naidi Wang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Xiaoyan Xing
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Ru Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Yuhui Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Yisi Liu
- The First Department of Liver Disease Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Dan Lu
- Institute of Systems Biomedicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Xiaolin Sun
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China.,State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China.,State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yudong Liu
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing He
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China.,State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China
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Plocque A, Mitri C, Lefèvre C, Tabary O, Touqui L, Philippart F. Should We Interfere with the Interleukin-6 Receptor During COVID-19: What Do We Know So Far? Drugs 2023; 83:1-36. [PMID: 36508116 PMCID: PMC9743129 DOI: 10.1007/s40265-022-01803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 12/14/2022]
Abstract
Severe manifestations of COVID-19 consist of acute respiratory distress syndrome due to an initially local reaction leading to a systemic inflammatory response that results in hypoxia. Many therapeutic approaches have been attempted to reduce the clinical consequences of an excessive immune response to viral infection. To date, systemic corticosteroid therapy is still the most effective intervention. More recently, new hope has emerged with the use of interleukin (IL)-6 receptor inhibitors (tocilizumab and sarilumab). However, the great heterogeneity of the methodology and results of published studies obfuscate the true value of this treatment, leading to a confusing synthesis in recent meta-analyses, and the persistence of doubts in terms of patient groups and the appropriate time to treat. Moreover, their effects on the anti-infectious or pro-healing response are still poorly studied. This review aims to clarify the potential role of IL-6 receptor inhibitors in the treatment of severe forms of COVID-19.
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Affiliation(s)
- Alexia Plocque
- Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Christie Mitri
- Centre de Recherche Saint-Antoine, CRSA, Sorbonne Université, Inserm, 75012, Paris, France
| | - Charlène Lefèvre
- Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Olivier Tabary
- Centre de Recherche Saint-Antoine, CRSA, Sorbonne Université, Inserm, 75012, Paris, France
| | - Lhousseine Touqui
- INSERM U938 Unit, St. Antoine Research Centre, Sorbona University, Paris, France
- Mucoviscidosis and Pulmonary Disease Units, Institute Pasteur, Paris, France
- Cystic fibrosis and Bronchial diseases team-INSERM U938, Institut Pasteur, Paris, France
| | - Francois Philippart
- Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France.
- Endotoxins, Structures and Host Response, Department of Microbiology, Institute for Integrative Biology of the Cell, UMR 9891 CNRS-CEA-Paris Saclay University, 98190, Gif-sur-Yvette, France.
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Siegel CH, Choi JM, D'Angelo D, Christos P, Lally L, Navarro-Millan I, Cooke J, Goyal P, Mandl LA, Barbhaiya M. Outcomes of COVID-19 and Factors Associated With Its Severity Among Hospitalized Patients With and Without Systemic Rheumatic Disease During the First Wave of the Pandemic in New York City. J Clin Rheumatol 2023; 29:7-15. [PMID: 35905465 PMCID: PMC9803346 DOI: 10.1097/rhu.0000000000001891] [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] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVE Conflicting data exist regarding whether patients with systemic rheumatic disease (SRD) experience more severe outcomes related to COVID-19. Using data from adult patients hospitalized with COVID-19 in New York City during the first wave of the pandemic, we evaluated whether patients with SRD were at an increased risk for severe outcomes. METHODS We conducted a medical records review study including patients aged ≥18 years with confirmed SARS-CoV-2 infection hospitalized at 3 NewYork-Presbyterian sites, March 3-May 15, 2020. Inverse probability of treatment weighting was applied to a multivariable logistic regression model to assess the association between SRD status and the composite of mechanical ventilation, intensive care unit admission, or death. RESULTS Of 3710 patients hospitalized with COVID-19 (mean [SD] age, 63.7 [17.0] years; 41% female, 29% White, and 34% Hispanic/Latinx), 92 (2.5%) had SRD. Patients with SRD had similar age and body mass index but were more likely to be female, ever smokers, and White or Black, compared with those without SRD. A higher proportion of patients with versus without SRD had hypertension and pulmonary disease, and used hydroxychloroquine, corticosteroids, and immunomodulatory/immunosuppressive medications before admission. In the weighted multivariable analysis, patients with SRD had an odds ratio of 1.24 (95% confidence interval, 1.10-1.41; p < 0.01) for the composite of mechanical ventilation, intensive care unit admission, or death, compared with patients without SRD. CONCLUSIONS During the initial peak of the pandemic in New York City, patients with versus without SRD hospitalized with COVID-19 had a 24% increased likelihood of having severe COVID-19 after multivariable adjustment.
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Affiliation(s)
- Caroline H. Siegel
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Jacky M. Choi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Debra D'Angelo
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Paul Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Lindsay Lally
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Iris Navarro-Millan
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Joseph Cooke
- Department of Medicine, Weill Cornell Medicine
- Department of Medicine, NewYork-Presbyterian/Queens, Queens, NY
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine
| | - Lisa A. Mandl
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Medha Barbhaiya
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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Heslin KP, Haruna A, George RA, Chen S, Nobel I, Anderson KB, Faraone SV, Zhang-James Y. Association Between ADHD and COVID-19 Infection and Clinical Outcomes: A Retrospective Cohort Study From Electronic Medical Records. J Atten Disord 2023; 27:169-181. [PMID: 36264064 PMCID: PMC9596686 DOI: 10.1177/10870547221129305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Though psychiatric illnesses have been associated with increased COVID-19 infection risk, limited information exists about the relationship between ADHD and COVID-19. METHODS Using the TriNetX COVID-19 Research Network, we examined the impact of ADHD diagnosis and treatment on COVID-19 infection rates and outcomes. RESULTS ADHD patients had greater risk of COVID-19 (risk ratio (RR) 1.11, 95% CI [1.09, 1.12]). Increased risk was higher in females than males, and highest among Asian and Black patients. Within 60 days after COVID-19 diagnosis, ADHD patients had lower rates of hospitalization (RR 0.91, 95% CI [0.86, 0.96]) and mechanical ventilation (RR 0.69, 95% CI [0.58, 0.83]), and a nonsignificant reduced death rate (RR 0.65, 95% CI [0.42, 1.02]). Patients who recently received ADHD medication had higher rates of COVID-19 (RR 1.13; 95% CI [1.10, 1.15]). CONCLUSION ADHD poses increased risk for COVID-19, but may reduce risk of severe outcomes. ADHD medications modestly impacted COVID-19 risk.
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Affiliation(s)
- Kathleen P. Heslin
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Aminat Haruna
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Regina A. George
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Shiyu Chen
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ishak Nobel
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kathryn B. Anderson
- Institute for Global Health and Translational Sciences, SUNY Upstate Medical University, Syracuse, New York
- Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, New York
| | - Stephen V. Faraone
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, New York
- Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York
| | - Yanli Zhang-James
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, New York
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Rorat M, Zarębska-Michaluk D, Kowalska J, Kujawa K, Rogalska M, Kozielewicz D, Lorenc B, Sikorska K, Czupryna P, Bolewska B, Maciukajć J, Piekoś T, Podlasin R, Dworzańska A, Mazur W, Brzdęk M, Szymanek-Pasternak A, Flisiak R. The Course of COVID-19 in Patients with Systemic Autoimmune Rheumatic Diseases. J Clin Med 2022; 11:jcm11247342. [PMID: 36555957 PMCID: PMC9781406 DOI: 10.3390/jcm11247342] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Patients with systemic autoimmune rheumatic disease (SARD) have increased susceptibility to viral infections, including SARS-CoV-2. The aim of this study was to analyse the SARD patient population with COVID-19 (coronavirus disease 2019) in terms of baseline characteristics, severity, course and outcomes of the disease compared with the non-SARD group, and to identify factors associated with prognosis, including remdesivir therapy efficacy. Retrospective study comprised 8220 COVID-19 cases from the SARSTer database, including 185 with SARD. Length of hospitalisation, duration of oxygen therapy, mortality and the need for HFNO (high-flow nasal oxygen) and/or NIV (noninvasive ventilation) were significantly higher in the SARD versus non-SARD group. There was no difference in clinical features on admission to hospital. Patients with SARD were older and more likely to have cardiovascular, pulmonary and chronic kidney diseases. Age, the presence of cardiovascular disease, more severe conditions on admission and higher inflammatory marker values were found to be risk factors for death in the SARD group. In patients with SARD treated with remdesivir, there was a trend towards improved mortality but without statistical significance. Length of hospitalisation, 28-day mortality and the need for HFNO and/or NIV were higher in the SARD group. These patients often had other chronic diseases and were older.
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Affiliation(s)
- Marta Rorat
- Department of Forensic Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Correspondence:
| | | | - Justyna Kowalska
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Krzysztof Kujawa
- Statistical Analysis Centre, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Magdalena Rogalska
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-089 Białystok, Poland
| | - Dorota Kozielewicz
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland
| | - Beata Lorenc
- Pomeranian Center of Infectious Diseases, Department of Infectious Diseases, 80-210 Gdansk, Poland
| | - Katarzyna Sikorska
- Division of Tropical Medicine and Epidemiology, Department of Tropical Medicine and Parasitology, Faculty of Health Sciences, Medical University of Gdańsk, 80–210 Gdańsk, Poland
- Division of Tropical and Parasitic Diseases, Department of Tropical Medicine and Parasitology, Faculty of Health Sciences, Medical University of Gdańsk, 80–210 Gdańsk, Poland
| | - Piotr Czupryna
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, 15-089 Białystok, Poland
| | - Beata Bolewska
- Department of Infectious Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Jadwiga Maciukajć
- Department of Infectious Diseases, District Healthcare Center, 27-200 Starachowice, Poland
| | - Tomasz Piekoś
- Independent Public Healthcare Center in Puławy, Department of Infectious Diseases and Observation for Adults, 24-100 Puławy, Poland
| | - Regina Podlasin
- IV-th Department, Hospital for Infectious Diseases, 01-301 Warsaw, Poland
| | - Anna Dworzańska
- Department of Infectious Diseases and Hepatology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Włodzimierz Mazur
- Clinical Department of Infectious Diseases in Chorzów, Medical University of Silesia, 41-500 Katowice, Poland
| | - Michał Brzdęk
- Department of Infectious Diseases, Jan Kochanowski University, 25-369 Kielce, Poland
| | - Anna Szymanek-Pasternak
- Department of Infectious Diseases and Hepatology, Wrocław Medical University, 50-367 Wrocław, Poland
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-089 Białystok, Poland
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Mehta P, Gasparyan AY, Zimba O, Kitas GD, Yessirkepov M. Interplay of diabetes mellitus and rheumatic diseases amidst the COVID-19 pandemic: influence on the risk of infection, outcomes, and immune responses. Clin Rheumatol 2022; 41:3897-3913. [PMID: 36076125 PMCID: PMC9458477 DOI: 10.1007/s10067-022-06365-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 12/04/2022]
Abstract
Outcomes of COrona VIrus Disease-19 (COVID-19) in patients with rheumatic diseases (RDs) reported in various studies are heterogenous owing to the influence of age and comorbidities which have a significant bearing on the infection risk, severity, morbidity, and mortality. Diabetes mellitus (DM) and RDs are closely linked with underlying pathobiology and treatment of RDs affecting the risk for DM as well as the glycemic control. Hence, we undertook this narrative review to study the influence of DM on outcomes of COVID-19 in patients with RDs. Additionally, aspects of patient attitudes and immune response to COVID-19 vaccination were also studied. The databases of MEDLINE/PubMed, Scopus, and Directory of Open Access Journals (DOAJ) were searched for relevant articles. Studies from mixed cohorts revealed insufficient data to comment on the influence of DM on the risk of infection, while most studies showed twice the odds for hospitalization and mortality with DM. Specific cohorts of rheumatoid arthritis and systemic lupus erythematosus revealed a similar association. Poor health was noted in patients with spondyloarthritis and DM during the pandemic. The presence of DM did not affect patient attitudes towards vaccination and did not predispose to additional vaccine-related adverse effects. Immune response to inactivated vaccines was reduced but mRNA vaccines were maintained in patients with DM. Detailed assessment of DM with its duration, end-organ damage, and glycemic control along with a focused association of DM with various aspects of COVID-19 like risk, hospitalization, severity, mortality, post-COVID sequelae, immune response to infection, and vaccination are needed in the future. Key Points • Diabetes mellitus is associated with the severity of infection, COVID-19-related hospitalization, and mortality in rheumatic diseases across most studies but studies analyzing its specific role are lacking. • Poor outcomes of COVID-19 in RA and poor health in spondyloarthritis are strongly associated with diabetes mellitus. • Diabetes mellitus may negatively influence the humoral response to inactivated vaccines but does not seem to affect the immune responses to mRNA vaccines. • Diabetes mellitus does not influence the attitude towards vaccination or deviation from the prescribed medications during the pandemic.
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Affiliation(s)
- Pankti Mehta
- Department of Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, India
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, UK.
| | - Olena Zimba
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - George D Kitas
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
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Pereira RMR, Dagostin MA, Caparbo VF, Sales LP, Pasoto SG, Silva CA, Yuki EFN, Saad CGS, Medeiros-Ribeiro AC, Kupa LVK, Fusco SRG, Martins VAO, Martins CCMF, Barbas CV, Shinjo SK, Aikawa NE, Bonfa E. Anti-SARS-CoV-2 inactivated vaccine in patients with ANCA-associated vasculitis: Immunogenicity, safety, antibody decay and the booster dose. Clinics (Sao Paulo) 2022; 78:100150. [PMID: 36529052 PMCID: PMC9705212 DOI: 10.1016/j.clinsp.2022.100150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/10/2022] [Accepted: 11/17/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate inactivated CoronaVac prime vaccination, antibody decay, booster dose, and safety in ANCA-Associated Vasculitis (AAV) patients. METHODS Fifty-three AAV patients and 106 Controls (CG) received CoronaVac on days: D0 (first dose), D28(second dose), and D210 (booster dose, 32 AAV: 32 CG). The primary outcome was immunogenicity after the second vaccine dose (day 69) assessed by Seroconversion Rates (SC) of anti-SARS-CoV-2 S1/S2 IgG and Neutralizing Antibodies (NAb). Secondary outcomes were safety, immunogenicity (D28/D240), 6-months antibody decay (D210) and the booster dose response (D240). RESULTS At D69 SC (65.1% vs. 96.8%, p = 0.0001), GMT (21.3 UA/mL vs. 67.7 UA/mL, p < 0.001) and NAb- positivity (53.7% vs. 80.6%, p = 0.001) were moderate but lower in naïve-AAV patients than CG. Patients without SC used more often IS (93.3% vs. 53.3%, p = 0.015), mycophenolate mofetil (20% vs. 0%, p = 0.037) and prednisone (60.0% vs. 28.6%, p = 0.057) than seroconverted. NAb negativity in AAV patients was associated with prednisone treatment (57.9% vs. 18.2%, p = 0.015) and IS (84.2% vs. 55.0%, p = 0.046). Logistic regression analysis models showed that only prednisone was associated with lower seroconversion (OR = 0.2, 0,95% CI 0.05‒0.86, p = 0.030) and with lower NAb positivity (OR = 0.2, 0,95% CI 0.05‒0.88, p = 0.034). After six months (D69‒D210) a decrease in IgG positivity occurred in 32 AAV patients (15.7%, p = 0.074) and 32 CG (18.7%, p = 0.041). For the NAb positivity, the 6-month decrease was not significant (p = 0.114) whereas a major reduction occurred for CG (p < 0.001). A booster dose (D240) resulted in an increment in IgG-positivity (21.9%, p = 0.023) and NAb-positivity (34.4%, p = 0.006) in AAV patients. No moderate/severe adverse events attributable to the vaccine were observed. CONCLUSION This study provides novel data on the excellent safety and moderate immunogenicity of CoronaVac in AAV patients. A six-month mild antibody waning was observed with a good response to the booster dose, although levels remained lower than CG (CoronavRheum-NCT04754698).
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Affiliation(s)
- Rosa M R Pereira
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Marilia A Dagostin
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - Valeria F Caparbo
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Lucas P Sales
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Emily F N Yuki
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Carla G S Saad
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Ana C Medeiros-Ribeiro
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Leonard V K Kupa
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Solange R G Fusco
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Victor A O Martins
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Carolina C M F Martins
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Carmen Valente Barbas
- Pulmonary Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Samuel K Shinjo
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Nadia E Aikawa
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Arachchillage DJ, Rajakaruna I, Pericleous C, Nicolson PLR, Makris M, Laffan M. Autoimmune disease and COVID-19: a multicentre observational study in the United Kingdom. Rheumatology (Oxford) 2022; 61:4643-4655. [PMID: 35377457 PMCID: PMC8992350 DOI: 10.1093/rheumatology/keac209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/26/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To establish the demographic characteristics, laboratory findings and clinical outcomes in patients with autoimmune disease (AD) compared with a propensity-matched cohort of patients without AD admitted with COVID-19 to hospitals in the UK. METHODS This is a multicentre observational study across 26 NHS Trusts. Data were collected both retrospectively and prospectively using a predesigned standardized case record form. Adult patients (≥18 years) admitted between 1 April 2020 and 31 July 2020 were included. RESULTS Overall, 6288 patients were included to the study. Of these, 394 patients had AD prior to admission with COVID-19. Of 394 patients, 80 patients with SLE, RA or aPL syndrome were classified as severe rheumatologic AD. A higher proportion of those with AD had anaemia [240 (60.91%) vs 206 (52.28%), P = 0.015], elevated LDH [150 (38.08%) vs 43 (10.92%), P < 0.001] and raised creatinine [122 (30.96%) vs 86 (21.83%), P = 0.01], respectively. A significantly higher proportion of patients with severe rheumatologic AD had elevated CRP [77 (96.25%) vs 70 (87.5%), P = 0.044] and LDH [20 (25%) vs 6 (7.5%), P = 0.021]. Patients with severe rheumatologic AD had significantly higher mortality [32/80 (40%)] compared with propensity matched cohort of patients without AD [20/80 (25%), P = 0.043]. However, there was no difference in 180-day mortality between propensity-matched cohorts of patients with or without AD in general (P = 0.47). CONCLUSIONS Patients with severe rheumatologic AD had significantly higher mortality. Anaemia, renal impairment and elevated LDH were more frequent in patients with any AD while elevated CRP and LDH were more frequent in patients with severe rheumatologic AD both of which have been shown to associate with increased mortality in patients with COVID-19.
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Affiliation(s)
- Deepa J Arachchillage
- Correspondence to: Deepa R. J. Arachchillage, Centre of Haematology, Department of Immunology and Inflammation, Imperial College London, 4th Floor, Commonwealth Building, Du Cane Road, London W12 0NN, UK. E-mail:
| | | | | | - Philip L R Nicolson
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham
| | - Mike Makris
- Sheffield Teaching Hospitals NHS Foundation Trust, Department of Haematology, Royal Hallamshire Hospital, Broomhall, Sheffield, UK
| | - Mike Laffan
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College London
- Department of Haematology, Imperial College Healthcare NHS Trust
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