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Perez-Garzon M, Poveda-Henao C, Bastidas-Goyes A, Robayo-Amortegui H. Oxygen Debt as Predictor of Mortality and Multiple Organ Dysfunction Syndrome in Severe COVID-19 Patients: A Retrospective Study. J Intensive Care Med 2024; 39:358-367. [PMID: 37876236 DOI: 10.1177/08850666231208433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Background: Oxygen debt (DEOx) represents the disparity between resting and shock oxygen consumption (VO2) and is associated with metabolic insufficiency, acidosis, severity, and mortality. This study aimed to assess the reliability of DEOx as an indirect quantitative measure for predicting multiple organ dysfunction syndrome (MODS) and 28-day mortality in patients admitted to the intensive care unit (ICU) with respiratory syndrome severe acute coronavirus type 2 (SARS-CoV-2) infection, in comparison to the Acute Physiology and Chronic Health Evaluation II (APACHE II), sepsis-related organ failure assessment (SOFA), and 4C scores. Methods: A retrospective cohort study was conducted, including ICU patients with SARS-CoV-2 infection between 2020 and 2021. Clinical data were extracted from the EPIMED Monitor Database®. APACHE II, SOFA, and 4C scores were calculated upon ICU admission, and their accuracy in predicting 28-day mortality and MODS was compared to DEOx. Multivariate logistic regression analysis was performed to analyze the outcome variables. Results: 708 patients were included, with a mortality rate of 44.4%. DEOx value was 11.16 ml O2/kg. The mean age was 58.7 years. Multivariate analysis showed that DEOx was independently associated with mortality, intubation, and renal injury. Each point increase in creatinine was associated with a higher risk of MODS. To determine the precision of the scores, area under the receiver operating characteristic curves (AUROC) analysis was performed with weak discrimination and similar behavior for the primary outcomes. The most accurate scale for mortality and MODS was 4C with an AUC of 0.683 and APACHE II with an AUC of 0.814, while that of the AUROC of DEOx was 0.612 and 0.646, respectively. Conclusions: DEOx showed similar predictive value to established scoring systems in critically ill patients with SARS-CoV-2 infection. The correlation of DEOx with these scores may facilitate early intervention in critically ill patients.
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Affiliation(s)
- Michel Perez-Garzon
- Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
- Critical Medicine and Intensive Care, Msc Mechanical Ventilation and Respiratory Support, Department of Investigation, Fundación Clínica Shaio. Bogota DC. Colombia
| | - Claudia Poveda-Henao
- Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
- Critical Medicine and Intensive Care, Msc Mechanical Ventilation and Respiratory Support, Department of Investigation, Fundación Clínica Shaio. Bogota DC. Colombia
- Clinical Cardiology, Intensive Care Department, Shaio Clinic Foundation. Bogota DC. Colombia
| | - Alirio Bastidas-Goyes
- Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
| | - Henry Robayo-Amortegui
- Critical Care Resident, Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
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Yuan H, Tian J, Wen L. Meta-analysis of the systemic immune-inflammatory index and in-hospital mortality of COVID-19 patients. Heliyon 2024; 10:e23441. [PMID: 38223728 PMCID: PMC10784146 DOI: 10.1016/j.heliyon.2023.e23441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 01/16/2024] Open
Abstract
Background The potential significance of immunoinflammatory factors in the prognosis of individuals afflicted with coronavirus disease 2019 (COVID-19) is worthy of examination. The systemic immune-inflammatory index (SII), a recently developed immunoinflammatory metric based on the enumeration of neutrophils, platelets, and lymphocytes in blood samples, holds promise for elucidating this relationship. Consequently, in order to explore any possible correlation between the SII levels at admission and the in-hospital mortality of patients with COVID-19, we undertook a thorough systematic review and meta-analysis. Methods In pursuit of accomplishing the aim of this meta-analysis, an extensive search was conducted to seek out pertinent observational studies featuring longitudinal follow-up across PubMed, Cochrane Library, Embase and the Web of Science databases. The I2 statistic was utilized to estimate the extent of heterogeneity and the Cochrane Q test was employed to evaluate heterogeneity between studies. The synthesis of outcomes involved the use of random-effects models, accounting for the possible influence of heterogeneity. Results Our analysis included sixteen studies, encompassing 10,007 hospitalized COVID-19 patients. Among them, 1801 patients (18.0 %) succumbed during hospitalization. The pooled results indicated that a high SII at admission was substantially linked to a higher risk of all-cause mortality (risk ratio [RR]: 2.41, 95 % confidence interval: 1.78 to 3.24, p < 0.001; I2 = 86 %). Meta-regression analysis demonstrated a negative correlation between mean SII at baseline and patient mortality in individual studies (coefficients = -0.00023 and -0.030, p < 0.05), effectively explaining the observed heterogeneity. Furthermore, in patients with lower baseline SII (<1300) and a lower risk of mortality (<20 %), we observed a more pronounced association between high SII levels and the risk of all-cause mortality. Conclusion The results of our study indicate that a high SII upon admission could potentially function as a prognostic indicator for mortality during hospitalization in patients diagnosed with COVID-19, particularly in individuals categorized as low risk.
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Affiliation(s)
- Hao Yuan
- Department of Respiratory and Critical Care Medicine, The Fourth Hospital of Changsha, Changsha, China
| | - Jing Tian
- Department of Respiratory and Critical Care Medicine, The Fourth Hospital of Changsha, Changsha, China
| | - Lu Wen
- Department of Hospital Infection Management, The Fourth Hospital of Changsha, Changsha, China
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Liu W, Song Q, Li F, Cao Y, Han Y, Wu J, Hu Z, Zhang Y, Ma Y. Real-World Effectiveness of Nirmatrelvir/Ritonavir and Dexamethasone Among Hospitalized Patients with COVID-19: A Prospective Cohort Study. Infect Drug Resist 2023; 16:5223-5231. [PMID: 37589014 PMCID: PMC10426452 DOI: 10.2147/idr.s419373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023] Open
Abstract
Purpose Anti-viral and anti-inflammatory therapies were effective in altering virus repletion and immune dysregulation in Coronavirus Disease 2019 (COVID-19) patients. This study aimed to explore the effect of combination therapy on disease progression in a real-world setting. Patients and Methods A total of 836 patients confirmed with SARS-CoV-2 infection participated in the study from 15 November to 25 December 2022 at Beijing Youan Hospital, Capital Medical University. A prospective cohort study was implemented to investigate the prognostic effect of the combination therapy on virus shedding and clinical recovery. Results About 78% of patients used nirmatrelvir/ritonavir (N/R, Paxlovid®, Pfizer) negatively, 16% of patients were prescribed nirmatrelvir/ritonavir beyond five days of symptom onset, 4% of patients received N/R monotherapy within five days of symptom onset and 2% of patients received N/R combined with dexamethasone. Compared with untreated patients, N/R monotherapy reduced the median time to 10.0 days from 12.0 days according to the negative conversion of nucleic acid amplification test (NAAT), and combination therapy reduced the time to 7.0 days, and increased to a 1.99 (95% CI 0.92, 4.32) and 14.23-fold (95% CI 4.50, 44.95) probability of negative NAAT, respectively. N/R monotherapy reduced the clinical recovery time to 10.0 days from 13.0 days. Single-use and combined-use non-significantly increased the recovery probability by 61% and 69%, respectively. In mild and moderate patients, the HRs for clinical recovery increased to 1.69 (95% CI 0.73, 3.94) and 2.18 (95% CI 0.29, 16.62), respectively. Conclusion Combination therapy of N/R and dexamethasone increased negative conversion of NAAT and was associated with a non-significant improvement in clinical recovery. Further studies are warranted to confirm this efficacy.
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Affiliation(s)
- Wei Liu
- Department of Pharmacy, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Qingkun Song
- Department of Clinical Epidemiology, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fang Li
- Department of Pharmacy, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yu Cao
- Department of Clinical Epidemiology, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ying Han
- Center of Liver Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jiangping Wu
- Department of Clinical Epidemiology, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zhongjie Hu
- Department of Gastroenterology, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yonghong Zhang
- Department of Hepatic Intervention, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yingmin Ma
- Department of Respiratory and Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
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Mangoni AA, Zinellu A. Systemic inflammation index, disease severity, and mortality in patients with COVID-19: a systematic review and meta-analysis. Front Immunol 2023; 14:1212998. [PMID: 37415980 PMCID: PMC10320859 DOI: 10.3389/fimmu.2023.1212998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction An excessive systemic pro-inflammatory state increases the risk of severe disease and mortality in patients with coronavirus disease 2019 (COVID-19). However, there is uncertainty regarding whether specific biomarkers of inflammation can enhance risk stratification in this group. We conducted a systematic review and meta-analysis to investigate an emerging biomarker of systemic inflammation derived from routine hematological parameters, the systemic inflammation index (SII), in COVID-19 patients with different disease severity and survival status. Methods A systematic literature search was conducted in PubMed, Web of Science, and Scopus, between the 1st of December 2019 and the 15th of March 2023. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the Grades of Recommendation, Assessment, Development and Evaluation, respectively (PROSPERO registration number: CRD42023420517). Results In 39 studies, patients with a severe disease or non-survivor status had significantly higher SII values on admission compared to patients with a non-severe disease or survivor status (standard mean difference (SMD)=0.91, 95% CI 0.75 to 1.06, p<0.001; moderate certainty of evidence). The SII was also significantly associated with the risk of severe disease or death in 10 studies reporting odds ratios (1.007, 95% CI 1.001 to 1.014, p=0.032; very low certainty of evidence) and in six studies reporting hazard ratios (1.99, 95% CI 1.01 to 3.92, p=0.047; very low certainty of evidence). Pooled sensitivity, specificity, and area under the curve for severe disease or mortality were 0.71 (95% CI 0.67 to 0.75), 0.71 (95% CI 0.64 to 0.77), and 0.77 (95% CI 0.73 to 0.80), respectively. In meta-regression, significant correlations were observed between the SMD and albumin, lactate dehydrogenase, creatinine, and D-dimer. Discussion Our systematic review and meta-analysis has shown that the SII on admission is significantly associated with severe disease and mortality in patients with COVID-19. Therefore, this inflammatory biomarker derived from routine haematological parameters can be helpful for early risk stratification in this group. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023420517.
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Affiliation(s)
- Arduino A. Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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5
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Vlad ND, Dumea E, Cambrea CS, Puscasu CG, Ionescu C, Averian B, Mihai RV, Dumitru A, Dumitru IM. Risk factors in non‑surviving patients with infection with carbapenemase‑producing Enterobacterales strains in an intensive care unit. Med Int (Lond) 2023; 3:30. [PMID: 37359053 PMCID: PMC10288429 DOI: 10.3892/mi.2023.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
Carbapenemase-producing Enterobacterales (CPE) are Gram-negative bacteria that belong to the Enterobacterales family and produce enzymes known as carbapenemases, which inhibit carbapenems, cephalosporins and penicillins. Carbapenem-resistant Enterobacterales (CRE) are resistant to carbapenems, cephalosporins and penicillins via mechanisms that may or may not produce carbapenemases. The identification of carbapenems is critical for the initiation of proper antibiotic therapy. The present case-control, retrospective study included 64 patients with CPE strains admitted to an intensive care unit between September, 2017 and October, 2021; of these, 34 patients with CPE succumbed and 30 control patients with CPE strains survived. CPE strains in the deceased patients were caused by Klebsiella spp. in 31 cases (91.2%) and Escherichia coli in 3 cases (8.8%). The univariate analysis revealed that the predictive factors associated with mortality in patients with CPE were admission with coronavirus disease 2019 (COVID-19) (P=0.001), invasive mechanical ventilation (P=0.001), and treatment with corticosteroids (P=0.006). The multivariate analysis revealed that admission with COVID-19 [odds ratio (OR), 16.26; 95% confidence interval (CI), 3.56-74.14; P≤0.05] and invasive mechanical ventilation (OR, 14.98; 95% CI, 1.35-166.22; P≤0.05) were associated with mortality as independent risk factors. Admission with COVID-19 increased the risk of mortality 16.26-fold and invasive mechanical ventilation increased the risk of mortality by 14.98-fold. On the whole, the present study demonstrates that the length of hospital duration in patients who acquired CPE did not influence mortality, whereas infection with COVID-19 increased and invasive mechanical ventilation were associated with an increased risk of mortality.
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Affiliation(s)
- Nicoleta-Dorina Vlad
- Clinical Infectious Diseases Hospital of Constanta, 900709 Constan£a, Romania
- Military Emergency Hospital Constanta, 900228 Constan£a, Romania
- Doctoral School of Medicine, Ovidius University of Constan£a, 900470 Constanta, Romania
| | - Elena Dumea
- Clinical Infectious Diseases Hospital of Constanta, 900709 Constan£a, Romania
- Faculty of Medicine, Ovidius University of Constan£a, 900470 Constanta, Romania
| | - Claudia-Simona Cambrea
- Clinical Infectious Diseases Hospital of Constanta, 900709 Constan£a, Romania
- Doctoral School of Medicine, Ovidius University of Constan£a, 900470 Constanta, Romania
- Faculty of Medicine, Ovidius University of Constan£a, 900470 Constanta, Romania
| | | | - Constantin Ionescu
- Faculty of Medicine, Ovidius University of Constan£a, 900470 Constanta, Romania
| | - Bianca Averian
- Doctoral School of Medicine, Ovidius University of Constan£a, 900470 Constanta, Romania
| | - Raluca-Vasilica Mihai
- Clinical Infectious Diseases Hospital of Constanta, 900709 Constan£a, Romania
- Doctoral School of Medicine, Ovidius University of Constan£a, 900470 Constanta, Romania
| | - Andrei Dumitru
- Doctoral School of Medicine, Ovidius University of Constan£a, 900470 Constanta, Romania
| | - Irina-Magdalena Dumitru
- Clinical Infectious Diseases Hospital of Constanta, 900709 Constan£a, Romania
- Doctoral School of Medicine, Ovidius University of Constan£a, 900470 Constanta, Romania
- Faculty of Medicine, Ovidius University of Constan£a, 900470 Constanta, Romania
- Romania Academy of Sciences, 50085 Bucharest, Romania
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6
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Sasani E, Bahrami F, Salehi M, Aala F, Bakhtiari R, Abdollahi A, Bashardoust B, Abdorahimi M, Khodavaisy S. Pneumocystis pneumonia in COVID-19 patients: A comprehensive review. Heliyon 2023; 9:e13618. [PMID: 36789388 DOI: 10.1016/j.heliyon.2023.e13618] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
The admitted patients of intensive care units with coronavirus disease 2019 (COVID-19) meet the challenges of subsequent infections. Opportunistic fungal infections such as Pneumocystis pneumonia (PCP) are among the important factors in the context of COVID-19 patients affecting illness severity and mortality. We reviewed the literature on COVID-19 patients with PCP to identify features of this infection. Although studies confirmed at least the presence of one immunosuppressive condition in half of PCP patients, this disease can also occur in immunocompetent patients who developed the immunosuppressive condition during Covid-19 treatment. The major risk factors associated with COVID-19 patients with PCP can be considered low lymphocyte counts and corticosteroid therapy. Diagnostic and treatment options are complicated by the overlapping clinical and radiologic characteristics of PCP and COVID-19 pneumonia. Therefore, physicians should comprehensively evaluate high-risk patients for PCP prophylaxis.
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7
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Muacevic A, Adler JR, Amrani A, Yacoubi A, Yahyaoui A, Belmahi S, Nassiri O, Elmezgueldi I, Sebbar EH, Choukri M. Biomarkers Predicting Poor Prognosis in Covid-19 Patients: A Survival Analysis. Cureus 2023; 15:e33921. [PMID: 36819312 PMCID: PMC9937634 DOI: 10.7759/cureus.33921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
Introduction With the spread of the Covid-19 pandemic and its overwhelming impact on health systems in several countries, the importance of identifying predictors of severity is of paramount importance. The objective of this study is to determine the relationship between death and the biological parameters of patients with Covid-19. Materials and methods This is an analytical retrospective cohort study conducted on 326 patients admitted to the Mohammed VI University Hospital in Oujda, Morocco. The statistical analysis concerned the biological parameters carried out on the admission of the patients, in addition to age and sex. The comparison between the two surviving and non-surviving groups was made by a simple analysis than a multivariate analysis by logistic regression. Next, a survival analysis was performed by the Kaplan-Meier method and then by Cox regression. Results A total of 326 patients were included in the study, including 108 fatal cases. The mean age was 64.66 ± 15.51 and the sex ratio was 1.08:1 (M:F). Age, procalcitonin, liver enzymes, and coagulation factors were significantly higher in patients who died of Covid-19 and are therefore considered to be the main prognostic factors identified in this study. Conclusion Knowledge and monitoring of predictive biomarkers of poor prognosis in patients with Covid-19 could be of great help in the identification of patients at risk and in the implementation of an effective diagnostic and therapeutic strategy to predict severe disease forms.
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8
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Vakil MK, Mansoori Y, Al‐Awsi GRL, Hosseinipour A, Ahsant S, Ahmadi S, Ekrahi M, Montaseri Z, Pezeshki B, Mohaghegh P, Sohrabpour M, Bahmanyar M, Daraei A, Dadkhah Jouybari T, Tavassoli A, Ghasemian A. Individual genetic variability mainly of Proinflammatory cytokines, cytokine receptors, and toll-like receptors dictates pathophysiology of COVID-19 disease. J Med Virol 2022; 94:4088-4096. [PMID: 35538614 PMCID: PMC9348290 DOI: 10.1002/jmv.27849] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 11/12/2022]
Abstract
Innate and acquired immunity responses are crucial for viral infection elimination. However, genetic variations in coding genes may exacerbate the inflammation or initiate devastating cytokine storms which poses severe respiratory conditions in coronavirus disease-19 (COVID-19). Host genetic variations in particular those related to the immune responses determine the patients' susceptibility and COVID-19 severity and pathophysiology. Gene polymorphisms such as single nucleotide polymorphisms (SNPs) of interferons, TNF, IL1, IL4, IL6, IL7, IL10, and IL17 predispose patients to the severe form of COVID-19 or severe acute respiratory syndrome coronavirus-2 (SARS-COV-2). These variations mainly alter the gene expression and cause a severe response by B cells, T cells, monocytes, neutrophils, and natural killer cells participating in a cytokine storm. Moreover, cytokines and chemokines SNPs are associated with the severity of COVID-19 and clinical outcomes depending on the corresponding effect. Additionally, genetic variations in genes encoding toll-like receptors (TLRs) mainly TLR3, TLR7, and TLR9 have been related to the COVID-19 severe respiratory symptoms. The specific relation of these mutations with the novel variants of concern (VOCs) infection remains to be elucidated. Genetic variations mainly within genes encoding proinflammatory cytokines, cytokine receptors, and TLRs predispose patients to COVID-19 disease severity. Understanding host immune gene variations associated with the SARS-COV-2 infection opens insights to control the pathophysiology of emerging viral infections.
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Affiliation(s)
- Mohammad Kazem Vakil
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
| | - Yaser Mansoori
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
| | - Ghaidaa Raheem Lateef Al‐Awsi
- University of Al‐QadisiyahCollege of ScienceAl DiwaniyahIraq
- Department of Radiological TechniquesAl‐Mustaqbal University CollegeBabylonIraq
| | - Ali Hosseinipour
- Department of Internal MedicineFasa University of Medical SciencesFasaIran
| | - Samaneh Ahsant
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
| | - Sedigheh Ahmadi
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
| | - Mohammad Ekrahi
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
| | - Zahra Montaseri
- Department of Infectious DiseasesFasa University of Medical SciencesFasaIran
| | - Babak Pezeshki
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
| | - Poopak Mohaghegh
- Pediatrics Department, School of MedicineFasa University of Medical SciencesFasaIran
| | - Mojtaba Sohrabpour
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
| | - Maryam Bahmanyar
- Pediatrics Department, School of MedicineFasa University of Medical SciencesFasaIran
| | - Abdolreza Daraei
- Department of Medical Genetics, School of MedicineBabol University of Medical SciencesBabolIran
| | | | | | - Abdolmajid Ghasemian
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
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Latifi-pupovci H, Namani S, Ahmetaj-shala B, Pajaziti A, Bunjaku G, Ajazaj Berisha L, Gegaj V, Kotori A. Biomarkers of Inflammation among Patients with COVID-19: A Single-Centre Prospective Study from Prishtina, Kosovo. Canadian Journal of Infectious Diseases and Medical Microbiology 2022; 2022:1-8. [PMID: 35873360 PMCID: PMC9298187 DOI: 10.1155/2022/4461647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/29/2022] [Accepted: 06/17/2022] [Indexed: 01/08/2023]
Abstract
SARS-CoV-2 infection involves the phase of viral replication and inflammatory response predicting the severity of COVID-19. The aim of the study was to analyze the association between IL-6 and hematological and inflammatory parameters and outcomes of patients with COVID-19. Plasma interleukin 6 (IL-6) levels and other inflammatory and hematological parameters were analyzed in 86 adult patients diagnosed with SARS-CoV-2 infection in Kosovo. The median age of patients was 61.50 (49.75–67.25) years. Over half of patients were categorised as severe (58%) and had comorbidities (69%) with hypertension being the most common. The overall mortality rate was 4.7%. The distribution of biochemical parameters across disease severity groups was significantly different for C-reactive protein (CRP), lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), white blood cells (WBC), and granulocytes with higher median values in more severe and critically ill patients whereas lower percentage of lymphocytes, monocytes, and platelet count in severe and critically ill patients. IL-6 levels were increased in 63% of patients with significant differences in the distribution across the following groups; age, disease severity, hospitalisation status, pulmonary infiltrates, oxygen therapy, and hypertension status. IL-6 significantly correlated with CRP, LDH, CK, ESR, and percentages of granulocytes. IL-6 and other inflammatory and hematological parameters were strongly associated with disease severity and may predict the outcome of the SARS-CoV-2 infection.
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Degarege A, Naveed Z, Kabayundo J, Brett-Major D. Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis. Pathogens 2022; 11:563. [PMID: 35631084 PMCID: PMC9147100 DOI: 10.3390/pathogens11050563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA; (Z.N.); (J.K.); (D.B.-M.)
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11
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Rokni M, Sarhadi M, Heidari Nia M, Mohamed Khosroshahi L, Asghari S, Sargazi S, Mirinejad S, Saravani R. Single nucleotide polymorphisms located in TNFA, IL1RN, IL6R, and IL6 genes are associated with COVID-19 risk and severity in an Iranian population. Cell Biol Int 2022; 46:1109-1127. [PMID: 35521908 PMCID: PMC9347541 DOI: 10.1002/cbin.11807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/29/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022]
Abstract
Cytokines play pivotal functions in coronavirus disease 2019 (COVID-19) pathogenesis. However, little is known about the rationale and importance of genetic variations associated with immune system responses, so-called "immunogenetic profiling." We studied whether polymorphisms of IL6, IL6R, TNFA, and IL1RN affect the disorder severity and outcome in patients infected with COVID19. We recruited 317 hospitalized patients with laboratory-confirmed COVID-19 from Bu-Ali hospital and 317 high-risk participants who had high exposure to COVID-19 patients but with a negative real-time-polymerase chain reaction (PCR) test. Multiple regression analyses were applied. We indicated that participants carrying the A allele in TNFA-rs361525, G>A (p < .004), the C allele in IL1RN-rs419598 T>C (p < .004), the A allele in IL6R-rs2228145, A>C (p = .047) are more susceptible to develop COVID-19. In contrast, those who carry the G allele of IL6-rs2069827, G>T (p = .01), are more protected from COVID-19. Also, we compared the various genotypes regarding the disorder severity and poor prognosis; we found that the AA genotype in TNFA is related to more aggressive illness and bad prognostic in contrast to the other inflammatory cytokines' genotypes. In addition, a high level of inflammatory indications, such as neutrophil-to-lymphocyte ratio and systemic immune-inflammation index, was observed in deceased patients compared with the survived subjects (p < .0001). We advised considering inflammatory cytokines polymorphisms as the main item to realize the therapeutic response against the acute respiratory distress syndrome induced by the SARS-CoV-2 virus.
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Affiliation(s)
- Mohsen Rokni
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Immunology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Sarhadi
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Milad Heidari Nia
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Somaye Asghari
- Department of Immunology, Buali Hospital of Laboratory, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Saman Sargazi
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Shekoufeh Mirinejad
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ramin Saravani
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran.,Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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12
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Bakhtiarvand N, Khashei M, Mahnam M, Hajiahmadi S. A novel reliability-based regression model to analyze and forecast the severity of COVID-19 patients. BMC Med Inform Decis Mak 2022; 22:123. [PMID: 35513811 PMCID: PMC9069125 DOI: 10.1186/s12911-022-01861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 04/25/2022] [Indexed: 11/28/2022] Open
Abstract
Background Coronavirus outbreak (SARS-CoV-2) has become a serious threat to human society all around the world. Due to the rapid rate of disease outbreaks and the severe shortages of medical resources, predicting COVID-19 disease severity continues to be a challenge for healthcare systems. Accurate prediction of severe patients plays a vital role in determining treatment priorities, effective management of medical facilities, and reducing the number of deaths. Various methods have been used in the literature to predict the severity prognosis of COVID-19 patients. Despite the different appearance of the methods, they all aim to achieve generalizable results by increasing the accuracy and reducing the errors of predictions. In other words, accuracy is considered the only effective factor in the generalizability of models. In addition to accuracy, reliability and consistency of results are other critical factors that must be considered to yield generalizable medical predictions. Since the role of reliability in medical decisions is significant, upgrading reliable medical data-driven models requires more attention. Methods This paper presents a new modeling technique to specify and maximize the reliability of results in predicting the severity prognosis of COVID-19 patients. We use the well-known classic regression as the basic model to implement our proposed procedure on it. To assess the performance of the proposed model, it has been applied to predict the severity prognosis of COVID-19 by using a dataset including clinical information of 46 COVID-19 patients. The dataset consists of two types of patients’ outcomes including mild (discharge) and severe (ICU or death). To measure the efficiency of the proposed model, we compare the accuracy of the proposed model to the classic regression model. Results The proposed reliability-based regression model, by achieving 98.6% sensitivity, 88.2% specificity, and 93.10% accuracy, has better performance than classic accuracy-based regression model with 95.7% sensitivity, 85.5% specificity, and 90.3% accuracy. Also, graphical analysis of ROC curve showed AUC 0.93 (95% CI 0.88–0.98) and AUC 0.90 (95% CI 0.85–0.96) for classic regression models, respectively. Conclusions Maximizing reliability in the medical forecasting models can lead to more generalizable and accurate results. The competitive results indicate that the proposed reliability-based regression model has higher performance in predicting the deterioration of COVID-19 patients compared to the classic accuracy-based regression model. The proposed framework can be used as a suitable alternative for the traditional regression method to improve the decision-making and triage processes of COVID-19 patients.
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Affiliation(s)
- Negar Bakhtiarvand
- Department of Industrial and Systems Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | - Mehdi Khashei
- Department of Industrial and Systems Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran.,Center for Optimization and Intelligent Decision Making in Healthcare Systems (COID-Health), Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | - Mehdi Mahnam
- Department of Industrial and Systems Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran. .,Center for Optimization and Intelligent Decision Making in Healthcare Systems (COID-Health), Isfahan University of Technology, Isfahan, 84156-83111, Iran.
| | - Somayeh Hajiahmadi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Rokni M, Heidari Nia M, Sarhadi M, Mirinejad S, Sargazi S, Moudi M, Saravani R, Rahdar S, Kargar M. Association of TMPRSS2 Gene Polymorphisms with COVID-19 Severity and Mortality: a Case-Control Study with Computational Analyses. Appl Biochem Biotechnol 2022; 194:3507-3526. [PMID: 35386063 PMCID: PMC8986508 DOI: 10.1007/s12010-022-03885-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/14/2022] [Indexed: 12/12/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a severe disease caused by a new variant of beta-coronavirus that first appeared in China. Human genetic factors, including polymorphisms, serve pivotal roles in the high transmission of SARS-CoV-2 and the stubbornly progressing sickness seen in a small but significant percentage of infected people; however, but these factors remain ill-defined. A total of 288 COVID-19 patients and 288 controls were genotyped for TMPRSS2 polymorphisms using both restriction fragment length polymorphism polymerase chain reaction (RFLP-PCR) and amplification refractory mutation system (ARMS)-PCR techniques. Different genotypes of TMPRSS2 polymorphisms were compared in terms of disease susceptibility and mortality. The statistical analysis showed that minor alleles of all studied variants statistically increased the risk of COVID-19, except for the rs75603675 C > A variant. The T allele of rs12329760 conferred an increased risk of COVID-19. Moreover, the AG/AC/TT/AG combination of genotypes significantly enhanced the risk of COVID-19 in our population. Different haplotypes of rs17854725/rs75603675/rs12329760/rs4303795 polymorphisms, including GACA, GACG, GATG, GATA, AATA, ACCG, ACTG, ACTA, GCCA, and GCTG, were found to be associated with increased risk of the disease (odds ratio > 1). Regarding the clinical and paraclinical characteristics, a statistically significant difference was found between non-severe and severe forms except for gender, platelet, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and underlying diseases. In addition, case genotypes of TMPRSS2 rs17854725 A > G, rs12329760 C > T, and rs4303795 A > G were significantly different regarding severe and non-severe forms of the disease (P-value < 0.001). Specifically, death was more frequent in carriers of the AG genotype of rs17854725 A > G (P-value = 0.022). Patients who carry the minor alleles of the four studied TMPRSS2 variants were rather vulnerable to COVID-19 infection. Our findings indicated that rs17854725 A > G (AA vs. AG and AA vs. GG), rs12329760 C > T (CC vs. CT and CC vs. TT), and rs4303795 A > G (AA vs. AG) genotypes of TMPRSS2 variations are associated with a more invasive disorder pattern. More studies on larger populations are needed to confirm our results.
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Affiliation(s)
- Mohsen Rokni
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Immunology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Milad Heidari Nia
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, 9816743463, Iran
| | - Mohammad Sarhadi
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, 9816743463, Iran
| | - Shekoufeh Mirinejad
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, 9816743463, Iran
| | - Saman Sargazi
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, 9816743463, Iran.
| | - Mahdiyeh Moudi
- Genetics of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ramin Saravani
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, 9816743463, Iran.,Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Sara Rahdar
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, 9816743463, Iran
| | - Maryam Kargar
- Department of Laboratory Hematology and Blood Bank, School of Allied Medical Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Hassanali F, Ahmadikia K, Mirenayat MS, Zahiri R, Fakharian A. COVID-19 Associated Unilateral Diaphragm Paralysis: A Case Report. Tanaffos 2022; 21:516-519. [PMID: 37583779 PMCID: PMC10423864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/27/2022] [Indexed: 08/17/2023]
Abstract
Diaphragm paralysis may be either idiopathic or associated with several medical conditions including viral and bacterial infection. The association of phrenic nerve palsy with viral infections is rare but well-appreciated in several case reports. Neuropathy, both central and peripheral, is a common neurological consequence of COVID-19. Here, we describe a case of diaphragm paralysis in a woman who was admitted to the hospital because of COVID-19 pneumonia. Post-COVID-19 unilateral paralyzed diaphragm was diagnosed with a chest X-ray for her and the disorder was attributed to COVID-19 because no other etiology was found to be associated. So far, phrenic neuropathy and diaphragmatic paralysis in a COVID-19-affected patient have not been reported from Iran.
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Affiliation(s)
- Fahimeh Hassanali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kazem Ahmadikia
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Sadat Mirenayat
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Zahiri
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Fakharian
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Gusev E, Sarapultsev A, Solomatina L, Chereshnev V. SARS-CoV-2-Specific Immune Response and the Pathogenesis of COVID-19. Int J Mol Sci 2022; 23:1716. [PMID: 35163638 PMCID: PMC8835786 DOI: 10.3390/ijms23031716] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 12/13/2022] Open
Abstract
The review aims to consolidate research findings on the molecular mechanisms and virulence and pathogenicity characteristics of coronavirus disease (COVID-19) causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and their relevance to four typical stages in the development of acute viral infection. These four stages are invasion; primary blockade of antiviral innate immunity; engagement of the virus's protection mechanisms against the factors of adaptive immunity; and acute, long-term complications of COVID-19. The invasion stage entails the recognition of the spike protein (S) of SARS-CoV-2 target cell receptors, namely, the main receptor (angiotensin-converting enzyme 2, ACE2), its coreceptors, and potential alternative receptors. The presence of a diverse repertoire of receptors allows SARS-CoV-2 to infect various types of cells, including those not expressing ACE2. During the second stage, the majority of the polyfunctional structural, non-structural, and extra proteins SARS-CoV-2 synthesizes in infected cells are involved in the primary blockage of antiviral innate immunity. A high degree of redundancy and systemic action characterizing these pathogenic factors allows SARS-CoV-2 to overcome antiviral mechanisms at the initial stages of invasion. The third stage includes passive and active protection of the virus from factors of adaptive immunity, overcoming of the barrier function at the focus of inflammation, and generalization of SARS-CoV-2 in the body. The fourth stage is associated with the deployment of variants of acute and long-term complications of COVID-19. SARS-CoV-2's ability to induce autoimmune and autoinflammatory pathways of tissue invasion and development of both immunosuppressive and hyperergic mechanisms of systemic inflammation is critical at this stage of infection.
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Affiliation(s)
- Evgenii Gusev
- Laboratory of Immunology of Inflammation, Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Science, 620049 Ekaterinburg, Russia
| | - Alexey Sarapultsev
- Laboratory of Immunology of Inflammation, Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Science, 620049 Ekaterinburg, Russia
- Russian-Chinese Education and Research Center of System Pathology, South Ural State University, 454080 Chelyabinsk, Russia
| | - Liliya Solomatina
- Laboratory of Immunology of Inflammation, Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Science, 620049 Ekaterinburg, Russia
| | - Valeriy Chereshnev
- Laboratory of Immunology of Inflammation, Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Science, 620049 Ekaterinburg, Russia
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16
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Qi X, Shen L, Chen J, Shi M, Shen B. Predicting the Disease Severity of Virus Infection. Advances in Experimental Medicine and Biology 2022; 1368:111-139. [DOI: 10.1007/978-981-16-8969-7_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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17
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Zhou SY, Tao L, Zhang Z, Zhang Z, An S. Mediators of neutrophil lymphocyte ratio in the relationship between ondansetron pre-treatment and the mortality of ICU patients on mechanical ventilation: causal mediation analysis from the MIMIC-IV database. Br J Clin Pharmacol 2021; 88:2747-2756. [PMID: 34964162 DOI: 10.1111/bcp.15204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/29/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022] Open
Abstract
AIMS The mortality of critically ill patients undergoing mechanical ventilation (MV) is high and few strategies are available. We explored the relationship between ondansetron pre-treatment, the neutrophil:lymphocyte ratio (NLR), and platelet:lymphocyte ratio (PLR), and mortality of ventilated patients in the intensive care unit. METHODS We developed a retrospective cohort study that involved patients undergoing MV in the Multiparameter Intelligent Monitoring in Intensive Care IV (MIMIC-IV) database. Causal mediation analysis was conducted to assess the relationship of ondansetron use and mortality and explore the potential causal pathway mediated by the NLR or PLR. The primary outcome was 28-day mortality. RESULTS A total of 17,927 eligible patients was obtained (5665 had taken ondansetron before MV initiation and 12,262 patients had not). The OR for 28-day mortality for ondansetron use uncorrelated with the mediator (NLR, PLR) was 0.72 (95%CI=0.64-0.81, P <0.001). Ondansetron was also associated with a reduction in 28-day mortality after controlling for the mediator of NLR (OR = 0.98, 95%CI = 0.97-0.99, P < 0.01). For the indirect effect, the NLR could explain 13.47% (95%CI = 8.59-20.54%, P < 0.01) of the impact of ondansetron use on 28-day mortality. The proportion mediated increased to 21.50% (95%CI = 12.36-47.44%, P < 0.01) for 90-day mortality. Adjusted mediation analysis revealed no suggestion of a causal mediation pathway for this effect by the PLR (P = 0.12). CONCLUSIONS NLR may play substantial roles in the relationship between ondansetron pre-treatment before initiation of mechanical ventilation and the reduction of death risk in ventilated patients.
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Affiliation(s)
- Shi Yu Zhou
- Department of Biostatistics, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Lili Tao
- Department of Critical Care Medicine, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zheng Zhang
- Department of Biostatistics, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Zhenhui Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shengli An
- Department of Biostatistics, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
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18
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Jamal M, Bangash HI, Habiba M, Lei Y, Xie T, Sun J, Wei Z, Hong Z, Shao L, Zhang Q. Immune dysregulation and system pathology in COVID-19. Virulence 2021; 12:918-936. [PMID: 33757410 PMCID: PMC7993139 DOI: 10.1080/21505594.2021.1898790] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/08/2021] [Accepted: 02/19/2021] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 19 (COVID-19) caused by the novel coronavirus known as SARS-CoV-2 has caused a global public health crisis. As of 7 January 2021, 87,640,402 confirmed cases and 1,891,692 mortalities have been reported worldwide. Studies focusing on the epidemiological and clinical characteristics of COVID-19 patients have suggested a dysregulated immune response characterized by lymphopenia and cytokine storm in these patients. The exaggerated immune response induced by the cytokine storm causes septic shock, acute respiratory distress syndrome (ARDS), and/or multiple organs failure, which increases the fatality rate of patients with SARS-CoV-2 infection. Herein, we review the recent research progress on epidemiology, clinical features, and system pathology in COVID-19. Moreover, we summarized the recent therapeutic strategies, which are either approved, under clinical trial, and/or under investigation by the local or global health authorities. We assume that treatments should focus on the use of antiviral drugs in combination with immunomodulators as well as treatment of the underlying comorbidities.
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Affiliation(s)
- Muhammad Jamal
- Department of Immunology, School of Basic Medical Science, Wuhan University, WuhanP.R. China
| | - Hina Iqbal Bangash
- State Key Laboratory of Agricultural Microbiology, College of Life Science and Technology, Huazhong Agricultural University, WuhanChina
| | - Maria Habiba
- Department of Zoology, University of Malakand, Chakdara Dir Lower, Khyber PakhtunkhwaPakistan
| | - Yufei Lei
- Department of Immunology, School of Basic Medical Science, Wuhan University, WuhanP.R. China
| | - Tian Xie
- Department of Immunology, School of Basic Medical Science, Wuhan University, WuhanP.R. China
| | - Jiaxing Sun
- Department of Immunology, School of Basic Medical Science, Wuhan University, WuhanP.R. China
| | - Zimeng Wei
- Department of Immunology, School of Basic Medical Science, Wuhan University, WuhanP.R. China
| | - Zixi Hong
- Department of Immunology, School of Basic Medical Science, Wuhan University, WuhanP.R. China
| | - Liang Shao
- Department of Hematology, Zhongnan Hospital of Wuhan University, WuhanP.R. China
| | - Qiuping Zhang
- Department of Immunology, School of Basic Medical Science, Wuhan University, WuhanP.R. China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan University, WuhanP.R. China
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19
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Madrazo Z, Osorio J, Videla S, Sainz B, Rodríguez-González A, Campos A, Santamaría M, Pelegrina A, González-Serrano C, Aldeano A, Sarriugarte A, Gómez-Díaz CJ, Ruiz-Luna D, García-Ruiz-de-Gordejuela A, Gómez-Gavara C, Gil-Barrionuevo M, Vila M, Clavell A, Campillo B, Millán L, Olona C, Sánchez-Cordero S, Medrano R, López-Arévalo CA, Pérez-Romero N, Artigau E, Calle M, Echenagusia V, Otero A, Tebé C, Pallarès N, Biondo S. P-POSSUM as mortality predictor in COVID-19-infected patients submitted to emergency digestive surgery. A retrospective cohort study. Int J Surg 2021; 96:106171. [PMID: 34774727 PMCID: PMC8580568 DOI: 10.1016/j.ijsu.2021.106171] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/25/2021] [Accepted: 10/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND COVID-19 infection is associated with a higher mortality rate in surgical patients, but surgical risk scores have not been validated in the emergency setting. We aimed to study the capacity for postoperative mortality prediction of the P-POSSUM score in COVID-19-positive patients submitted to emergency general and digestive surgery. MATERIAL AND METHODS Consecutive patients undergoing emergency general and digestive surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective cohort study. MAIN OUTCOME 30-day mortality. P-POSSUM discrimination was quantified by the area under the curve (AUC) of ROC curves; calibration was assessed by linear regression slope (β estimator); and sensitivity and specificity were expressed as percentage and 95% confidence interval (CI). RESULTS 4988 patients were included: 177 COVID-19-positive; 2011 intra-pandemic COVID-19-negative; and 2800 pre-pandemic. COVID-19-positive patients were older, with higher surgical risk, more advanced pathologies, and higher P-POSSUM values (1.79% vs. 1.09%, p < 0.001, in both the COVID-19-negative and control cohort). 30-day mortality in the COVID-19-positive, intra-pandemic COVID-19-negative and pre-pandemic cohorts were: 12.9%, 4.6%, and 3.2%. The P-POSSUM predictive values in the three cohorts were, respectively: AUC 0.88 (95% CI 0.81-0.95), 0.89 (95% CI 0.87-0.92), and 0.91 (95% CI 0.88-0.93); β value 0.97 (95% CI 0.74-1.2), 0.99 (95% CI 0.82-1.16), and 0.78 (95% CI 0.74-0.82); sensitivity 83% (95% CI 61-95), 91% (95% CI 84-96), and 89% (95% CI 80-94); and specificity 81% (95% CI 74-87), 76% (95% CI 74-78), and 80% (95% CI 79-82). CONCLUSION The P-POSSUM score showed a good predictive capacity for postoperative mortality in COVID-19-positive patients submitted to emergency general and digestive surgery.
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Affiliation(s)
- Zoilo Madrazo
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain Clinical Research Support Unit (HUB-IDIBELL), Clinical Pharmacology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain Department of Surgery, Donostia University Hospital, San Sebastian, Spain Department of Surgery, Parc Taulí Health Corporation, Sabadell Hospital, Sabadell, Spain Department of Surgery, Arnau de Vilanova University Hospital, Lleida, Spain Department of Surgery, Hospital del Mar University Hospital, Barcelona, Spain Department of Surgery. Basurto University Hospital, Bilbao, Spain Department of Surgery, Granollers General Hospital, Granollers, Spain Department of Surgery, Cruces University Hospital, Bilbao, Spain Department of Surgery, Althaia Foundation, Manresa, Spain Department of Surgery, Terrassa Health Consortium, Terrassa Hospital, Terrassa, Spain General Surgery Department, Vall d'Hebrón University Hospital, Barcelona, Spain Hepatobiliopancreatic Surgery and Transplantation Department, Vall d'Hebrón University Hospital, Barcelona, Spain Department of Surgery, Viladecans Hospital, Viladecans, Spain Department of Surgery, Mataró Hospital, Maresme Health Consortium, Mataró, Spain Department of Surgery, Germans Trias i Pujol University Hospital, Badalona, Spain Department of Surgery, Sant Joan de Deu Hospital Foundation, Martorell, Spain Department of Surgery, Dr. José Molina Orosa Hospital, Lanzarote, Spain Department of Surgery, Joan XXIII University Hospital, Tarragona, Spain Department of Surgery, Igualada University Hospital, Anoia Health Consortium, Igualada, Spain Department of Surgery, Sant Pau University Hospital, Barcelona, Spain Department of Surgery. Moisès Broggi Hospital, Sant Joan Despí, Spain Department of Surgery, Mútua de Terrassa University Hospital, Terrassa, Spain Department of Surgery, Girona Dr.Josep Trueta University Hospital, Girona, Spain Department of Surgery, Alto Deba Hospital, Mondragon, San Sebastián, Spain Department of Surgery, Araba University Hospital, Txagorritxu Hospital, Vitoria, Spain Clinical Research Support Unit, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Heidari Nia M, Rokni M, Mirinejad S, Kargar M, Rahdar S, Sargazi S, Sarhadi M, Saravani R. Association of polymorphisms in tumor necrosis factors with SARS-CoV-2 infection and mortality rate: A case-control study and in silico analyses. J Med Virol 2021; 94:1502-1512. [PMID: 34821383 PMCID: PMC9015227 DOI: 10.1002/jmv.27477] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022]
Abstract
The present coronavirus disease 2019 (COVID-19) is spreading rapidly and existing data has suggested a number of susceptibility factors for developing a severe course of the disease. The current case-control experiment is aimed to study the associations of genetic polymorphisms in tumor necrosis factors (TNFs) with COVID-19 and its mortality rate. A total of 550 participants (275 subjects and 275 controls) were enrolled. The tetra-amplification refractory mutation system polymerase chain reaction technique was recruited to detect -308G>A TNFα and +252A>G TNFβ polymorphisms among the Iranian subjects. We demonstrated that carriers of the G allele of TNFβ-252A/G, rs909253 A>G were more frequent in COVID-19 subjects compared to the healthy group and this allele statistically increased the disease risk (odds ratio [OR] = 1.55, 95% confidence interval [CI] = 1.23-1.96, p < 0.0001). At the same time, the A allele of TNFα-311A/G, rs1800629 G>A moderately decreased the risk of COVID-19 (OR = 0.68, 95% CI = 0.53-0.86, p < 0.002). Also, we analyzed the various genotypes regarding the para-clinical and disorder severity; we found that in the AA genotype of TNFβ-252A/G (rs909253 A>G), the computed tomography scan pattern was different in comparison to cases carrying the AG genotype with p1 < 0.001. In addition, in the severe cases of COVID-19, leukocyte and neutrophil count and duration of intensive care unit hospitalization in the deceased patients were significantly increased (p < 0.001). Moreover, the TNFα-311A/G (rs1800629 G>A) variant is likely to change the pattern of splicing factor sites. Our findings provided deep insights into the relationship between TNFα/TNFβ polymorphisms and severe acute respiratory syndrome coronavirus 2. Replicated studies may give scientific evidence for exploring molecular mechanisms of COVID-19 in other ethnicities.
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Affiliation(s)
- Milad Heidari Nia
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohsen Rokni
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Immunology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Shekoufeh Mirinejad
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Maryam Kargar
- Department of Laboratory Hematology and Blood Bank, School of Allied Medical Science Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Rahdar
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Saman Sargazi
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Sarhadi
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ramin Saravani
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran.,Department of Clinical Biochemistry, School of Medicine Zahedan University of Medical Sciences, Zahedan, Iran
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21
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Nooh HA, Abdellateif MS, Refaat L, Kandeel EZ, Bayoumi A, Samra M, Khafagy M. The role of inflammatory indices in the outcome of COVID-19 cancer patients. Med Oncol 2021; 39:6. [PMID: 34748094 PMCID: PMC8573297 DOI: 10.1007/s12032-021-01605-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/27/2021] [Indexed: 02/08/2023]
Abstract
To assess the prognostic role of different inflammatory indices on the outcome of cancer patients with COVID-19. Sixty-two adults and 22 pediatric cancer patients with COVID-19 infection were assessed for the prognostic value of certain inflammatory indices including the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), derived NLR (dNLR), systemic inflammation index (SII), mean platelet volume to platelet ratio (MPR), C-reactive protein to lymphocyte ratio (CRP/L), aggregate index of systemic inflammation (AISI), systemic inflammation response index (SIRI), and neutrophil to lymphocyte, platelet ratio (NLPR). Data were correlated to patients' outcome regarding ICU admission, and incidence of mortality. Increased CRP/L ratio in adult COVID-19 cancer patients was significantly associated with inferior survival [152 (19-2253) in non-survivors, compared to 27.4 (0.8-681) in survivors (P = 0.033)]. It achieved a sensitivity (60%) and a specificity (90.2%) at a cut-off 152, while it achieved a sensitivity of 60% and specificity 95.1% at a cut-off 252 (AUC 0.795, P = 0.033). When combining both CRP/L and NLPR for the prediction of poor outcome in adult cancer patients with COVID19, the sensitivity increased to 80% and the specificity was 70.7% (AUC 0.805, P = 0.027). Increased incidence of ICU admission in pediatric cancer patients associated significantly with the severity of covid19 infection, decreased mean corpuscular hemoglobin (MCH) < 28.3, increased red cell distribution width (RDW) > 16, lymphopenia < 1.04, pseudo Pelger-Huet appearance, and PLR < 196.4 (P = 0.004, P = 0.040, P = 0.029, P = 0. 0.039, P = 0.050, and P = 0.040; respectively). The mean corpuscular volume (MCV), MCH, and RDW could be useful prognostic markers for poor outcome in COVID-19 pediatric cancer patients (P < 0.05 for all). Increased both CRP/L and NLPR associated significantly with poor survival in adult COVID-19 cancer patients, while PLR associated significantly with ICU admission in pediatric COVID-19 cancer patients.
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Affiliation(s)
- Hend A Nooh
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mona S Abdellateif
- Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt. .,Medical Biochemistry and Molecular Biology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Lobna Refaat
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Eman Z Kandeel
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Bayoumi
- Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Samra
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Medhat Khafagy
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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22
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Abstract
Background: The neutrophil–lymphocyte count ratio (NLR) has emerged
as a potential prognostic tool for different diseases. In the current
coronavirus disease (COVID-19) pandemic, the NLR may be a useful tool for risk
scarification and the optimal utilization of limited healthcare resources.
However, there is no consensus regarding the optimal value of NLR, and the
association with disease severity and mortality. Thus, this study aims to
systematically analyze the current evidence of the utility of baseline NLR as a
predictive tool for mortality, disease severity in COVID-19 patients.
Methods: A compendious screening of electronic databases up to
June 15, 2021, was done after enlisting the protocol in PROSPERO
(CRD42020202659). Studies evaluating the utility of baseline NLR in COVID-19 are
included for this review as per the PRISMA statement. Results: We
retrieved a total of 13112 and 12986 COVID-19 patients for survivability and
severity over 90 studies. The expired and critically sick patients had elevated
baseline NLR on admission, in comparison to survivors and noncritical patients.
(SMD = 3.82; 95% CI: 2.79-4.85; I2 = 100% and SMD = 1.42; 95% CI:
1.22-1.63; I2 = 95%, respectively). The summary receiver operating
curve analysis for mortality (AUC = 0.87; 95% CI: 0.86-0.87;
I2 = 94.7%), and severity (AUC = 0.82; 95% CI: 0.80-0.84;
I2 = 79.7%) were also suggestive of its significant predictive
value. Conclusions: The elevated NLR on admission in COVID-19
patients is associated with poor outcomes.
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23
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Öcal S. SARS-CoV-2 and lung injury: Dysregulation of immune response but not hyperimmune response as in "cytokine storm syndrome". Clin Respir J 2021; 16:13-16. [PMID: 34674363 PMCID: PMC8653083 DOI: 10.1111/crj.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/02/2021] [Accepted: 10/19/2021] [Indexed: 12/01/2022]
Abstract
SARS‐CoV‐2 infection can present either an asymptomatic or symptomatic; the spectrum of symptomatic infection ranges from mild to critical. A majority of patients have experienced mild symptoms with a good prognosis. But approximately 14% of them have severe infection presenting with hypoxemia and extensive lung involvement. The current mini‐review describes the dysregulation of immune response for SARS‐CoV‐2 viral pneumonia and virus‐induced lung injury. Also, many confounding factors can increase lung injury, in addition to virus‐induced lung injury. Especially in critically ill patients, confounding factors can cause the inflammatory cascade, acute respiratory distress syndrome (ARDS), and mortality.
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Affiliation(s)
- Serpil Öcal
- Department of Internal Medicine, Medical Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
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24
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Geng J, Yu X, Bao H, Feng Z, Yuan X, Zhang J, Chen X, Chen Y, Li C, Yu H. Chronic Diseases as a Predictor for Severity and Mortality of COVID-19: A Systematic Review With Cumulative Meta-Analysis. Front Med (Lausanne) 2021; 8:588013. [PMID: 34540855 PMCID: PMC8440884 DOI: 10.3389/fmed.2021.588013] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/05/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Given the ongoing coronavirus disease 2019 (COVID-19) pandemic and the consequent global healthcare crisis, there is an urgent need to better understand risk factors for symptom deterioration and mortality among patients with COVID-19. This systematic review aimed to meet the need by determining the predictive value of chronic diseases for COVID-19 severity and mortality. Methods: We searched PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Complete to identify studies published between December 1, 2019, and December 31, 2020. Two hundred and seventeen observational studies from 26 countries involving 624,986 patients were included. We assessed the risk of bias of the included studies and performed a cumulative meta-analysis. Results: We found that among COVID-19 patients, hypertension was a very common condition and was associated with higher severity, intensive care unit (ICU) admission, acute respiratory distress syndrome, and mortality. Chronic obstructive pulmonary disease was the strongest predictor for COVID-19 severity, admission to ICU, and mortality, while asthma was associated with a reduced risk of COVID-19 mortality. Patients with obesity were at a higher risk of experiencing severe symptoms of COVID-19 rather than mortality. Patients with cerebrovascular disease, chronic liver disease, chronic renal disease, or cancer were more likely to become severe COVID-19 cases and had a greater probability of mortality. Conclusions: COVID-19 patients with chronic diseases were more likely to experience severe symptoms and ICU admission and faced a higher risk of mortality. Aggressive strategies to combat the COVID-19 pandemic should target patients with chronic diseases as a priority.
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Affiliation(s)
- JinSong Geng
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoLan Yu
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - HaiNi Bao
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - Zhe Feng
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoYu Yuan
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - JiaYing Zhang
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoWei Chen
- Library and Reference Department, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - YaLan Chen
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - ChengLong Li
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
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25
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Bilge M, Akilli IK, Karaayvaz EB, Yesilova A, Kart Yasar K. Comparison of systemic immune-inflammation index (SII), early warning score (ANDC) and prognostic nutritional index (PNI) in hospitalized patients with malignancy, and their influence on mortality from COVID-19. Infect Agent Cancer 2021; 16:60. [PMID: 34526045 PMCID: PMC8441248 DOI: 10.1186/s13027-021-00400-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction We evaluated several biological indicators based on inflammation and/or nutritional status, such as systemic immune-inflammation index (SII), early warning score (ANDC) and prognostic nutritional index (PNI) in hospitalized COVID-19 patients with and without malignancies for a prognostic significance. Methodology This is a retrospective and observational study on 186 patients with SARS-CoV-2, who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. 75 patients had various malignancies, and the rest (111), having a similar age and comorbidity profile based on propensity score matching, had no malignancy. Results None of the measures as neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, monocyte to lymphocyte ratio, SII, PNI or ANDC was found to be significantly different between two groups. Odds ratio for the mortality, OR 2.39 (%95 CI 1.80–3.16) was found to be significantly higher for the malignancy group, even though the duration of hospitalization was statistically similar for both groups. PNI was found to be significantly lower for deceased patients compared with survivors in the malignancy group. Contrarily, ANDC was found to be significantly higher for deceased patients in the malignancy group. Conclusions PNI and ANDC have independent predictive power on determining the in-hospital death in COVID-19 malignancy cases. It is suggested that ANDC seems to be a more sensitive score than SII in COVID-19 cases with malignancies.
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Affiliation(s)
- Muge Bilge
- Department of Internal Medicine, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Darulaceze Street, No: 27 Sisli, 34384, Istanbul, Turkey.
| | - Isil Kibar Akilli
- Department of Pulmonary Disease, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Halaskargazi Street, 34371, Istanbul, Turkey
| | - Ekrem Bilal Karaayvaz
- Department of Cardiology, Istanbul Medical Faculty, University of Istanbul, Turgut Ozal Millet Street, Fatih, 34093, Istanbul, Turkey
| | - Aylia Yesilova
- Department of Internal Medicine, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Darulaceze Street, No: 27 Sisli, 34384, Istanbul, Turkey
| | - Kadriye Kart Yasar
- Department of Infectious Disease, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No: 11, Bakirkoy, 34147, Istanbul, Turkey
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26
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Sarkar S, Kannan S, Khanna P, Singh AK. Role of platelet-to-lymphocyte count ratio (PLR), as a prognostic indicator in COVID-19: A systematic review and meta-analysis. J Med Virol 2021; 94:211-221. [PMID: 34436785 PMCID: PMC8661888 DOI: 10.1002/jmv.27297] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/30/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022]
Abstract
Prognostic predictors are of paramount interest for prompt intervention and optimal utilization of the healthcare system in the ongoing context of the COVID-19 pandemic. The platelet-to-lymphocyte count ratio (PLR), has emerged as a potential tool for risk stratification of critically ill patients with sepsis. The current systematic review explores the utility of PLR as a prognostic predictor of COVID-19 patients. We screened the electronic databases until May 15, 2021 after enrolling in PROSPERO (CRD42021220269). Studies evaluating the association between PLR on admission and outcomes in terms of mortality and severity among COVID-19 patients were included. We retrieved 32 studies, with a total of 2768 and 3262 COVID-19 patients for mortality and disease severity outcomes. Deceased and critically ill patients had higher PLR levels on admission in comparison to survivors and non-severe patients (mean differences [MD] = 66.10; 95% confidence interval [CI]: 47.75-84.44; p < 0.00001 and MD = 86.74; 95% CI: 67.7-105.7; p < 0.00001, respectively). A higher level of PLR on admission in COVID-19 patients is associated with increased morbidity and mortality. However, the evidence is of low quality and further studies regarding the cut-off value of PLR are the need of the hour.
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Affiliation(s)
- Soumya Sarkar
- Department of Anaesthesia, Pain Medicine & Critical Care, AIIMS, Ansari Nagar, New Delhi, India
| | - Sundara Kannan
- Department of Anaesthesia, Pain Medicine & Critical Care, AIIMS, Ansari Nagar, New Delhi, India
| | - Puneet Khanna
- Department of Anaesthesia, Pain Medicine & Critical Care, AIIMS, Ansari Nagar, New Delhi, India
| | - Akhil Kant Singh
- Department of Anaesthesia, Pain Medicine & Critical Care, AIIMS, Ansari Nagar, New Delhi, India
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27
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Sargazi S, Sheervalilou R, Rokni M, Shirvaliloo M, Shahraki O, Rezaei N. The role of autophagy in controlling SARS-CoV-2 infection: An overview on virophagy-mediated molecular drug targets. Cell Biol Int 2021; 45:1599-1612. [PMID: 33818861 PMCID: PMC8251464 DOI: 10.1002/cbin.11609] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/22/2021] [Accepted: 04/01/2021] [Indexed: 12/16/2022]
Abstract
Autophagy-dependent cell death is a prominent mechanism that majorly contributes to homeostasis by maintaining the turnover of organelles under stressful conditions. Several viruses, including coronaviruses (CoVs), take advantage of cellular autophagy to facilitate their own replication. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a beta-coronavirus (β-CoVs) that mediates its replication through a dependent or independent ATG5 pathway using specific double-membrane vesicles that can be considered as similar to autophagosomes. With due attention to several mutations in NSP6, a nonstructural protein with a positive regulatory effect on autophagosome formation, a potential correlation between SARS-CoV-2 pathogenesis mechanisms and autophagy can be expected. Certain medications, albeit limited in number, have been indicated to negatively regulate autophagy flux, potentially in a way similar to the inhibitory effect of β-CoVs on the process of autophagy. However, there is no conclusive evidence to support their direct antagonizing effect on CoVs. Off-target accumulation of a major fraction of FDA-approved autophagy modulating drugs may result in adverse effects. Therefore, medications that have modulatory effects on autophagy could be considered as potential lead compounds for the development of new treatments against this virus. This review discusses the role of autophagy/virophagy in controlling SARS-CoV-2, focusing on the potential therapeutic implications.
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Affiliation(s)
- Saman Sargazi
- Cellular and Molecular Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Mohsen Rokni
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Milad Shirvaliloo
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Omolbanin Shahraki
- Pharmacology Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Nima Rezaei
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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28
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Ahmadikia K, Hashemi SJ, Khodavaisy S, Getso MI, Alijani N, Badali H, Mirhendi H, Salehi M, Tabari A, Mohammadi Ardehali M, Kord M, Roilides E, Rezaie S. The double-edged sword of systemic corticosteroid therapy in viral pneumonia: A case report and comparative review of influenza-associated mucormycosis versus COVID-19 associated mucormycosis. Mycoses 2021; 64:798-808. [PMID: 33590551 PMCID: PMC8013756 DOI: 10.1111/myc.13256] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/16/2022]
Abstract
Acute respiratory distress syndrome is a common complication of severe viral pneumonia, such as influenza and COVID‐19, that requires critical care including ventilatory support, use of corticosteroids and other adjunctive therapies to arrest the attendant massive airways inflammation. Although recommended for the treatment of viral pneumonia, steroid therapy appears to be a double‐edged sword, predisposing patients to secondary bacterial and invasive fungal infections (IFIs) whereby impacting morbidity and mortality. Mucormycosis is a fungal emergency with a highly aggressive tendency for contiguous spread, associated with a poor prognosis if not promptly diagnosed and managed. Classically, uncontrolled diabetes mellitus (DM) and other immunosuppressive conditions including corticosteroid therapy are known risk factors for mucormycosis. Upon the background lung pathology, immune dysfunction and corticosteroid therapy, patients with severe viral pneumonia are likely to develop IFIs like aspergillosis and mucormycosis. Notably, the combination of steroid therapy and DM can augment immunosuppression and hyperglycaemia, increasing the risk of mucormycosis in a susceptible individual. Here, we report a case of sinonasal mucormycosis in a 44‐year‐old woman with hyperglycaemia secondary to poorly controlled diabetes following dexamethasone therapy on a background of influenza pneumonia and review 15 available literatures on reported cases of influenza and COVID‐19 associated mucormycosis.
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Affiliation(s)
- Kazem Ahmadikia
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Jamal Hashemi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Muhammad Ibrahim Getso
- Department of Medical Microbiology and Parasitology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Neda Alijani
- Department of Infectious Disease, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Badali
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, TX, USA
| | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Salehi
- Department of infectious diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Tabari
- Department of Otorhinolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Mohammadi Ardehali
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Educational Hospital, Tehran, Iran
| | - Mohammad Kord
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece
| | - Sassan Rezaie
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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29
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Raadsen M, Du Toit J, Langerak T, van Bussel B, van Gorp E, Goeijenbier M. Thrombocytopenia in Virus Infections. J Clin Med 2021; 10:jcm10040877. [PMID: 33672766 PMCID: PMC7924611 DOI: 10.3390/jcm10040877] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
Thrombocytopenia, which signifies a low platelet count usually below 150 × 109/L, is a common finding following or during many viral infections. In clinical medicine, mild thrombocytopenia, combined with lymphopenia in a patient with signs and symptoms of an infectious disease, raises the suspicion of a viral infection. This phenomenon is classically attributed to platelet consumption due to inflammation-induced coagulation, sequestration from the circulation by phagocytosis and hypersplenism, and impaired platelet production due to defective megakaryopoiesis or cytokine-induced myelosuppression. All these mechanisms, while plausible and supported by substantial evidence, regard platelets as passive bystanders during viral infection. However, platelets are increasingly recognized as active players in the (antiviral) immune response and have been shown to interact with cells of the innate and adaptive immune system as well as directly with viruses. These findings can be of interest both for understanding the pathogenesis of viral infectious diseases and predicting outcome. In this review, we will summarize and discuss the literature currently available on various mechanisms within the relationship between thrombocytopenia and virus infections.
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Affiliation(s)
- Matthijs Raadsen
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
| | - Justin Du Toit
- Department of Haematology, Wits University Donald Gordon Medical Centre Johannesburg, Johannesburg 2041, South Africa;
| | - Thomas Langerak
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
| | - Bas van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Center Plus, 6229 HX Maastricht, The Netherlands;
- Care and Public Health Research Institute (CAPHRI), Maastricht University, 6229 GT Maastricht, The Netherlands
| | - Eric van Gorp
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
- Department of Internal Medicine, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Marco Goeijenbier
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
- Department of Internal Medicine, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands
- Correspondence:
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Mohamed Khosroshahi L, Rokni M, Mokhtari T, Noorbakhsh F. Immunology, immunopathogenesis and immunotherapeutics of COVID-19; an overview. Int Immunopharmacol 2021; 93:107364. [PMID: 33486333 DOI: 10.1016/j.intimp.2020.107364] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) infection which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to a “public health emergency of international concern” (PHEIC). The infection is highly contagious, has a high mortality rate, and its pathophysiology remains poorly understood. Pulmonary inflammation with substantial lung damage together with generalized immune dysregulation are major components of COVID-19 pathogenesis. The former component, lung damage, seems to be at least in part a consequence of immune dysregulation. Indeed, studies have revealed that immune alteration is not merely an association, as it might occur in systemic infections, but, very likely, the core pathogenic element of COVID-19. In addition, precise management of immune response in COVID-19, i.e. enhancing anti-viral immunity while inhibiting systemic inflammation, may be key to successful treatment. Herein, we have reviewed current evidence related to different aspects of COVID-19 immunology, including innate and adaptive immune responses against the virus and mechanisms of virus-induced immune dysregulation. Considering that current antiviral therapies are chiefly experimental, strategies to do immunotherapy for the management of disease have also been reviewed. Understanding immunology of COVID-19 is important in developing effective therapies as well as diagnostic, and prophylactic strategies for this disease.
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Mohamed Khosroshahi L, Rezaei N. Dysregulation of the immune response in coronavirus disease 2019. Cell Biol Int 2020; 45:702-707. [PMID: 33289192 PMCID: PMC7753769 DOI: 10.1002/cbin.11517] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/04/2020] [Accepted: 11/28/2020] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) can trigger a cytokine storm in the pulmonary tissue by releasing various types of mediators, leading to acute respiratory distress syndrome (ARDS). Increased neutrophil‐to‐lymphocyte ratio, as well as CD4+ T lymphopenia, is reported in cases with novel coronavirus disease (COVID‐19), meanwhile, lymphopenia is a significant finding in the majority of COVID‐19 cases with a severe phenotype. Moreover, excessive activation of monocyte/macrophage and cytokine storms are associated with the severity of the disease and the related complications in SARS‐CoV‐2 infection. Understanding the immune response dysregulation in COVID‐19 is essential to develop more effective diagnostic, therapeutic, and prophylactic strategies in this pandemic.
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Affiliation(s)
| | - Nima Rezaei
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Fois AG, Paliogiannis P, Scano V, Cau S, Babudieri S, Perra R, Ruzzittu G, Zinellu E, Pirina P, Carru C, Arru LB, Fancellu A, Mondoni M, Mangoni AA, Zinellu A. The Systemic Inflammation Index on Admission Predicts In-Hospital Mortality in COVID-19 Patients. Molecules. 2020;25. [PMID: 33291581 PMCID: PMC7731255 DOI: 10.3390/molecules25235725] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The rapid onset of a systemic pro-inflammatory state followed by acute respiratory distress syndrome is the leading cause of mortality in patients with COVID-19. We performed a retrospective observational study to explore the capacity of different complete blood cell count (CBC)-derived inflammation indexes to predict in-hospital mortality in this group. METHODS The neutrophil to lymphocyte ratio (NLR), derived NLR (dNLR), platelet to lymphocyte ratio (PLR), mean platelet volume to platelet ratio (MPR), neutrophil to lymphocyte × platelet ratio (NLPR), monocyte to lymphocyte ratio (MLR), systemic inflammation response index (SIRI), systemic inflammation index (SII), and the aggregate index of systemic inflammation (AISI) were calculated on hospital admission in 119 patients with laboratory confirmed COVID-19. RESULTS Non-survivors had significantly higher AISI, dNLR, NLPR, NLR, SII, and SIRI values when compared to survivors. Similarly, Kaplan-Meier survival curves showed significantly lower survival in patients with higher AISI, dNLR, MLR, NLPR, NLR, SII, and SIRI. However, after adjusting for confounders, only the SII remained significantly associated with survival (HR = 1.0001; 95% CI, 1.0000-1.0001, p = 0.029) in multivariate Cox regression analysis. CONCLUSIONS The SII on admission independently predicts in-hospital mortality in COVID-19 patients and may assist with early risk stratification in this group.
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