1
|
Sadana D, Granton D, Adhikari NKJ, Pinto R, Murthy S, Fowler RA. Trends in characteristics, interventions, and outcomes of hospitalized patients with COVID-19 in Canada: a multicentre prospective cohort study. Can J Anaesth 2024:10.1007/s12630-024-02826-x. [PMID: 39231882 DOI: 10.1007/s12630-024-02826-x] [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: 09/08/2023] [Revised: 03/08/2024] [Accepted: 04/18/2024] [Indexed: 09/06/2024] Open
Abstract
PURPOSE Our objective was to investigate the temporal trends in baseline characteristics, interventions, and clinical outcomes in patients hospitalized with COVID-19 in Canada over five pandemic waves. METHODS We conducted a multicentre prospective cohort study enrolling adults and children admitted with COVID-19 from 47 Canadian hospitals. We compared characteristics, interventions, and outcomes of patients across five distinct pandemic waves. RESULTS We enrolled 5,285 patients between 2 January 2020 and 8 February 2022. The mean (standard deviation) age was 62.6 (21.0) yr; 41.2% (n = 2,176) were female, and 48% (n = 2,539) required admission to an intensive care unit (ICU), of whom 60.3% (n = 1,530) underwent invasive mechanical ventilation. The proportion of vaccinated patients increased over time. The proportion of vaccinated hospitalized patients progressing to require ICU admission fell over pandemic waves while the proportion of unvaccinated hospitalized patients progressing to require ICU admission did not. Patients were most commonly treated with corticosteroids (48.7%; n = 2,575); use of corticosteroids and other evidence-based treatments increased over time. Hospital mortality was 22.1% (n = 1,166) among all patients, 30.2% (n = 766) among those admitted to an ICU, and 37.9% (n = 580) among those requiring invasive mechanical ventilation. Younger age, absence of chronic cardiac or pulmonary disease, severity of illness at admission, and prior vaccination was associated with a lower mortality; however, pandemic wave itself was not. CONCLUSION Among patients hospitalized in Canada with COVID-19, several clinical factors including prior vaccination were associated with lower mortality, but pandemic wave was not.
Collapse
Affiliation(s)
- Divyajot Sadana
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - David Granton
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Neill K J Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Srinivas Murthy
- Division of Critical Care, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Robert A Fowler
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
2
|
Nasir N, Tajuddin S, Akhtar A, Sheikh CF, Al Karim Manji A, Bhutto S, Khan N, Khan A, Khan MF, Mahmood SF, Jamil B, Khanum I, Habib K, Latif A, Samad Z, Haider AH. Risk factors for mortality in hospitalized COVID-19 patients across five waves in Pakistan. Sci Rep 2024; 14:20205. [PMID: 39215007 PMCID: PMC11364537 DOI: 10.1038/s41598-024-70662-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
This retrospective cohort study aims to describe the clinical characteristics and outcomes and assess risk factors for mortality across the epidemic waves in hospitalized COVID-19 patients in a major tertiary-care center in Pakistan. A total of 5368 patients with COVID-19, hospitalized between March 2020 and April 2022 were included. The median age was 58 years (IQR: 44-69), 41% were females, and the overall mortality was 12%. Comparative analysis of COVID-19 waves showed that the proportion of patients aged ≥ 60 years was highest during the post-wave 4 period (61.4%) and Wave 4 (Delta) (50%) (p < 0.001). Male predominance decreased from 65.2% in Wave 2 to 44.2% in Wave 5 (Omicron) (p < 0.001). Mortality rate was lowest at 9.4% in wave 5 and highest at 21.6% in the post-wave 4 period (p = 0.041). In multivariable analysis for risk factors of mortality, acute respiratory distress syndrome (ARDS) was most strongly associated with mortality (aOR 22.98, 95% CI 15.28-34.55, p < 0.001), followed by need for mechanical ventilation (aOR 6.81, 95% CI 5.13-9.05, p < 0.001). Other significant risk factors included acute kidney injury (aOR 3.05, 95% CI 2.38-3.91, p < 0.001), stroke (aOR 2.40, 95% CI 1.26-4.60, p = 0.008), pulmonary embolism (OR 2.07, 95% CI 1.28-3.35, p = 0.003), and age ≥ 60 years (aOR 2.45, 95% CI 1.95-3.09, p < 0.001). Enoxaparin use was associated with lower mortality odds (aOR 0.45, 95% CI 0.35-0.60, p < 0.001. Patients hospitalized during Wave 4 (aOR 2.22, 95% CI 1.39-3.56, p < 0.001) and the post-wave 4 period (aOR 2.82, 95% CI 1.37-5.80, p = 0.005) had higher mortality odds compared to other waves. The study identifies higher mortality risk in patients admitted in Delta wave and post-wave, aged ≥ 60 years, and with respiratory and renal complications, and lower risk with anticoagulation during COVID-19 waves.
Collapse
Affiliation(s)
- Nosheen Nasir
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Salma Tajuddin
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Afshan Akhtar
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Chanza Fahim Sheikh
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | | | - Naveera Khan
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Adnan Khan
- Medical College, Aga Khan University, Karachi, Pakistan
| | | | - Syed Faisal Mahmood
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Bushra Jamil
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Iffat Khanum
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Kiren Habib
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Asad Latif
- Department of Anesthesiology, Aga Khan University, Karachi, Pakistan
| | - Zainab Samad
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Adil H Haider
- Medical College, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
3
|
Hannemann J, Zink A, Mileva Y, Balfanz P, Dahl E, Volland S, Illig T, Schwedhelm E, Kurth F, Stege A, Aepfelbacher M, Hoffmann A, Böger R. A multicenter study of asymmetric and symmetric dimethylarginine as predictors of mortality risk in hospitalized COVID-19 patients. Sci Rep 2024; 14:15739. [PMID: 38977837 PMCID: PMC11231343 DOI: 10.1038/s41598-024-66288-3] [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: 02/28/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
Mortality of patients hospitalized with COVID-19 has remained high during the consecutive SARS-CoV-2 pandemic waves. Early discrimination of patients at high mortality risk is crucial for optimal patient care. Symmetric (SDMA) and asymmetric dimethylarginine (ADMA) have been proposed as possible biomarkers to improve risk prediction of COVID-19 patients. We measured SDMA, ADMA, and other L-arginine-related metabolites in 180 patients admitted with COVID-19 in four German university hospitals as compared to 127 healthy controls. Patients were treated according to accepted clinical guidelines and followed-up until death or hospital discharge. Classical inflammatory markers (leukocytes, CRP, PCT), renal function (eGFR), and clinical scores (SOFA) were taken from hospital records. In a small subgroup of 23 COVID-19 patients, sequential blood samples were available and analyzed for biomarker trends over time until 14 days after admission. Patients had significantly elevated SDMA, ADMA, and L-ornithine and lower L-citrulline concentrations than controls. Within COVID-19 patients, SDMA and ADMA were significantly higher in non-survivors (n = 41, 22.8%) than in survivors. In ROC analysis, the optimal cut-off to discriminate non-survivors from survivors was 0.579 µmol/L for SDMA and 0.599 µmol/L for ADMA (both p < 0.001). High SDMA and ADMA were associated with odds ratios for death of 11.45 (3.37-38.87) and 5.95 (2.63-13.45), respectively. Analysis of SDMA and ADMA allowed discrimination of a high-risk (mortality, 43.7%), medium-risk (15.1%), and low-risk group (3.6%); risk prediction was significantly improved over classical laboratory markers. We conclude that analysis of ADMA and SDMA after hospital admission significantly improves risk prediction in COVID-19.
Collapse
Affiliation(s)
- Juliane Hannemann
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Zink
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yoana Mileva
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paul Balfanz
- Department of Cardiology, Angiology and Intensive Care Medicine, Medical Clinic I, University Hospital Aachen, Aachen, Germany
- Institute of Pathology and Central Biobank, University Hospital Aachen, Aachen, Germany
| | - Edgar Dahl
- Hannover Unified Biobank, Medizinische Hochschule Hannover, Hannover, Germany
| | - Sonja Volland
- Department of Physiology, Henri Mondor Hospital, FHU-SENEC, INSERM U955, Université Paris-Est Créteil (UPEC), AP-HP, Créteil, France
| | - Thomas Illig
- Department of Physiology, Henri Mondor Hospital, FHU-SENEC, INSERM U955, Université Paris-Est Créteil (UPEC), AP-HP, Créteil, France
| | - Edzard Schwedhelm
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Florian Kurth
- Department of Infectious Diseases and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alexandra Stege
- Central Biobank Charité, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Aepfelbacher
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Armin Hoffmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Böger
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.
| |
Collapse
|
4
|
Mendoza-Hernandez MA, Hernandez-Fuentes GA, Sanchez-Ramirez CA, Rojas-Larios F, Guzman-Esquivel J, Rodriguez-Sanchez IP, Martinez-Fierro ML, Cardenas-Rojas MI, De-Leon-Zaragoza L, Trujillo-Hernandez B, Fuentes-Murguia M, Ochoa-Díaz-López H, Sánchez-Meza K, Delgado-Enciso I. Time‑dependent ROC curve analysis to determine the predictive capacity of seven clinical scales for mortality in patients with COVID‑19: Study of a hospital cohort with very high mortality. Biomed Rep 2024; 20:100. [PMID: 38765855 PMCID: PMC11099607 DOI: 10.3892/br.2024.1788] [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: 02/12/2024] [Accepted: 04/12/2024] [Indexed: 05/22/2024] Open
Abstract
Clinical data from hospital admissions are typically utilized to determine the prognostic capacity of Coronavirus disease 2019 (COVID-19) indices. However, as disease status and severity markers evolve over time, time-dependent receiver operating characteristic (ROC) curve analysis becomes more appropriate. The present analysis assessed predictive power for death at various time points throughout patient hospitalization. In a cohort study involving 515 hospitalized patients (General Hospital Number 1 of Mexican Social Security Institute, Colima, Mexico from February 2021 to December 2022) with COVID-19, seven severity indices [Pneumonia Severity Index (PSI) PaO2/FiO2 arterial oxygen pressure/fraction of inspired oxygen (Kirby index), the Critical Illness Risk Score (COVID-GRAM), the National Early Warning Score 2 (NEWS-2), the quick Sequential Organ Failure Assessment score (qSOFA), the Fibrosis-4 index (FIB-4) and the Viral Pneumonia Mortality Score (MuLBSTA were evaluated using time-dependent ROC curves. Clinical data were collected at admission and at 2, 4, 6 and 8 days into hospitalization. The study calculated the area under the curve (AUC), sensitivity, specificity, and predictive values for each index at these time points. Mortality was 43.9%. Throughout all time points, NEWS-2 demonstrated the highest predictive power for mortality, as indicated by its AUC values. PSI and COVID-GRAM followed, with predictive power increasing as hospitalization duration progressed. Additionally, NEWS-2 exhibited the highest sensitivity (>96% in all periods) but showed low specificity, which increased from 22.9% at admission to 58.1% by day 8. PSI displayed good predictive capacity from admission to day 6 and excellent predictive power at day 8 and its sensitivity remained >80% throughout all periods, with moderate specificity (70.6-77.3%). COVID-GRAM demonstrated good predictive capacity across all periods, with high sensitivity (84.2-87.3%) but low-to-moderate specificity (61.5-67.6%). The qSOFA index initially had poor predictive power upon admission but improved after 4 days. FIB-4 had a statistically significant predictive capacity in all periods (P=0.001), but with limited clinical value (AUC, 0.639-0.698), and with low sensitivity and specificity. MuLBSTA and IKIRBY exhibited low predictive power at admission and no power after 6 days. In conclusion, in COVID-19 patients with high mortality rates, NEWS-2 and PSI consistently exhibited predictive power for death during hospital stay, with PSI demonstrating the best balance between sensitivity and specificity.
Collapse
Affiliation(s)
- Martha A. Mendoza-Hernandez
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
- COVID Unit, General Hospital Number 1, Mexican Institute of Social Security, Villa de Alvarez, Colima 28984, Mexico
| | | | | | - Fabian Rojas-Larios
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
| | - Jose Guzman-Esquivel
- Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Villa de Alvarez, Colima 28984, Mexico
| | - Iram P. Rodriguez-Sanchez
- Molecular and Structural Physiology Laboratory, School of Biological Sciences, Autonomous University of Nuevo Leon, San Nicolas de los Garza 66455, Mexico
| | - Margarita L. Martinez-Fierro
- Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Autonomous University of Zacatecas, Zacatecas 98160, Mexico
| | - Martha I. Cardenas-Rojas
- Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Villa de Alvarez, Colima 28984, Mexico
- Department of Research, Colima Cancerology State Institute, IMSS-Bienestar Colima, Colima 28085, Mexico
| | - Luis De-Leon-Zaragoza
- Department of Research, Colima Cancerology State Institute, IMSS-Bienestar Colima, Colima 28085, Mexico
| | | | - Mercedes Fuentes-Murguia
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
| | - Héctor Ochoa-Díaz-López
- Department of Health, El Colegio de La Frontera Sur, San Cristóbal de Las Casas, 29290 Chiapas, Mexico
| | - Karmina Sánchez-Meza
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
| | - Ivan Delgado-Enciso
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
- Department of Research, Colima Cancerology State Institute, IMSS-Bienestar Colima, Colima 28085, Mexico
| |
Collapse
|
5
|
Yousufuddin M, Mahmood M, Barkoudah E, Badr F, Khandelwal K, Manyara W, Sharma U, Abdalrhim AD, Issa M, Bhagra S, Murad MH. Rural-urban Differences in Long-term Mortality and Readmission Following COVID-19 Hospitalization, 2020 to 2023. Open Forum Infect Dis 2024; 11:ofae197. [PMID: 38698896 PMCID: PMC11065360 DOI: 10.1093/ofid/ofae197] [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: 11/17/2023] [Accepted: 04/03/2024] [Indexed: 05/05/2024] Open
Abstract
Background We compared long-term mortality and readmission rates after COVID-19 hospitalization based on rural-urban status and assessed the impact of COVID-19 vaccination introduction on clinical outcomes by rurality. Methods The study comprised adults hospitalized for COVID-19 at 17 hospitals in 4 US states between March 2020 and July 2022, followed until May 2023. The main analysis included all patients, whereas a sensitivity analysis focused on residents from 4 states containing 17 hospitals. Additional analyses compared the pre- and postvaccination periods. Results The main analysis involved 9325 COVID-19 hospitalized patients: 31% were from 187 rural counties in 31 states; 69% from 234 urban counties in 44 states; the mean age was 65 years (rural, 66 years; urban, 64 years); 3894 women (rural, 41%; urban, 42%); 8007 Whites (rural, 87%; urban, 83%); 1738 deaths (rural, 21%; urban, 17%); and 2729 readmissions (rural, 30%; urban, 29%). During a median follow-up of 602 days, rural residence was associated with a 22% higher all-cause mortality (log-rank, P < .001; hazard ratio, 1.22; 95% confidence interval, 1.10-1.34, P < .001), and a trend toward a higher readmission rate (log-rank, P = .038; hazard ratio, 1.06; 95% confidence interval, .98-1.15; P = .130). The results remained consistent in the sensitivity analysis and in both pre- and postvaccination time periods. Conclusions and Relevance Patients from rural counties experienced higher mortality and tended to be readmitted more frequently following COVID-19 hospitalization over the long term compared with those from urban counties, a difference that remained even after the introduction of COVID-19 vaccines.
Collapse
Affiliation(s)
- Mohammed Yousufuddin
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Maryam Mahmood
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ebrahim Barkoudah
- Department of Internal Medicine/Hospital Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Fatimazahra Badr
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Kanika Khandelwal
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Warren Manyara
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Umesh Sharma
- Division of Hospital Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Ahmed D Abdalrhim
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Meltiady Issa
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sumit Bhagra
- Department of Endocrine and Metabolism, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Mohammad H Murad
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
6
|
Ayyaz FM, Joyner J, Cheetham M, Briggs T, Gray WK. Association of day-case rates with post COVID-19 recovery of elective laparoscopic cholecystectomy activity across England. Ann R Coll Surg Engl 2024. [PMID: 38563060 DOI: 10.1308/rcsann.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION The aim of this study was to investigate the safety of day-case laparoscopic cholecystectomy, and the association between day-case rates and, post the COVID-19 pandemic, recovery of activity to prepandemic levels for integrated care boards (ICBs) in England. METHODS This was a retrospective observational study of the Hospital Episodes Statistics (HES) data set. Elective laparoscopic cholecystectomies for the period 1 January 2019 to 31 December 2022 were identified. Activity levels for 2022 were compared with those for the whole of 2019 (baseline). Day-case activity was identified where the length of stay recorded in the HES was zero days. RESULTS Data were available for 184,252 patients across the 42 ICBs in England, of which 120,408 (65.3%) were day-case procedures. By December 2022, activity levels for the whole of England had returned to 88.2% of prepandemic levels. The South West region stood out as having recovered activity levels to the greatest extent, with activity at 97.3% of prepandemic levels during 2022. The South West also had the highest postpandemic day-case rate at 74.9% of all patients seen as a day-case during 2022; this compares with an England average of 65.3%. At an ICB level, there was a significant correlation between day-case rates and postpandemic activity levels (r = 0.362, p = 0.019). There was no strong or consistent evidence that day-case surgery had poorer patient outcomes than inpatient surgery. CONCLUSIONS Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Increasing day-case rates may be important if ICBs in other regions are to increase activity levels up to and beyond prepandemic levels.
Collapse
Affiliation(s)
- F M Ayyaz
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- Manchester University NHS Foundation Trust, UK
| | - J Joyner
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- Croydon Health Services NHS Trust, UK
| | - M Cheetham
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- The Shrewsbury and Telford Hospital NHS Trust, UK
| | - Twr Briggs
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- Royal National Orthopaedic Hospital NHS Trust, UK
| | - W K Gray
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
| |
Collapse
|
7
|
Kolhe NV, Fluck RJ, Taal MW. Regional variation of COVID-19 admissions, acute kidney injury and mortality in England - a national observational study using administrative data. BMC Infect Dis 2024; 24:346. [PMID: 38519921 PMCID: PMC10960376 DOI: 10.1186/s12879-024-09210-6] [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: 10/31/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND This study explores regional variations in COVID-19 hospitalization rates, in-hospital mortality, and acute kidney injury (AKI) in England. We investigated the influence of population demographic characteristics, viral strain changes, and therapeutic advances on clinical outcomes. METHODS Using hospital episode statistics, we conducted a retrospective cohort study with 749,844 admissions in 337,029 adult patients with laboratory-confirmed COVID-19 infection (March 1, 2020, to March 31, 2021). Multivariable logistic regression identified factors predicting AKI and mortality in COVID-19 hospitalized patients. RESULTS London had the highest number of COVID-19 admissions (131,338, 18%), followed by the North-west region (122,683, 16%). The North-west had the highest population incidence of COVID-19 hospital admissions (21,167 per million population, pmp), while the South-west had the lowest (9,292 admissions pmp). Patients in London were relatively younger (67.0 ± 17.7 years) than those in the East of England (72.2 ± 16.8 years). The shortest length of stay was in the North-east (12.2 ± 14.9 days), while the longest was in the North-west (15.2 ± 17.9 days). All eight regions had higher odds of death compared to London, ranging from OR 1.04 (95% CI 1.00, 1.07) in the South-west to OR 1.24 (95% CI 1.21, 1.28) in the North-west. Older age, Asian ethnicity, emergency admission, transfers from other hospitals, AKI presence, ITU admission, social deprivation, and comorbidity were associated with higher odds of death. AKI incidence was 30.3%, and all regions had lower odds of developing AKI compared to London. Increasing age, mixed and black ethnicity, emergency admission, transfers from other providers, ITU care, and different levels of comorbidity were associated with higher odds of developing AKI. CONCLUSIONS London exhibited higher hospital admission numbers and AKI incidence, but lower odds of death compared to other regions in England. TRIAL REGISTRATION Registered on National Library of Medicine website ( www. CLINICALTRIALS gov ) with registration number NCT04579562 on 8/10/2020.
Collapse
Affiliation(s)
- Nitin V Kolhe
- University Hospitals of Derby and Burton NHS Trust, Uttoxeter Road, Derby, DE22 3NE, UK.
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Richard J Fluck
- University Hospitals of Derby and Burton NHS Trust, Uttoxeter Road, Derby, DE22 3NE, UK
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Maarten W Taal
- University Hospitals of Derby and Burton NHS Trust, Uttoxeter Road, Derby, DE22 3NE, UK
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
8
|
Wright G, Senthil K, Zadeh-Kochek A, Au JHS, Zhang J, Huang J, Saripalli R, Khan M, Ghauri O, Kim S, Mohammed Z, Alves C, Koduri G. Health-related quality of life after 12 months post discharge in patients hospitalised with COVID-19-related severe acute respiratory infection (SARI): a prospective analysis of SF-36 data and correlation with retrospective admission data on age, disease severity, and frailty. BMJ Open 2024; 14:e076797. [PMID: 38508629 PMCID: PMC10961539 DOI: 10.1136/bmjopen-2023-076797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/19/2024] [Indexed: 03/22/2024] Open
Abstract
Long-term outcome and 'health-related quality of life' (HRQoL) following hospitalisation for COVID-19-related severe acute respiratory infection (SARI) is limited. OBJECTIVE To assess the impact of HRQoL in patients hospitalised with COVID-19-related SARI at 1 year post discharge, focusing on the potential impact of age, frailty, and disease severity. METHOD Routinely collected outcome data on 1207 patients admitted with confirmed COVID-19 related SARI across all three secondary care sites in our NHS trust over 3 months were assessed in this retrospective cohort study. Of those surviving 1 year, we prospectively collected 36-item short form (SF-36) HRQoL questionnaires, comparing three age groups (<49, 49-69, and the over 69-year-olds), the relative impact of frailty (using the Clinical Frailty Score; CFS), and disease severity (using National Early Warning Score; NEWS) on HRQoL domains. RESULTS Overall mortality was 46.5% in admitted patients. In our SF-36 cohort (n=169), there was a significant reduction in all HRQoL domains versus normative data; the most significant reductions were in the physical component (p<0.001) across all ages and the emotional component (p<0.01) in the 49-69 year age group, with age having no additional impact on HRQoL. However, there was a significant correlation between physical well-being versus CFS (the correlation coefficient=-0.37, p<0.05), though not NEWS, with no gender difference observed. CONCLUSION There was a significant reduction in all SF-36 domains at 1 year. Poor CFS at admission was associated with a significant and prolonged impact on physical parameters at 1 year. Age had little impact on the severity of HRQoL, except in the domains of physical functioning and the overall physical component.
Collapse
Affiliation(s)
- Gavin Wright
- Gastroenterology, Mid and South Essex NHS Foundation Trust, Essex, UK
- King's College London, London, UK
| | - Keerthi Senthil
- Medicine, Mid and South Essex NHS Foundation Trust, Essex, UK
| | | | | | - Jufen Zhang
- Anglia Ruskin University, Chelmsford, Essex, UK
| | - Jiawei Huang
- Medicine, Mid and South Essex NHS Foundation Trust, Essex, UK
| | - Ravi Saripalli
- Medicine, Mid and South Essex NHS Foundation Trust, Essex, UK
| | - Mohiuddin Khan
- Medicine, Mid and South Essex NHS Foundation Trust, Essex, UK
| | - Omar Ghauri
- Medicine, Mid and South Essex NHS Foundation Trust, Essex, UK
| | - San Kim
- Medicine, Mid and South Essex NHS Foundation Trust, Essex, UK
| | | | - Carol Alves
- Research and Development, Mid and South Essex NHS Foundation Trust, Essex, UK
| | - Gouri Koduri
- Anglia Ruskin University, Chelmsford, Essex, UK
- Rheumatology, Mid and South Essex NHS Foundation Trust, Essex, UK
| |
Collapse
|
9
|
Habbous S, Lambrinos A, Ming K, Hellsten E. A cohort study of patients hospitalised with SARS-CoV-2 infection in Ontario: patient characteristics and outcomes by wave. Swiss Med Wkly 2024; 154:3636. [PMID: 38579312 DOI: 10.57187/s.3636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Each wave of the COVID-19 pandemic exhibited a unique combination of epidemiological, social and structural characteristics. We explore similarities and differences in wave-over-wave characteristics of patients hospitalised with COVID-19. METHODS This was a population-based study in Ontario province, Canada. Patients hospitalised with SARS-CoV-2 between 26 February 2020 and 31 March 2022 were included. An admission was considered related to SARS-CoV-2 infection if the provincial inpatient or outpatient hospital databases contained the ICD-10 diagnostic codes U071/U072 or the Ontario Laboratories Information System indicated a positive SARS-CoV-2 test result (PCR or rapid antigen testing) during the admission or up to two weeks prior. The primary outcome was 90-day mortality (modified Poisson regression). Secondary outcomes were use of critical care during the admission (logistic regression) and total length-of-stay (linear regression with heteroskedastic-consistent standard-error estimators). All models were adjusted for demographic characteristics, neighbourhood socioeconomic factors and indicators of illness severity. RESULTS There were 73,201 SARS-CoV-2-related admissions: 6127 (8%) during wave 1 (wild-type), 14,371 (20%) during wave 2 (wild-type), 16,653 (23%) during wave 3 (Alpha), 5678 (8%) during wave 4 (Delta) and 30,372 (42%) during wave 5 (Omicron). SARS-CoV-2 was the most responsible diagnosis for 70% of admissions during waves 1-2 and 42% in wave 5. The proportion of admitted patients who were long-term care residents was 18% (n = 1111) during wave 1, decreasing to 10% (n = 1468) in wave 2 and <5% in subsequent waves. During waves 1-3, 46% of all admitted patients resided in a neighbourhood assigned to the highest ethnic diversity quintile, which declined to 27% during waves 4-5. Compared to wave 1, 90-day mortality was similar during wave 2 (adjusted risk ratio [aRR]: 1.00 [95% CI: 0.95-1.04]), but lower during wave 3 (aRR: 0.89 [0.85-0.94]), wave 4 (aRR: 0.85 [0.79-0.91]) and wave 5 (aRR: 0.83 [0.80-0.88]). Improvements in survival over waves were observed among elderly patients (p-interaction <0.0001). Critical care admission was significantly less likely during wave 5 than previous waves (adjusted odds ratio: 0.50 [0.47-0.54]). The length of stay was a median of 8.5 (3.6-23.8) days during wave 1 and 5.3 (2.2-12.6) during wave 5. After adjustment, the mean length of stay was on average -10.4 (-11.1 to -9.8) days, i.e. shorter, in wave 5 vs wave 1. CONCLUSION Throughout the pandemic, sociodemographic characteristics of patients hospitalised with SARS-CoV-2 changed over time, particularly in terms of ethnic diversity, but still disproportionately affected patients from more marginalised regions. Improved survival and reduced use of critical care during the Omicron wave are reassuring.
Collapse
Affiliation(s)
- Steven Habbous
- Ontario Health, Toronto, Ontario, Canada
- Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | | | | | | |
Collapse
|
10
|
Hedberg P, Parczewski M, Serwin K, Marchetti G, Bai F, Ole Jensen BE, Pereira JP, Drobniewski F, Reschreiter H, Naumovas D, Ceccherini-Silberstein F, Rubio Quintanares GH, Mwau M, Toscano C, König F, Pfeifer N, Zazzi M, Fanti I, Incardona F, Cozzi-Lepri A, Sönnerborg A, Nauclér P. In-hospital mortality during the wild-type, alpha, delta, and omicron SARS-CoV-2 waves: a multinational cohort study in the EuCARE project. THE LANCET REGIONAL HEALTH. EUROPE 2024; 38:100855. [PMID: 38476753 PMCID: PMC10928271 DOI: 10.1016/j.lanepe.2024.100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 03/14/2024]
Abstract
Background Investigating outcomes of hospitalised COVID-19 patients throughout the pandemic is crucial to understand the impact of different SARS-CoV-2 variants. We compared 28-day in-hospital mortality of Wild-type, Alpha, Delta, and Omicron variant infections. Whether the difference in risk by variant varied by age was also evaluated. Methods We conducted a cohort study including patients ≥18 years, hospitalised between 2020 and 02-01 and 2022-10-15 with a SARS-CoV-2 positive test, from nine countries. Variant was classified based on sequenced viruses or from national public metadata. Mortality was compared using the cumulative incidence function and subdistribution hazard ratios (SHR) adjusted for age, sex, calendar time, and comorbidities. Results were shown age-stratified due to effect measure modification (P < 0.0001 for interaction between age and variant). Findings We included 38,585 participants: 19,763 Wild-type, 6387 Alpha, 3640 Delta, and 8795 Omicron. The cumulative incidence of mortality decreased throughout the study period. Among participants ≥70 years, the adjusted SHR (95% confidence interval) for Delta vs. Omicron was 1.66 (1.29-2.13). This estimate was 1.66 (1.17-2.36) for Alpha vs. Omicron, and 1.34 (0.92-1.95) for Wild-type vs. Omicron. These were 1.21 (0.81-1.82), 1.21 (0.68-2.17), and 0.98 (0.53-1.82) among unvaccinated participants. When comparing Omicron sublineages, the aSHR for BA.1 was 1.92 (1.43-2.58) compared to BA.2 and 1.52 (1.11-2.08) compared to BA.5. Interpretation The herein observed decrease in in-hospital mortality seems to reflect a combined effect of immunity from vaccinations and previous infections, although differences in virulence between SARS-CoV-2 variants may also have contributed. Funding European Union's Horizon Europe Research and Innovation Programme.
Collapse
Affiliation(s)
- Pontus Hedberg
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Milosz Parczewski
- Department of Tropical Infectious Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Karol Serwin
- Department of Tropical Infectious Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Giulia Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, ASST Santi Paolo E Carlo, University of Milan, Milan, Italy
| | - Francesca Bai
- Department of Health Sciences, Clinic of Infectious Diseases, ASST Santi Paolo E Carlo, University of Milan, Milan, Italy
| | - Björn-Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Joana P.V. Pereira
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Francis Drobniewski
- Department of Infectious Disease, Imperial College, London, W12 0NN, UK
- University Hospital Dorset, Poole Hospital, Poole, Dorset, UK
| | | | - Daniel Naumovas
- Vilnius Santaros Klinikos Biobank, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Gibran Horemheb Rubio Quintanares
- Virus Security Department, Paul Ehrlich Institute, Langen, Germany
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Matilu Mwau
- Center for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Cristina Toscano
- Microbiology Laboratory, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Florian König
- Institute for Bioinformatics and Medical Informatics and Medical Informatics (IBMI), University of Tübingen, Tübingen, Germany
- Methods in Medical Informatics Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Nico Pfeifer
- Institute for Bioinformatics and Medical Informatics and Medical Informatics (IBMI), University of Tübingen, Tübingen, Germany
- Methods in Medical Informatics Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, Italy
| | - Iuri Fanti
- EuResist Network GEIE, Via Guido Guinizelli, 98/100, 00152, Roma, Italy
| | - Francesca Incardona
- EuResist Network GEIE, Via Guido Guinizelli, 98/100, 00152, Roma, Italy
- InformaPRO s.r.l., Via Guido Guinizelli, 98/100, 00152, Roma, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME) Institute for Global Health UCL, Rowland Hill St, London, NW3 2PF, UK
| | - Anders Sönnerborg
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
11
|
Cummings MJ, Bakamutumaho B, Lutwama JJ, Owor N, Che X, Astorkia M, Postler TS, Kayiwa J, Kiconco J, Muwanga M, Nsereko C, Rwamutwe E, Nayiga I, Kyebambe S, Haumba M, Bosa HK, Ocom F, Watyaba B, Kikaire B, Tomoiaga AS, Kisaka S, Kiwanuka N, Lipkin WI, O'Donnell MR. COVID-19 immune signatures in Uganda persist in HIV co-infection and diverge by pandemic phase. Nat Commun 2024; 15:1475. [PMID: 38368384 PMCID: PMC10874401 DOI: 10.1038/s41467-024-45204-3] [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: 04/25/2023] [Accepted: 01/17/2024] [Indexed: 02/19/2024] Open
Abstract
Little is known about the pathobiology of SARS-CoV-2 infection in sub-Saharan Africa, where severe COVID-19 fatality rates are among the highest in the world and the immunological landscape is unique. In a prospective cohort study of 306 adults encompassing the entire clinical spectrum of SARS-CoV-2 infection in Uganda, we profile the peripheral blood proteome and transcriptome to characterize the immunopathology of COVID-19 across multiple phases of the pandemic. Beyond the prognostic importance of myeloid cell-driven immune activation and lymphopenia, we show that multifaceted impairment of host protein synthesis and redox imbalance define core biological signatures of severe COVID-19, with central roles for IL-7, IL-15, and lymphotoxin-α in COVID-19 respiratory failure. While prognostic signatures are generally consistent in SARS-CoV-2/HIV-coinfection, type I interferon responses uniquely scale with COVID-19 severity in persons living with HIV. Throughout the pandemic, COVID-19 severity peaked during phases dominated by A.23/A.23.1 and Delta B.1.617.2/AY variants. Independent of clinical severity, Delta phase COVID-19 is distinguished by exaggerated pro-inflammatory myeloid cell and inflammasome activation, NK and CD8+ T cell depletion, and impaired host protein synthesis. Combining these analyses with a contemporary Ugandan cohort of adults hospitalized with influenza and other severe acute respiratory infections, we show that activation of epidermal and platelet-derived growth factor pathways are distinct features of COVID-19, deepening translational understanding of mechanisms potentially underlying SARS-CoV-2-associated pulmonary fibrosis. Collectively, our findings provide biological rationale for use of broad and targeted immunotherapies for severe COVID-19 in sub-Saharan Africa, illustrate the relevance of local viral and host factors to SARS-CoV-2 immunopathology, and highlight underemphasized yet therapeutically exploitable immune pathways driving COVID-19 severity.
Collapse
Affiliation(s)
- Matthew J Cummings
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Barnabas Bakamutumaho
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Julius J Lutwama
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Nicholas Owor
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Xiaoyu Che
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Maider Astorkia
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Thomas S Postler
- Department of Microbiology and Immunology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - John Kayiwa
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Jocelyn Kiconco
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | | | - Irene Nayiga
- Entebbe Regional Referral Hospital, Entebbe, Uganda
| | | | - Mercy Haumba
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Henry Kyobe Bosa
- Uganda Peoples' Defence Forces, Kampala, Uganda
- Ministry of Health, Kampala, Uganda
| | | | - Benjamin Watyaba
- European and Developing Countries Clinical Trials Partnership-Eastern Africa Consortium for Clinical Research, Uganda Virus Research Institute, Entebbe, Uganda
| | - Bernard Kikaire
- European and Developing Countries Clinical Trials Partnership-Eastern Africa Consortium for Clinical Research, Uganda Virus Research Institute, Entebbe, Uganda
- Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alin S Tomoiaga
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Accounting, Business Analytics, Computer Information Systems, and Law, Manhattan College, New York, NY, USA
| | - Stevens Kisaka
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - W Ian Lipkin
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Max R O'Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
12
|
Rhee C, Klompas M, Pak TR, Köhler JR. In Support of Universal Admission Testing for SARS-CoV-2 During Significant Community Transmission. Clin Infect Dis 2024; 78:439-444. [PMID: 37463411 DOI: 10.1093/cid/ciad424] [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: 04/30/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
Many hospitals have stopped or are considering stopping universal admission testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We discuss reasons why admission testing should still be part of a layered system to prevent hospital-acquired SARS-CoV-2 infections during times of significant community transmission. These include the morbidity of SARS-CoV-2 in vulnerable patients, the predominant contribution of presymptomatic and asymptomatic people to transmission, the high rate of transmission between patients in shared rooms, and data suggesting surveillance testing is associated with fewer nosocomial infections. Preferences of diverse patient populations, particularly the hardest-hit communities, should be surveyed and used to inform prevention measures. Hospitals' ethical responsibility to protect patients from serious infections should predominate over concerns about costs, labor, and inconvenience. We call for more rigorous data on the incidence and morbidity of nosocomial SARS-CoV-2 infections and more research to help determine when to start, stop, and restart universal admission testing and other prevention measures.
Collapse
Affiliation(s)
- Chanu Rhee
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Theodore R Pak
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julia R Köhler
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
13
|
Plášek J, Dodulík J, Gai P, Hrstková B, Škrha J, Zlatohlávek L, Vlasáková R, Danko P, Ondráček P, Čubová E, Čapek B, Kollárová M, Fürst T, Václavík J. A Simple Risk Formula for the Prediction of COVID-19 Hospital Mortality. Infect Dis Rep 2024; 16:105-115. [PMID: 38391586 PMCID: PMC10887710 DOI: 10.3390/idr16010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
SARS-CoV-2 respiratory infection is associated with significant morbidity and mortality in hospitalized patients. We aimed to assess the risk factors for hospital mortality in non-vaccinated patients during the 2021 spring wave in the Czech Republic. A total of 991 patients hospitalized between January 2021 and March 2021 with a PCR-confirmed SARS-CoV-2 acute respiratory infection in two university hospitals and five rural hospitals were included in this analysis. After excluding patients with unknown outcomes, 790 patients entered the final analyses. Out of 790 patients included in the analysis, 282/790 (35.7%) patients died in the hospital; 162/790 (20.5) were male and 120/790 (15.2%) were female. There were 141/790 (18%) patients with mild, 461/790 (58.3%) with moderate, and 187/790 (23.7%) with severe courses of the disease based mainly on the oxygenation status. The best-performing multivariate regression model contains only two predictors-age and the patient's state; both predictors were rendered significant (p < 0.0001). Both age and disease state are very significant predictors of hospital mortality. An increase in age by 10 years raises the risk of hospital mortality by a factor of 2.5, and a unit increase in the oxygenation status raises the risk of hospital mortality by a factor of 20.
Collapse
Affiliation(s)
- Jiří Plášek
- Department of Internal Medicine and Cardiology, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
- Centre for Research on Internal Medicine and Cardiovascular Diseases, University of Ostrava, 703 00 Ostrava, Czech Republic
| | - Jozef Dodulík
- Department of Internal Medicine and Cardiology, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
| | - Petr Gai
- Department of Pulmonary Medicine and Tuberculosis, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
| | - Barbora Hrstková
- Department of Infectious Diseases, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
| | - Jan Škrha
- Department of Internal Medicine, General University Hospital, 128 08 Prague, Czech Republic
| | - Lukáš Zlatohlávek
- Department of Internal Medicine, General University Hospital, 128 08 Prague, Czech Republic
| | - Renata Vlasáková
- Department of Internal Medicine, General University Hospital, 128 08 Prague, Czech Republic
| | - Peter Danko
- Department of Internal Medicine, Havířov Regional Hospital, 736 01 Havířov, Czech Republic
| | - Petr Ondráček
- Department of Internal Medicine, Bílovec Regional Hospital, 743 01 Bílovec, Czech Republic
| | - Eva Čubová
- Department of Internal Medicine, Fifejdy City Hospital, 728 80 Ostrava, Czech Republic
| | - Bronislav Čapek
- Department of Internal Medicine, Associated Medical Facilities, 794 01 Krnov, Czech Republic
| | - Marie Kollárová
- Department of Internal Medicine, Třinec Regional Hospital, 739 61 Třinec, Czech Republic
| | - Tomáš Fürst
- Department of Mathematical Analysis and Application of Mathematics, Palacky University, 771 46 Olomouc, Czech Republic
| | - Jan Václavík
- Department of Internal Medicine and Cardiology, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
- Centre for Research on Internal Medicine and Cardiovascular Diseases, University of Ostrava, 703 00 Ostrava, Czech Republic
| |
Collapse
|
14
|
Mendoza-Hernandez MA, Guzman-Esquivel J, Ramos-Rojas MA, Santillan-Luna VV, Sanchez-Ramirez CA, Hernandez-Fuentes GA, Diaz-Martinez J, Melnikov V, Rojas-Larios F, Martinez-Fierro ML, Tiburcio-Jimenez D, Rodriguez-Sanchez IP, Delgado-Enciso OG, Cabrera-Licona A, Delgado-Enciso I. Differences in the Evolution of Clinical, Biochemical, and Hematological Indicators in Hospitalized Patients with COVID-19 According to Their Vaccination Scheme: A Cohort Study in One of the World's Highest Hospital Mortality Populations. Vaccines (Basel) 2024; 12:72. [PMID: 38250885 PMCID: PMC10821037 DOI: 10.3390/vaccines12010072] [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: 11/30/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
COVID-19 vaccines primarily prevent severe illnesses or hospitalization, but there is limited data on their impact during hospitalization for seriously ill patients. In a Mexican cohort with high COVID-19 mortality, a study assessed vaccination's effects. From 2021 to 2022, 462 patients with 4455 hospital days were analyzed. The generalized multivariate linear mixed model (GENLINMIXED) with binary logistic regression link, survival analysis and ROC curves were used to identify risk factors for death. The results showed that the vaccinated individuals were almost half as likely to die (adRR = 0.54, 95% CI = 0.30-0.97, p = 0.041). When stratifying by vaccine, the Pfizer group (BNT162b2) had a 2.4-times lower risk of death (adRR = 0.41, 95% CI = 0.2-0.8, p = 0.008), while the AstraZeneca group (ChAdOx1-S) group did not significantly differ from the non-vaccinated (adRR = 1.04, 95% CI = 0.5-2.3, p = 0.915). The Pfizer group exhibited a higher survival, the unvaccinated showed increasing mortality, and the AstraZeneca group remained intermediate (p = 0.003, multigroup log-rank test). Additionally, BNT162b2-vaccinated individuals had lower values for markers, such as ferritin and D-dimer. Biochemical and hematological indicators suggested a protective effect of both types of vaccines, possibly linked to higher lymphocyte counts and lower platelet-to-lymphocyte ratio (PLR). It is imperative to highlight that these results reinforce the efficacy of COVID-19 vaccines. However, further studies are warranted for a comprehensive understanding of these findings.
Collapse
Affiliation(s)
- Martha A. Mendoza-Hernandez
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
- General Hospital of Zone 1, Colima Delegation, Mexican Institute of Social Security, Villa de Álvarez, Colima 28984, Mexico;
| | - Jose Guzman-Esquivel
- Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Villa de Alvarez, Colima 28984, Mexico;
| | - Marco A. Ramos-Rojas
- General Hospital of Zone 1, Colima Delegation, Mexican Institute of Social Security, Villa de Álvarez, Colima 28984, Mexico;
| | - Vanessa V. Santillan-Luna
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
| | - Carmen A. Sanchez-Ramirez
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
| | - Gustavo A. Hernandez-Fuentes
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
- Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico;
| | - Janet Diaz-Martinez
- Research Center in Minority Institutions, Robert Stempel College of Public Health, Florida International University, Miami, FL 33199, USA;
| | - Valery Melnikov
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
| | - Fabian Rojas-Larios
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
| | - Margarita L. Martinez-Fierro
- Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Autonomous University of Zacatecas, Zacatecas 98160, Mexico;
| | - Daniel Tiburcio-Jimenez
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
| | - Iram P. Rodriguez-Sanchez
- Molecular and Structural Physiology Laboratory, School of Biological Sciences, Autonomous University of Nuevo Leon, San Nicolas de los Garza 66455, Mexico;
| | - Osiris G. Delgado-Enciso
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
| | | | - Ivan Delgado-Enciso
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
- Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico;
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
| |
Collapse
|
15
|
Rehms R, Ellenbach N, Rehfuess E, Burns J, Mansmann U, Hoffmann S. A Bayesian hierarchical approach to account for evidence and uncertainty in the modeling of infectious diseases: An application to COVID-19. Biom J 2024; 66:e2200341. [PMID: 38285407 DOI: 10.1002/bimj.202200341] [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: 12/05/2022] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 01/30/2024]
Abstract
Infectious disease models can serve as critical tools to predict the development of cases and associated healthcare demand and to determine the set of nonpharmaceutical interventions (NPIs) that is most effective in slowing the spread of an infectious agent. Current approaches to estimate NPI effects typically focus on relatively short time periods and either on the number of reported cases, deaths, intensive care occupancy, or hospital occupancy as a single indicator of disease transmission. In this work, we propose a Bayesian hierarchical model that integrates multiple outcomes and complementary sources of information in the estimation of the true and unknown number of infections while accounting for time-varying underreporting and weekday-specific delays in reported cases and deaths, allowing us to estimate the number of infections on a daily basis rather than having to smooth the data. To address dynamic changes occurring over long periods of time, we account for the spread of new variants, seasonality, and time-varying differences in host susceptibility. We implement a Markov chain Monte Carlo algorithm to conduct Bayesian inference and illustrate the proposed approach with data on COVID-19 from 20 European countries. The approach shows good performance on simulated data and produces posterior predictions that show a good fit to reported cases, deaths, hospital, and intensive care occupancy.
Collapse
Affiliation(s)
- Raphael Rehms
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Nicole Ellenbach
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Eva Rehfuess
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jacob Burns
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ulrich Mansmann
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Statistics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sabine Hoffmann
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Statistics, Ludwig-Maximilians-University Munich, Munich, Germany
| |
Collapse
|
16
|
Auger N, Bilodeau-Bertrand M, Ayoub A, Blackburn M, Potter BJ. Hospitalization and hospital mortality rates during the first and second waves of the COVID-19 pandemic in Quebec: interrupted time series and decomposition analysis. Public Health 2023; 225:28-34. [PMID: 37918174 DOI: 10.1016/j.puhe.2023.09.016] [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: 04/28/2023] [Revised: 08/17/2023] [Accepted: 09/19/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES We investigated hospitalization and hospital mortality rates by cause during the first year of the COVID-19 pandemic in Quebec, Canada. STUDY DESIGN Interrupted time series and decomposition analysis. METHODS We analyzed hospital mortality during the first (February 25-August 22, 2020) and second waves (August 23, 2020-March 31, 2021), compared with 2019. We identified the cause of death and examined trends using: 1) interrupted time series analysis; 2) log-binomial regression; and 3) decomposition of cause-specific mortality. RESULTS Hospitalization rates decreased; however, the proportion of deaths increased from 27.0 per 1000 in 2019 to 35.0 per 1000 in the first wave, for an excess of 8.0 deaths per 1000 admissions. COVID-19 was the cause of a third of excess deaths (2.6 per 1000). Other drivers of excess deaths included respiratory conditions (1.6 deaths per 1000), circulatory disorders (0.6 deaths per 1000), and cancer (0.9 deaths per 1000). COVID-19 was the cause of 58% of excess deaths in the second wave. Interrupted time series regression indicated that the proportion of deaths increased at the outset of the first wave but returned to prepandemic levels before increasing again in the second wave. Compared with 2019, the first wave was associated with 1.31 times (95% confidence interval [CI] 1.28-1.33) and the second wave with 1.17 times (95% CI 1.15-1.19) the risk of death during hospitalization. CONCLUSIONS The pandemic was associated with a greater risk of hospital mortality. Excess deaths were driven by COVID-19 but also other causes, including respiratory conditions, circulatory disorders, and cancer.
Collapse
Affiliation(s)
- N Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
| | | | - A Ayoub
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - M Blackburn
- Department of Community Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - B J Potter
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Division of Cardiology, Department of Medicine, University of Montreal Hospital Centre, Montreal, Quebec, Canada
| |
Collapse
|
17
|
Samaan F, Freitas RAP, Viana R, Gâmbaro L, Cunha K, Vieira TD, Feitosa V, Correa EA, Maciel AT, Aranha S, Osawa EA, Pillar R, Flato EMDS, da Silva RC, Carneiro E, Souza FBGDL, Rossi PRG, Abud MB, Konigsfeld HP, da Silva RG, de Souza RBC, Coutinho SM, Goes MÂ, da Silva BAB, Zanetta DMT, Burdmann EA. Critically ill patients with COVID-19-associated acute kidney injury treated with kidney replacement therapy: Comparison between the first and second pandemic waves in São Paulo, Brazil. PLoS One 2023; 18:e0293846. [PMID: 37922282 PMCID: PMC10624321 DOI: 10.1371/journal.pone.0293846] [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: 07/10/2023] [Accepted: 10/20/2023] [Indexed: 11/05/2023] Open
Abstract
INTRODUCTION This study aimed to compare the characteristics and outcomes of critically ill patients with COVID-19-associated acute kidney injury (AKI) who were treated with kidney replacement therapy (KRT) in the first and second waves of the pandemic in the megalopolis of Sao Paulo, Brazil. METHODS A multicenter retrospective study was conducted in 10 intensive care units (ICUs). Patients aged ≥18 years, and treated with KRT due to COVID-19-associated AKI were included. We compared demographic, laboratory and clinical data, KRT parameters and patient outcomes in the first and second COVID-19 waves. RESULTS We assessed 656 patients (327 in the first wave and 329 in the second one). Second-wave patients were admitted later (7.1±5.0 vs. 5.6±3.9 days after the onset of symptoms, p<0.001), were younger (61.4±13.7 vs. 63.8±13.6 years, p = 0.023), had a lower frequency of diabetes (37.1% vs. 47.1%, p = 0.009) and obesity (29.5% vs. 40.0%, p = 0.007), had a greater need for vasopressors (93.3% vs. 84.6%, p<0.001) and mechanical ventilation (95.7% vs. 87.8%, p<0.001), and had higher lethality (84.8% vs. 72.7%, p<0.001) than first-wave patients. KRT quality markers were independently associated with a reduction in the OR for death in both pandemic waves. CONCLUSIONS In the Sao Paulo megalopolis, the lethality of critically ill patients with COVID-19-associated AKI treated with KRT was higher in the second wave of the pandemic, despite these patients being younger and having fewer comorbidities. Potential factors related to this poor outcome were difficulties in health care access, lack of intra-hospital resources, delay vaccination and virus variants.
Collapse
Affiliation(s)
- Farid Samaan
- Grupo Hapvida-NotreDame Intermédica, São Paulo, SP, Brazil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
- Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brazil
| | | | - Renata Viana
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Lívia Gâmbaro
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Karlla Cunha
- Grupo Hapvida-NotreDame Intermédica, São Paulo, SP, Brazil
| | | | | | | | | | - Sylvia Aranha
- Imed Research Group, Hospital São Camilo Pompéia, São Paulo, SP, Brazil
| | | | - Roberta Pillar
- Unidade Assistencial Hospital Ipiranga, São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emmanuel Almeida Burdmann
- Laboratório de Investigação Médica (LIM 12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
18
|
Wong JY, Cheung JK, Lin Y, Bond HS, Lau EHY, Ip DKM, Cowling BJ, Wu P. Intrinsic and Effective Severity of Coronavirus Disease 2019 Cases Infected With the Ancestral Strain and Omicron BA.2 Variant in Hong Kong. J Infect Dis 2023; 228:1231-1239. [PMID: 37368235 DOI: 10.1093/infdis/jiad236] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/25/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Understanding severity of infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its variants is crucial to inform public health measures. Here we used coronavirus disease 2019 (COVID-19) patient data from Hong Kong to characterize the severity profile of COVID-19. METHODS Time-varying and age-specific effective severity measured by case hospitalization risk and hospitalization fatality risk was estimated with all individual COVID-19 case data collected in Hong Kong from 23 January 2020 through 26 October 2022 over 6 epidemic waves. The intrinsic severity of Omicron BA.2 was compared with the estimate for the ancestral strain with the data from unvaccinated patients without previous infections. RESULTS With 32 222 COVID-19 hospitalizations and 9669 deaths confirmed over 6 epidemic waves, the time-varying hospitalization fatality risk dramatically increased from <10% before the largest fifth wave of Omicron BA.2 to 41% during the peak of the fifth wave when hospital resources were severely constrained. The age-specific fatality risk in unvaccinated hospitalized Omicron cases was comparable to the estimates for unvaccinated cases with the ancestral strain. During epidemics predominated by Omicron BA.2, fatality risk was highest among older unvaccinated patients. CONCLUSIONS Omicron has comparable intrinsic severity to the ancestral Wuhan strain, although the effective severity is substantially lower in Omicron cases due to vaccination.
Collapse
Affiliation(s)
- Jessica Y Wong
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Justin K Cheung
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yun Lin
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Helen S Bond
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric H Y Lau
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong Special Administrative Region, China
| | - Dennis K M Ip
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong Special Administrative Region, China
| | - Peng Wu
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong Special Administrative Region, China
| |
Collapse
|
19
|
Boasman A, Jones M, Dyer P, Briggs TWR, Gray WK. The association of demographics, frailty and multiple health conditions with outcomes from acute medical admissions to hospitals in England: exploratory analysis of an administrative dataset. Future Healthc J 2023; 10:278-286. [PMID: 38162202 PMCID: PMC10753216 DOI: 10.7861/fhj.2023-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Emergency and acute hospital services in England are under increasing pressure. The aim of this study was to investigate the association between key case-mix indicators and outcomes for adults admitted to hospital with an acute medical condition in England. All patients aged ≥16 years admitted to hospital in England as an acute unselected medical admission and who survived to discharge during the financial year 2021-2022 were included. Length of hospital stay was the primary outcome of interest. Data were available for 1,586,168 unique patients. A case-mix index was developed with a score that ranged from 0 to 12. Frailty was the most important variable in the index, followed by multiple health conditions and patient age. The mean case-mix score across hospital trusts in England ranged from 5.3 to 7.8. The case-mix index will support initiatives to better understand factors contributing to outcomes from acute medical admissions to hospital.
Collapse
Affiliation(s)
- Andrew Boasman
- Getting It Right First Time Programme, NHS England, London, UK
| | - Michael Jones
- Getting It Right First Time Programme, NHS England, London, UK, and consultant physician in acute medicine, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Philip Dyer
- Getting It Right First Time Programme, NHS England, London, UK and consultant physician in general medicine, diabetes and endocrinology, Heartlands Hospital, Birmingham, UK
| | - Tim WR Briggs
- Getting It Right First Time Programme and NHS England national director for clinical improvement and elective recovery, NHS England, London, UK
| | - William K Gray
- Getting It Right First Time programme, NHS England, London, UK
| |
Collapse
|
20
|
Di Costanzo D, Mazza M, Carbone A, Pratillo A, Di Perna F, Graziani V, Casals Marin C, Tartaglione S, Ponticiello A. Retrospective analysis of epidemiologic features and clinical course of COVID-19 patients and comparison between vaccinated and unvaccinated patients. Monaldi Arch Chest Dis 2023. [PMID: 37860843 DOI: 10.4081/monaldi.2023.2771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
At our Pneumology Department, we dealt with three waves of COVID-19 pandemics. The purpose of this study is to compare patients' epidemiological and clinical characteristics across waves and to assess the effect of vaccination on clinical presentation, course, and prognosis. From March 2020 to March 2022, a retrospective cohort study was conducted to compare patient characteristics. Based on the time of hospital admission, data from 456 patients were collected and divided into three groups (IW, IIW, and IIIW). In addition, we looked at the link between vaccination and clinical presentation and hospitalization outcome. The average age and comorbidities of patients increased, as did the worsening of respiratory conditions at admission (PaO2/FiO2 median 207 in IW, 95.5 in IIW, and 99 in IIIW). Continuous positive airway pressure (CPAP) was the primary respiratory support during the first wave, but an increase in the use of high flow nasal cannula and noninvasive ventilation was later observed, resulting in a higher hospital discharge rate and a lower intubation rate. Vaccinated patients had less severe COVID-19-related respiratory failure, a better clinical course, and a higher hospital discharge rate (71.4% in V-group vs 44.7% in NV-group, p<0.001). Patients' characteristics changed over the three waves, possibly due to virus mutations. The advancement of clinical and therapeutic management knowledge has contributed to a reduction in the severity of respiratory failure. The vaccination campaign improved the clinical course and reduced mortality.
Collapse
Affiliation(s)
| | | | - Andreina Carbone
- Cardiology Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples.
| | - Anna Pratillo
- Pneumology Department, Sant'Anna and San Sebastiano Hospital, Caserta.
| | - Felice Di Perna
- Pneumology Department, Sant'Anna and San Sebastiano Hospital, Caserta.
| | - Vittoria Graziani
- Pneumology Department, Sant'Anna and San Sebastiano Hospital, Caserta.
| | | | | | | |
Collapse
|
21
|
Hrycek E, Walawska-Hrycek A, Hamankiewicz M, Milewski K, Nowakowski P, Buszman P, Żurakowski A. The Influence of SARS-CoV-2 Infection on Acute Myocardial Infarction Outcomes. J Clin Med 2023; 12:5899. [PMID: 37762840 PMCID: PMC10532337 DOI: 10.3390/jcm12185899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND This multicenter retrospective study with a control group was designed to assess the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the outcomes of patients with myocardial infarction (MI). METHODS A total of 129 patients with COVID-19 who were treated for MI were included in this study. The control group comprised 129 comparable patients without SARS-CoV-2 infection. The in-hospital, out-of-hospital, and overall mortality were analyzed. RESULTS A total of thirty-one (24%) patients died in the study group, and two (1.6%) patients died in the control group (OR = 20.09; CI: 4.69-85.97; p < 0.001). Similar results were observed in all analyzed patient subgroups. Multivariable Cox regression analysis confirmed the significant influence of SARS-CoV-2 infection on in-hospital outcomes (HR: 8.48459; CI: 1.982-36.320; p = 0.004). Subanalysis of the groups with COVID-19 plus ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) revealed comparable mortality rates: 14 (21.12%) patients in the NSTEMI group and 17 (26.98%) patients in the STEMI subgroup died (OR: 1.3; CI: 0.56-3.37; p = 0.45). During out-of-hospital observation, no differences in mortality were observed (OR: 0.77; CI: 0.11-4.07; p = 0.73). CONCLUSIONS SARS-CoV-2 infection affects the in-hospital outcomes of patients with both MI and COVID-19, regardless of MI type (STEMI vs. NSTEMI).
Collapse
Affiliation(s)
- Eugeniusz Hrycek
- American Heart of Poland, Topolowa 16, 32-500 Chrzanów, Poland
- Department of Cardiology, Faculty of Medical Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland
| | - Anna Walawska-Hrycek
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | | | - Krzysztof Milewski
- American Heart of Poland, Armii Krajowej 101, 43-316 Bielsko-Biała, Poland
| | - Przemysław Nowakowski
- American Heart of Poland, Topolowa 16, 32-500 Chrzanów, Poland
- Department of Vascular Surgery, Faculty of Medical Sciences, University of Technology, Rolna 43, 40-555 Katowice, Poland
| | - Piotr Buszman
- Department of Cardiology, Faculty of Medical Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland
- American Heart of Poland, Armii Krajowej 101, 43-316 Bielsko-Biała, Poland
| | - Aleksander Żurakowski
- American Heart of Poland, Topolowa 16, 32-500 Chrzanów, Poland
- Department of Cardiology, Faculty of Medical Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland
| |
Collapse
|
22
|
Sorrell L, Leta V, Barnett A, Stevens K, King A, Inches J, Kobylecki C, Walker R, Chaudhuri KR, Martin H, Rideout J, Sneyd JR, Campbell S, Carroll C. Clinical features and outcomes of hospitalised patients with COVID-19 and Parkinsonian disorders: A multicentre UK-based study. PLoS One 2023; 18:e0285349. [PMID: 37523365 PMCID: PMC10389727 DOI: 10.1371/journal.pone.0285349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Parkinson's disease has been identified as a risk factor for severe Coronavirus disease 2019 (COVID-19) outcomes. However, whether the significant high risk of death from COVID-19 in people with Parkinson's disease is specific to the disease itself or driven by other concomitant and known risk factors such as comorbidities, age, and frailty remains unclear. OBJECTIVE To investigate clinical profiles and outcomes of people with Parkinson's disease and atypical parkinsonian syndromes who tested positive for COVID-19 in the hospital setting in a multicentre UK-based study. METHODS A retrospective cohort study of Parkinson's disease patients with a positive SARS-CoV-2 test admitted to hospital between February 2020 and July 2021. An online survey was used to collect data from clinical care records, recording patient, Parkinson's disease and COVID-19 characteristics. Associations with time-to-mortality and severe outcomes were analysed using either the Cox proportional hazards model or logistic regression models, as appropriate. RESULTS Data from 552 admissions were collected: 365 (66%) male; median (inter-quartile range) age 80 (74-85) years. The 34-day all-cause mortality rate was 38.4%; male sex, increased age and frailty, Parkinson's dementia syndrome, requirement for respiratory support and no vaccination were associated with increased mortality risk. Community-acquired COVID-19 and co-morbid chronic neurological disorder were associated with increased odds of requiring respiratory support. Hospital-acquired COVID-19 and delirium were associated with requiring an increase in care level post-discharge. CONCLUSIONS This first, multicentre, UK-based study on people with Parkinson's disease or atypical parkinsonian syndromes, hospitalised with COVID-19, adds and expands previous findings on clinical profiles and outcomes in this population.
Collapse
Affiliation(s)
- Lexy Sorrell
- University of Plymouth, Plymouth, United Kingdom
| | - Valentina Leta
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | | | - Kara Stevens
- Exploristics Ltd, Belfast, Northern Ireland, United Kingdom
| | - Angela King
- University of Plymouth, Plymouth, United Kingdom
| | - Jemma Inches
- University of Plymouth, Plymouth, United Kingdom
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Christopher Kobylecki
- Division of Neuroscience and Experimental Psychology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Richard Walker
- Department of Medicine, North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom
- Population Health Science Institute, Newcastle University, Newcastle, United Kingdom
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Hannah Martin
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | | | | | | | - Camille Carroll
- University of Plymouth, Plymouth, United Kingdom
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
- Newcastle University, Newcastle, United Kingdom
| |
Collapse
|
23
|
Akbulut S, Yagin FH, Sahin TT, Garzali IU, Tuncer A, Akyuz M, Bagci N, Barut B, Unsal S, Sarici KB, Saritas S, Ozer A, Bentli R, Colak C, Bayindir Y, Yilmaz S. Effect of COVID-19 Pandemic on Patients Who Have Undergone Liver Transplantation: Retrospective Cohort Study. J Clin Med 2023; 12:4466. [PMID: 37445501 DOI: 10.3390/jcm12134466] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND In liver transplant (LT) recipients, immunosuppressive therapy may potentially increase the risk of severe COVID-19 and may increase the mortality in patients. However, studies have shown conflicting results, with various studies reporting poor outcomes while the others show no difference between the LT recipients and healthy population. The aim of this study is to determine the impact of the COVID-19 pandemic on survival of LT recipients. METHODS This is a retrospective cohort study analyzing the data from 387 LT recipients diagnosed with COVID-19. LT recipients were divided into two groups: survival (n = 359) and non-survival (n = 28) groups. A logistic regression model was used to determine the independent risk factors for mortality. Machine learning models were used to analyze the contribution of independent variables to the mortality in LT recipients. RESULTS The COVID-19-related mortality rate in LT recipients was 7.2%. Multivariate analysis showed that everolimus use (p = 0.012; OR = 6.2), need for intubation (p = 0.001; OR = 38.4) and discontinuation of immunosuppressive therapy (p = 0.047; OR = 7.3) were independent risk factors for mortality. Furthermore, COVID-19 vaccination reduced the risk of mortality by 100 fold and was the single independent factor determining the survival of the LT recipients. CONCLUSION The effect of COVID-19 infection on LT recipients is slightly different from the effect of the disease on the general population. The COVID-19-related mortality is lower than the general population and vaccination for COVID-19 significantly reduces the risk of mortality.
Collapse
Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Public Health, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Fatma Hilal Yagin
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Tevfik Tolga Sahin
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Ibrahim Umar Garzali
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Surgery, Aminu Kano Teaching Hospital, Kano 700101, Nigeria
| | - Adem Tuncer
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Musap Akyuz
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya 44280, Turkey
| | - Nazlican Bagci
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya 44280, Turkey
| | - Bora Barut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Selver Unsal
- Department of Nursing Service, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Kemal Baris Sarici
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Serdar Saritas
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya 44280, Turkey
| | - Ali Ozer
- Department of Public Health, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Recep Bentli
- Department of Internal Medicine, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Cemil Colak
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Yasar Bayindir
- Department of Infectious Diseases and Clinical Microbiology, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| |
Collapse
|
24
|
Palus DK, Gołębiewska ME, Piątek O, Grudziński K, Majeranowski A, Owczuk R, Kuziemski K, Stefaniak T. Analysing COVID-19 treatment outcomes in dedicated wards at a large university hospital in northern Poland: a result-based observational study. BMJ Open 2023; 13:e066734. [PMID: 37308272 DOI: 10.1136/bmjopen-2022-066734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVES Presenting outcomes of patients hospitalised for COVID-19 should be put in context and comparison with other facilities. However, varied methodology applied in published studies can impede or even hinder a reliable comparison. The aim of this study is to share our experience in pandemic management and highlight previously under-reported factors affecting mortality. We present outcomes of COVID-19 treatment in our facility that will allow for an intercentre comparison. We use simple statistical parameters-case fatality ratio (CFR) and length of stay (LOS). SETTING Large clinical hospital in northern Poland serving over 120 000 patients annually. PARTICIPANTS Data were collected from patients hospitalised in COVID-19 general and intensive care unit (ICU) isolation wards from November 2020 to June 2021. The sample consisted of 640 patients-250 (39.1 %) were women and 390 (60.9 %) were men, with a median age of 69 (IQR 59-78) years. RESULTS Values of LOS and CFR were calculated and analysed. Overall CFR for the analysed period was 24.8%, varying from 15.9 % during second quarter 2021 to 34.1% during fourth quarter 2020. The CFR was 23.2% in the general ward and 70.7% in the ICU. All ICU patients required intubation and mechanical ventilation, and 44 (75.9 %) of them developed acute respiratory distress syndrome. The average LOS was 12.6 (±7.5) days. CONCLUSIONS We highlighted the importance of some of the under-reported factors affecting CFR, LOS and thus, mortality. For further multicentre analysis, we recommend broad analysis of factors affecting mortality in COVID-19 using simple and transparent statistical and clinical parameters.
Collapse
Affiliation(s)
- Damian Krystian Palus
- Faculty of Medicine, Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | | | - Olga Piątek
- Faculty of Medicine, Department of Pulmonology and Allergology, Medical University of Gdansk, Gdansk, Poland
- Faculty of Medicine, Department of Gynecology, Obstetrics and Neonatology, Medical University of Gdansk, Gdansk, Poland
| | | | - Alan Majeranowski
- Department of Hematology and Transplantology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
- Department of Cell Biology and Immunology, Intercollegiate Faculty of Biotechnology, University of Gdansk, Medical University of Gdansk, Gdansk, Poland
| | - Radosław Owczuk
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Kuziemski
- Faculty of Medicine, Department of Pulmonology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Stefaniak
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
- Board of Directors, University Clinical Center of Medical University of Gdansk, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
25
|
Gray WK, Navaratnam AV, Day J, Heyl J, Hardy F, Wheeler A, Eve-Jones S, Briggs TWR. Role of hospital strain in determining outcomes for people hospitalised with COVID-19 in England. Emerg Med J 2023:emermed-2023-213329. [PMID: 37236779 DOI: 10.1136/emermed-2023-213329] [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: 05/04/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND In England, reported COVID-19 mortality rates increased during winter 2020/21 relative to earlier summer and autumn months. This study aimed to examine the association between COVID-19-related hospital bed-strain during this time and patient outcomes. METHODS This was a retrospective observational study using Hospital Episode Statistics data for England. All unique patients aged ≥18 years in England with a diagnosis of COVID-19 who had a completed (discharged alive or died in hospital) hospital stay with an admission date between 1 July 2020 and 28 February 2021 were included. Bed-strain was calculated as the number of beds occupied by patients with COVID-19 divided by the maximum COVID-19 bed occupancy during the study period. Bed-strain was categorised into quartiles for modelling. In-hospital mortality was the primary outcome of interest and length of stay a secondary outcome. RESULTS There were 253 768 unique hospitalised patients with a diagnosis of COVID-19 during a hospital stay. Patient admissions peaked in January 2021 (n=89 047), although the crude mortality rate peaked slightly earlier in December 2020 (26.4%). After adjustment for covariates, the mortality rate in the lowest and highest quartile of bed-strain was 23.6% and 25.3%, respectively (OR 1.13, 95% CI 1.09 to 1.17). For the lowest and the highest quartile of bed-strain, adjusted mean length of stay was 13.2 days and 11.6 days, respectively in survivors and was 16.5 days and 12.6 days, respectively in patients who died in hospital. CONCLUSIONS High levels of bed-strain were associated with higher in-hospital mortality rates, although the effect was relatively modest and may not fully explain increased mortality rates during winter 2020/21 compared with earlier months. Shorter hospital stay during periods of greater strain may partly reflect changes in patient management over time.
Collapse
Affiliation(s)
- William K Gray
- Getting It Right First Time programme, NHS England, London, UK
| | | | - Jamie Day
- Getting It Right First Time programme, NHS England, London, UK
| | - Johannes Heyl
- Getting It Right First Time programme, NHS England, London, UK
- Department of Physics and Astronomy, University College London, London, UK
| | - Flavien Hardy
- Getting It Right First Time programme, NHS England, London, UK
| | - Andrew Wheeler
- Getting It Right First Time programme, NHS England, London, UK
| | - Sue Eve-Jones
- Getting It Right First Time programme, NHS England, London, UK
| | - Tim W R Briggs
- Getting It Right First Time programme, NHS England, London, UK
- Department of Surgery, Royal National Orthopaedic Hospital NHS Trust, London, UK
| |
Collapse
|
26
|
Richter E, Liebl D, Schulte B, Lehmann N, Fuhrmann C, Jöckel KH, Ioannidis JPA, Streeck H. Analysis of fatality impact and seroprevalence surveys in a community sustaining a SARS-CoV-2 superspreading event. Sci Rep 2023; 13:5440. [PMID: 37012282 PMCID: PMC10069345 DOI: 10.1038/s41598-023-32441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
There is an ongoing debate on the COVID-19 infection fatality rate (IFR) and the impact of COVID-19 on overall population mortality. Here, we addressed these issues in a community in Germany with a major superspreader event analyzing deaths over time and auditing death certificates in the community.18 deaths that occurred within the first six months of the pandemic had a positive test for SARS-CoV-2. Six out of 18 deaths had non-COVID-19 related causes of death (COD). Individuals with COVID-19 COD typically died of respiratory failure (75%) and tended to have fewer reported comorbidities (p = 0.029). Duration between first confirmed infection and death was negatively associated with COVID-19 being COD (p = 0.04). Repeated seroprevalence essays in a cross-sectional epidemiological study showed modest increases in seroprevalence over time, and substantial seroreversion (30%). IFR estimates accordingly varied depending on COVID-19 death attribution. Careful ascertainment of COVID-19 deaths is important in understanding the impact of the pandemic.
Collapse
Affiliation(s)
- Enrico Richter
- Institute of Virology, University Hospital, University of Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Dominik Liebl
- Institute of Finance and Statistics and Hausdorff Center for Mathematics, University of Bonn, Bonn, Germany
| | - Bianca Schulte
- Institute of Virology, University Hospital, University of Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Nils Lehmann
- Institute of Medical Informatics, Biometry und Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Christine Fuhrmann
- Clinical Study Core Unit, Study Center Bonn (SZB), Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry und Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, Stanford University, Stanford, USA
| | - Hendrik Streeck
- Institute of Virology, University Hospital, University of Bonn, Bonn, Germany.
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany.
| |
Collapse
|
27
|
Convalescent Plasma Treatment of Patients Previously Treated with B-Cell-Depleting Monoclonal Antibodies Suffering COVID-19 Is Associated with Reduced Re-Admission Rates. Viruses 2023; 15:v15030756. [PMID: 36992465 PMCID: PMC10059055 DOI: 10.3390/v15030756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/12/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023] Open
Abstract
Patients receiving treatment with B-cell-depleting monoclonal antibodies, such as anti-CD20 monoclonal antibodies, such as rituximab and obinutuzumab, either for hematological disease or another diagnosis, such as a rheumatological disease, are at an increased risk for medical complications and mortality from COVID-19. Since inconsistencies persist regarding the use of convalescent plasma (CP), especially in the vulnerable patient population that has received previous treatment with B-cell-depleting monoclonal antibodies, further studies should be performed in thisdirection. The aim of the present study was to describe the characteristics of patients with previous use of B-cell-depleting monoclonal antibodies and describe the potential beneficial effects of CP use in terms of mortality, ICU admission and disease relapse. In this retrospective cohort study, 39 patients with previous use of B-cell-depleting monoclonal antibodies hospitalized in the COVID-19 department of a tertiary hospital in Greece were recorded and evaluated. The mean age was 66.3 years and 51.3% were male. Regarding treatment for COVID-19, remdesivir was used in 89.7%, corticosteroids in 94.9% and CP in 53.8%. In-hospital mortality was 15.4%. Patients who died were more likely to need ICU admission and also had a trend towards a longer hospital stay, even though the last did not reach statistical significance. Patients treated with CP had a lower re-admission rate for COVID-19 after discharge. Further studies should be performed to identify the role of CP in patients with treatment with B-cell-depleting monoclonal antibodies suffering from COVID-19.
Collapse
|
28
|
Irizar P, Pan D, Kapadia D, Bécares L, Sze S, Taylor H, Amele S, Kibuchi E, Divall P, Gray LJ, Nellums LB, Katikireddi SV, Pareek M. Ethnic inequalities in COVID-19 infection, hospitalisation, intensive care admission, and death: a global systematic review and meta-analysis of over 200 million study participants. EClinicalMedicine 2023; 57:101877. [PMID: 36969795 PMCID: PMC9986034 DOI: 10.1016/j.eclinm.2023.101877] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 03/08/2023] Open
Abstract
Background COVID-19 has exacerbated existing ethnic inequalities in health. Little is known about whether inequalities in severe disease and deaths, observed globally among minoritised ethnic groups, relates to greater infection risk, poorer prognosis, or both. We analysed global data on COVID-19 clinical outcomes examining inequalities between people from minoritised ethnic groups compared to the ethnic majority group. Methods Databases (MEDLINE, EMBASE, EMCARE, CINAHL, Cochrane Library) were searched from 1st December 2019 to 3rd October 2022, for studies reporting original clinical data for COVID-19 outcomes disaggregated by ethnicity: infection, hospitalisation, intensive care unit (ICU) admission, and mortality. We assessed inequalities in incidence and prognosis using random-effects meta-analyses, with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) use to assess certainty of findings. Meta-regressions explored the impact of region and time-frame (vaccine roll-out) on heterogeneity. PROSPERO: CRD42021284981. Findings 77 studies comprising over 200,000,000 participants were included. Compared with White majority populations, we observed an increased risk of testing positive for infection for people from Black (adjusted Risk Ratio [aRR]:1.78, 95% CI:1.59-1.99, I2 = 99.1), South Asian (aRR:3.00, 95% CI:1.59-5.66, I2 = 99.1), Mixed (aRR:1.64, 95% CI:1.02-1.67, I2 = 93.2) and Other ethnic groups (aRR:1.36, 95% CI:1.01-1.82, I2 = 85.6). Black, Hispanic, and South Asian people were more likely to be seropositive. Among population-based studies, Black and Hispanic ethnic groups and Indigenous peoples had an increased risk of hospitalisation; Black, Hispanic, South Asian, East Asian and Mixed ethnic groups and Indigenous peoples had an increased risk of ICU admission. Mortality risk was increased for Hispanic, Mixed, and Indigenous groups. Smaller differences were seen for prognosis following infection. Following hospitalisation, South Asian, East Asian, Black and Mixed ethnic groups had an increased risk of ICU admission, and mortality risk was greater in Mixed ethnic groups. Certainty of evidence ranged from very low to moderate. Interpretation Our study suggests that systematic ethnic inequalities in COVID-19 health outcomes exist, with large differences in exposure risk and some differences in prognosis following hospitalisation. Response and recovery interventions must focus on tackling drivers of ethnic inequalities which increase exposure risk and vulnerabilities to severe disease, including structural racism and racial discrimination. Funding ESRC:ES/W000849/1.
Collapse
Affiliation(s)
- Patricia Irizar
- School of Social Sciences, University of Manchester, United Kingdom
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, United Kingdom
- NIHR Leicester Biomedical Research Centre, United Kingdom
| | - Dharmi Kapadia
- School of Social Sciences, University of Manchester, United Kingdom
| | - Laia Bécares
- Department of Global Health and Social Medicine, King's College London, United Kingdom
| | - Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Harry Taylor
- School of Social Sciences, University of Manchester, United Kingdom
| | - Sarah Amele
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Eliud Kibuchi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Pip Divall
- University Hospitals of Leicester, Education Centre Library, Glenfield Hospital and Leicester Royal Infirmary, United Kingdom
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Laura B Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
- NIHR Leicester Biomedical Research Centre, United Kingdom
| |
Collapse
|
29
|
Muegge R, Dean N, Jack E, Lee D. National lockdowns in England: The same restrictions for all, but do the impacts on COVID-19 mortality risks vary geographically? Spat Spatiotemporal Epidemiol 2023; 44:100559. [PMID: 36707192 PMCID: PMC9719849 DOI: 10.1016/j.sste.2022.100559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/22/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Quantifying the impact of lockdowns on COVID-19 mortality risks is an important priority in the public health fight against the virus, but almost all of the existing research has only conducted macro country-wide assessments or limited multi-country comparisons. In contrast, the extent of within-country variation in the impacts of a nation-wide lockdown is yet to be thoroughly investigated, which is the gap in the knowledge base that this paper fills. Our study focuses on England, which was subject to 3 national lockdowns between March 2020 and March 2021. We model weekly COVID-19 mortality counts for the 312 Local Authority Districts in mainland England, and our aim is to understand the impact that lockdowns had at both a national and a regional level. Specifically, we aim to quantify how long after the implementation of a lockdown do mortality risks reduce at a national level, the extent to which these impacts vary regionally within a country, and which parts of England exhibit similar impacts. As the spatially aggregated weekly COVID-19 mortality counts are small in size we estimate the spatio-temporal trends in mortality risks with a Poisson log-linear smoothing model that borrows strength in the estimation between neighbouring data points. Inference is based in a Bayesian paradigm, using Markov chain Monte Carlo simulation. Our main findings are that mortality risks typically begin to reduce between 3 and 4 weeks after lockdown, and that there appears to be an urban-rural divide in lockdown impacts.
Collapse
Affiliation(s)
- Robin Muegge
- School of Mathematics and Statistics, University of Glasgow, United Kingdom.
| | - Nema Dean
- School of Mathematics and Statistics, University of Glasgow, United Kingdom.
| | - Eilidh Jack
- School of Mathematics and Statistics, University of Glasgow, United Kingdom.
| | - Duncan Lee
- School of Mathematics and Statistics, University of Glasgow, United Kingdom.
| |
Collapse
|
30
|
Papiris SA, Campo I, Mariani F, Kallieri M, Kolilekas L, Papaioannou AI, Gonca Chousein E, Cetinkaya E, Bonella F, Borie R, Kokosi M, Pickworth T, Molina-Molina M, Gasa M, Radzikowska E, Fijolek J, Jouneau S, Gomez E, McCarthy C, Bendstrup E, Piotrowski WJ, Pabary R, Hadchouel A, Coolen-Allou N, Alfaro T, Robalo Cordeiro C, Antonogiannaki EM, Tomos IP, Papakosta D, Kontakiotis T, Panagiotou P, Douros K, Schams A, Lettieri S, Papaevangelou V, Kanaka-Gantenbein C, Karakatsani A, Loukides S, Costabel U, Crestani B, Morgan C, Tazawa R, Bush A, Griese M, Manali ED. COVID-19 in patients with pulmonary alveolar proteinosis: a European multicentre study. ERJ Open Res 2023; 9:00199-2022. [PMID: 36601310 PMCID: PMC9271262 DOI: 10.1183/23120541.00199-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023] Open
Abstract
Adult PAP patients experience similar #COVID19 rates to the general population, and high rates of hospitalisation and deaths, underscoring their vulnerability and the need for measures to prevent infection. The impact of iGM-CSF must be considered. https://bit.ly/3M0wKnZ.
Collapse
Affiliation(s)
- Spyros A. Papiris
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilaria Campo
- Laboratorio di Biochimica e Genetica, UOC Pneumologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Mariani
- Laboratorio di Biochimica e Genetica, UOC Pneumologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maria Kallieri
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Andriana I. Papaioannou
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efsun Gonca Chousein
- University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Erdogan Cetinkaya
- University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Pneumology Dept, Ruhrlandklinik, University Hospital, University of Essen, Essen, Germany; European Reference Network (ERN)-LUNG, ILD Core Net
| | - Raphael Borie
- Université de Paris, INSERM UMR 1152, APHP, Hôpital Bichat, Service de Pneumologie A, FHU APOLLO, Centre de référence des maladies pulmonaires rares, Paris, France
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust and Interstitial Lung Disease Unit, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | | | - Maria Molina-Molina
- ILD Multidisciplinary Unit, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Mercè Gasa
- ILD Multidisciplinary Unit, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Elżbieta Radzikowska
- 3rd Dept of Lung Diseases and Oncology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Justyna Fijolek
- 3rd Dept of Lung Diseases and Oncology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Stéphane Jouneau
- IRSET UMR 1085, Université de Rennes Service de Pneumologie, CHU de Rennes, Rennes, France
| | | | - Cormac McCarthy
- University College Dublin School of Medicine Education and Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - Elisabeth Bendstrup
- Center for Rare Lung diseases, Dept of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Wojciech J. Piotrowski
- Dept of Pneumonology, 2nd Chair of Internal Medicine, Medical University of Lodz, Lodz, Poland
| | - Rishi Pabary
- Paediatrics and Paediatric Respirology, Imperial College and Imperial Centre for Paediatrics and Child Health, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Alice Hadchouel
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie Pédiatrique, Centre de Référence pour les Maladies Respiratoires Rares de l'Enfant and INSERM U1151, Institut Necker Enfants Malades, Université de Paris, Faculté de Médecine, Paris, France
| | | | - Tiago Alfaro
- Dept of Pulmonology, Coimbra University Hospital, University of Coimbra, Coimbra, Portugal
| | - Carlos Robalo Cordeiro
- Dept of Pulmonology, Coimbra University Hospital, University of Coimbra, Coimbra, Portugal
| | - Elvira-Markela Antonogiannaki
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P. Tomos
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Despoina Papakosta
- Dept of Pulmonary Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” Hospital, Exochi, Thessaloniki, Greece
| | - Theodoros Kontakiotis
- Dept of Pulmonary Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” Hospital, Exochi, Thessaloniki, Greece
| | - Panagiota Panagiotou
- First Dept of Paediatrics, Agia Sophia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Douros
- Third Dept of Pediatrics “Attikon” University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andrea Schams
- Dept of Pediatric Pneumology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, German Center for Lung Research, Munich, Germany
| | - Sara Lettieri
- Laboratorio di Biochimica e Genetica, UOC Pneumologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vassiliki Papaevangelou
- Third Dept of Pediatrics “Attikon” University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Christina Kanaka-Gantenbein
- First Dept of Paediatrics, Agia Sophia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Karakatsani
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stelios Loukides
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Pneumology Dept, Ruhrlandklinik, University Hospital, University of Essen, Essen, Germany; European Reference Network (ERN)-LUNG, ILD Core Net
| | - Bruno Crestani
- Université de Paris, INSERM UMR 1152, APHP, Hôpital Bichat, Service de Pneumologie A, FHU APOLLO, Centre de référence des maladies pulmonaires rares, Paris, France
| | - Cliff Morgan
- Interstitial Lung Disease Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust and Interstitial Lung Disease Unit, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Ryushi Tazawa
- Health Administration Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Andrew Bush
- Paediatrics and Paediatric Respirology, Imperial College and Imperial Centre for Paediatrics and Child Health, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Matthias Griese
- Dept of Pediatric Pneumology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, German Center for Lung Research, Munich, Germany
| | - Effrosyni D. Manali
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece,Effrosyni Manali ()
| |
Collapse
|
31
|
Bakamutumaho B, Lutwama JJ, Owor N, Kayiwa J, Kiconco J, Haumba M, Muwanga M, Nsereko C, Rwamutwe E, Nayiga I, Kyebambe S, Kyobe Bosa H, Ocom F, Watyaba B, Kikaire B, Kisaka S, Kiwanuka N, O’Donnell MR, Cummings MJ. Epidemiology, Clinical Characteristics, and Mortality of Hospitalized Patients with Severe COVID-19 in Uganda, 2020-2021. Ann Am Thorac Soc 2022; 19:2100-2103. [PMID: 35727227 PMCID: PMC9743472 DOI: 10.1513/annalsats.202203-244rl] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
| | | | | | - John Kayiwa
- Uganda Virus Research InstituteEntebbe, Uganda
| | | | | | | | | | | | - Irene Nayiga
- Entebbe Regional Referral Hospital,Entebbe, Uganda
| | | | | | | | | | - Bernard Kikaire
- Uganda Virus Research InstituteEntebbe, Uganda
- Makerere University College of Health SciencesKampala, Uganda
| | - Stevens Kisaka
- Makerere University College of Health SciencesKampala, Uganda
- Makerere University School of Public HealthKampala, Uganda
| | - Noah Kiwanuka
- Makerere University School of Public HealthKampala, Uganda
| | - Max R. O’Donnell
- Vagelos College of Physicians and Surgeons, Columbia UniversityNew York, New York
- Center for Infection and Immunity Columbia UniversityNew York, New York
- Mailman School of Public Health, Columbia UniversityNew York, New York
| | - Matthew J. Cummings
- Vagelos College of Physicians and Surgeons, Columbia UniversityNew York, New York
- Center for Infection and Immunity Columbia UniversityNew York, New York
| |
Collapse
|
32
|
Gál P, Brábek J, Holub M, Jakubek M, Šedo A, Lacina L, Strnadová K, Dubový P, Hornychová H, Ryška A, Smetana K. Autoimmunity, cancer and COVID-19 abnormally activate wound healing pathways: critical role of inflammation. Histochem Cell Biol 2022; 158:415-434. [PMID: 35867145 PMCID: PMC9305064 DOI: 10.1007/s00418-022-02140-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/30/2022]
Abstract
Recent evidence indicates that targeting IL-6 provides broad therapeutic approaches to several diseases. In patients with cancer, autoimmune diseases, severe respiratory infections [e.g. coronavirus disease 2019 (COVID-19)] and wound healing, IL-6 plays a critical role in modulating the systemic and local microenvironment. Elevated serum levels of IL-6 interfere with the systemic immune response and are associated with disease progression and prognosis. As already noted, monoclonal antibodies blocking either IL-6 or binding of IL-6 to receptors have been used/tested successfully in the treatment of rheumatoid arthritis, many cancer types, and COVID-19. Therefore, in the present review, we compare the impact of IL-6 and anti-IL-6 therapy to demonstrate common (pathological) features of the studied diseases such as formation of granulation tissue with the presence of myofibroblasts and deposition of new extracellular matrix. We also discuss abnormal activation of other wound-healing-related pathways that have been implicated in autoimmune disorders, cancer or COVID-19.
Collapse
Affiliation(s)
- Peter Gál
- Department of Pharmacology, Pavol Jozef Šafárik University, Košice, Slovak Republic
- Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic
- Prague Burn Centre, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jan Brábek
- Department of Cell Biology, Faculty of Science, Charles University, 120 00 Prague 2, Czech Republic
- BIOCEV, Faculty of Science, Charles University, 252 50 Vestec, Czech Republic
| | - Michal Holub
- Department of Infectious Diseases, First Faculty of Medicine, Military University Hospital Prague and Charles University, 160 00 Prague, Czech Republic
| | - Milan Jakubek
- Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic
- BIOCEV, First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
- Department of Analytical Chemistry, University of Chemistry and Technology Prague, 166 28 Prague 6, Czech Republic
| | - Aleksi Šedo
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, 120 00 Praha 2, Czech Republic
| | - Lukáš Lacina
- BIOCEV, First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic
- Department of Dermatovenereology, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic
| | - Karolína Strnadová
- BIOCEV, First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic
| | - Petr Dubový
- Institute of Anatomy, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Helena Hornychová
- The Fingerland Department of Pathology, Faculty of Medicine Hradec Králové, Charles University, 500 05 Hradec Králové, Czech Republic
| | - Aleš Ryška
- The Fingerland Department of Pathology, Faculty of Medicine Hradec Králové, Charles University, 500 05 Hradec Králové, Czech Republic
| | - Karel Smetana
- BIOCEV, First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic
| |
Collapse
|
33
|
|
34
|
Valladares-Garrido MJ, Failoc-Rojas VE, Soto-Becerra P, Zeña-Ñañez S, Torres-Roman JS, Fernández-Mogollón JL, Colchado-Palacios IG, Apolaya-Segura CE, Dávila-Gonzales JA, Arce-Villalobos LR, Neciosup-Puican RDP, Calvay-Requejo AG, Maguiña JL, Apolaya-Segura M, Díaz-Vélez C. Clinical-epidemiologic variation in patients treated in the first and second wave of COVID-19 in Lambayeque, Peru: A cluster analysis. Int J Infect Dis 2022; 123:212-220. [PMID: 35872099 PMCID: PMC9303067 DOI: 10.1016/j.ijid.2022.07.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To identify differences in the clinical and epidemiologic characteristics of patients during the first and second waves of the COVID-19 pandemic at the EsSalud Lambayeque health care network, Peru. METHODS An analytical cross-sectional study of 53,912 patients enrolled during the first and second waves of COVID-19 was conducted. Cluster analysis based on clustering large applications (CLARA) was applied to clinical-epidemiologic data presented at the time of care. The two pandemic waves were compared using clinical-epidemiologic data from epidemiologic surveillance. RESULTS Cluster analysis identified four COVID-19 groups with a characteristic pattern. Cluster 1 included the largest number of participants in both waves, and the participants were predominantly female. Cluster 2 included patients with gastrointestinal, respiratory, and systemic symptoms. Cluster 3 was the "severe" cluster, characterized by older adults and patients with dyspnea or comorbidities (cardiovascular, diabetes, obesity). Cluster 4 included asymptomatic, pregnant, and less severe patients. We found differences in all clinical-epidemiologic characteristics according to the cluster to which they belonged. CONCLUSION Using cluster analysis, we identified characteristic patterns in each group. Respiratory, gastrointestinal, dyspnea, anosmia, and ageusia symptoms were higher in the second COVID-19 wave than the first COVID-19 wave.
Collapse
Affiliation(s)
- Mario J. Valladares-Garrido
- Instituto de Evaluación de Tecnologías en Salud e Investigación – IETSI, EsSalud, Lima, Peru,South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Peru
| | - Virgilio E. Failoc-Rojas
- Instituto de Evaluación de Tecnologías en Salud e Investigación – IETSI, EsSalud, Lima, Peru,Universidad San Ignacio de Loyola, Lima, Peru,Corresponding author: Virgilio E. Failoc-Rojas, Tel: (+51) 948845837
| | - Percy Soto-Becerra
- Instituto de Evaluación de Tecnologías en Salud e Investigación – IETSI, EsSalud, Lima, Peru,Universidad Continental, Huancayo, Peru
| | - Sandra Zeña-Ñañez
- Instituto de Evaluación de Tecnologías en Salud e Investigación – IETSI, EsSalud, Lima, Peru,Universidad Continental, Huancayo, Peru
| | | | | | | | | | | | | | | | | | - Jorge L. Maguiña
- Instituto de Evaluación de Tecnologías en Salud e Investigación – IETSI, EsSalud, Lima, Peru,Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru
| | - Moisés Apolaya-Segura
- Instituto de Evaluación de Tecnologías en Salud e Investigación – IETSI, EsSalud, Lima, Peru,Facultad de Medicina, Universidad Cesar Vallejo, Chiclayo, Peru
| | - Cristian Díaz-Vélez
- Instituto de Evaluación de Tecnologías en Salud e Investigación – IETSI, EsSalud, Lima, Peru,Facultad de Medicina, Universidad Privada Antenor Orrego, Trujillo, Peru
| |
Collapse
|
35
|
Venous thromboembolism in patients hospitalised with COVID-19 in England. Thromb Res 2022; 213:138-144. [PMID: 35366435 PMCID: PMC8944169 DOI: 10.1016/j.thromres.2022.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/21/2022] [Indexed: 12/24/2022]
Abstract
Background The aim of this study was to detail the incidence of venous thromboembolism (VTE) in patients hospitalised with COVID-19 in England. Methods This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged ≥18 years in England with a diagnosis of COVID-19 who had a hospital stay that was completed between 1st March 2020 and 31st March 2021 were included. A recorded diagnosis of VTE during the index stay or during a subsequent admission in the six weeks following discharge was the primary outcome in the main analysis. In secondary analysis, VTE diagnosis was the primary exposure and in-hospital mortality the primary outcome. Results Over the 13 months, 374,244 unique patients had a diagnosis of COVID-19 during a hospital stay, of whom 17,346 (4.6%) had a recorded diagnosis of VTE. VTE was more commonly recorded in patients aged 40–79 years, males and in patients of Black ethnicity, even after adjusting for covariates. Recorded VTE diagnosis was associated with longer hospital stay and higher adjusted in-hospital mortality (odds ratio 1.35 (95% confidence interval 1.29 to 1.41)). Conclusions VTE was a common complication of hospitalisation with COVID-19 in England. VTE was associated with both increased length of stay and mortality rate.
Collapse
|