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Nielsen KF, Nielsen LB, Dalby T, Lomholt FK, Slotved HC, Fuursted K, Harboe ZB, Jørgensen CS, Valentiner-Branth P. Follow-Up Study of Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine Against All-Type and Serotype-Specific Invasive Pneumococcal Disease, Denmark. Emerg Infect Dis 2024; 30:1164-1172. [PMID: 38781925 PMCID: PMC11138992 DOI: 10.3201/eid3006.230975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
As a follow-up to a previous study, we investigated vaccine effectiveness (VE) of 23-valent pneumococcal polysaccharide vaccine (PPSV23) against invasive pneumococcal disease (IPD) among 1,254,498 persons >65 years of age as part of a vaccination program in Denmark during April 2020-January 2023. We assessed VE by using a Cox regression model and adjusted for age, sex, and underlying conditions. Using nationwide data, we estimated a VE of PPSV23 against all-type IPD of 32% and against PPSV23-serotype IPD of 41%. Because this follow-up study had more statistical power than the original study, we also estimated VE against IPD caused by PPSV23-serotypes excluding serotype 3; serotype 3; serotype 8; serotype 22F; PPSV23 non-PCV15 serotypes; PPSV23 non-PCV20 serotypes; and IPD over time. Our findings suggest PPSV23 vaccination can protect persons >65 years of age against IPD caused by all serotypes or serotype groupings, except serotype 3.
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Affiliation(s)
| | | | - Tine Dalby
- Statens Serum Institut, Copenhagen, Denmark (K. Finderup Nielsen, L.B. Nielsen, T. Dalby, F.K. Lomholt, H.-C. Slotved, K. Fuursted, Z.B. Harboe, C.S. Jørgensen, P. Valentiner-Branth)
- Copenhagen University Hospital, North Zealand, Copenhagen (Z.B. Harboe)
- University of Copenhagen, Copenhagen (Z.B. Harboe)
| | - Frederikke Kristensen Lomholt
- Statens Serum Institut, Copenhagen, Denmark (K. Finderup Nielsen, L.B. Nielsen, T. Dalby, F.K. Lomholt, H.-C. Slotved, K. Fuursted, Z.B. Harboe, C.S. Jørgensen, P. Valentiner-Branth)
- Copenhagen University Hospital, North Zealand, Copenhagen (Z.B. Harboe)
- University of Copenhagen, Copenhagen (Z.B. Harboe)
| | - Hans-Christian Slotved
- Statens Serum Institut, Copenhagen, Denmark (K. Finderup Nielsen, L.B. Nielsen, T. Dalby, F.K. Lomholt, H.-C. Slotved, K. Fuursted, Z.B. Harboe, C.S. Jørgensen, P. Valentiner-Branth)
- Copenhagen University Hospital, North Zealand, Copenhagen (Z.B. Harboe)
- University of Copenhagen, Copenhagen (Z.B. Harboe)
| | - Kurt Fuursted
- Statens Serum Institut, Copenhagen, Denmark (K. Finderup Nielsen, L.B. Nielsen, T. Dalby, F.K. Lomholt, H.-C. Slotved, K. Fuursted, Z.B. Harboe, C.S. Jørgensen, P. Valentiner-Branth)
- Copenhagen University Hospital, North Zealand, Copenhagen (Z.B. Harboe)
- University of Copenhagen, Copenhagen (Z.B. Harboe)
| | - Zitta Barrella Harboe
- Statens Serum Institut, Copenhagen, Denmark (K. Finderup Nielsen, L.B. Nielsen, T. Dalby, F.K. Lomholt, H.-C. Slotved, K. Fuursted, Z.B. Harboe, C.S. Jørgensen, P. Valentiner-Branth)
- Copenhagen University Hospital, North Zealand, Copenhagen (Z.B. Harboe)
- University of Copenhagen, Copenhagen (Z.B. Harboe)
| | - Charlotte Sværke Jørgensen
- Statens Serum Institut, Copenhagen, Denmark (K. Finderup Nielsen, L.B. Nielsen, T. Dalby, F.K. Lomholt, H.-C. Slotved, K. Fuursted, Z.B. Harboe, C.S. Jørgensen, P. Valentiner-Branth)
- Copenhagen University Hospital, North Zealand, Copenhagen (Z.B. Harboe)
- University of Copenhagen, Copenhagen (Z.B. Harboe)
| | - Palle Valentiner-Branth
- Statens Serum Institut, Copenhagen, Denmark (K. Finderup Nielsen, L.B. Nielsen, T. Dalby, F.K. Lomholt, H.-C. Slotved, K. Fuursted, Z.B. Harboe, C.S. Jørgensen, P. Valentiner-Branth)
- Copenhagen University Hospital, North Zealand, Copenhagen (Z.B. Harboe)
- University of Copenhagen, Copenhagen (Z.B. Harboe)
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Pan ZM, Zeng J, Li T, Hu F, Cai XY, Wang XJ, Liu GZ, Hu XH, Yang X, Lu YH, Liu MY, Gong YP, Liu M, Li N, Li CL. Age-adjusted Charlson comorbidity index is associated with the risk of osteoporosis in older fall-prone men: a retrospective cohort study. BMC Geriatr 2024; 24:413. [PMID: 38730354 PMCID: PMC11084079 DOI: 10.1186/s12877-024-05015-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND There is growing evidence linking the age-adjusted Charlson comorbidity index (aCCI), an assessment tool for multimorbidity, to fragility fracture and fracture-related postoperative complications. However, the role of multimorbidity in osteoporosis has not yet been thoroughly evaluated. We aimed to investigate the association between aCCI and the risk of osteoporosis in older adults at moderate to high risk of falling. METHODS A total of 947 men were included from January 2015 to August 2022 in a hospital in Beijing, China. The aCCI was calculated by counting age and each comorbidity according to their weighted scores, and the participants were stratified into two groups by aCCI: low (aCCI < 5), and high (aCCI ≥5). The Kaplan Meier method was used to assess the cumulative incidence of osteoporosis by different levels of aCCI. The Cox proportional hazards regression model was used to estimate the association of aCCI with the risk of osteoporosis. Receiver operating characteristic (ROC) curve was adapted to assess the performance for aCCI in osteoporosis screening. RESULTS At baseline, the mean age of all patients was 75.7 years, the mean BMI was 24.8 kg/m2, and 531 (56.1%) patients had high aCCI while 416 (43.9%) were having low aCCI. During a median follow-up of 6.6 years, 296 participants developed osteoporosis. Kaplan-Meier survival curves showed that participants with high aCCI had significantly higher cumulative incidence of osteoporosis compared with those had low aCCI (log-rank test: P < 0.001). When aCCI was examined as a continuous variable, the multivariable-adjusted model showed that the osteoporosis risk increased by 12.1% (HR = 1.121, 95% CI 1.041-1.206, P = 0.002) as aCCI increased by one unit. When aCCI was changed to a categorical variable, the multivariable-adjusted hazard ratios associated with different levels of aCCI [low (reference group) and high] were 1.00 and 1.557 (95% CI 1.223-1.983) for osteoporosis (P < 0.001), respectively. The aCCI (cutoff ≥5) revealed an area under ROC curve (AUC) of 0.566 (95%CI 0.527-0.605, P = 0.001) in identifying osteoporosis in older fall-prone men, with sensitivity of 64.9% and specificity of 47.9%. CONCLUSIONS The current study indicated an association of higher aCCI with an increased risk of osteoporosis among older fall-prone men, supporting the possibility of aCCI as a marker of long-term skeletal-related adverse clinical outcomes.
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Affiliation(s)
- Zi-Mo Pan
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- Graduate School of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jing Zeng
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Ting Li
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Fan Hu
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiao-Yan Cai
- Department of Nephrology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xin-Jiang Wang
- Department of Radiology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Guan-Zhong Liu
- Department of Radiology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xing-He Hu
- Department of Radiology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xue Yang
- Outpatient Department, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yan-Hui Lu
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Min-Yan Liu
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yan-Ping Gong
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Miao Liu
- Department of anti-NBC medicine, Graduate School of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Nan Li
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Chun-Lin Li
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Berenguer J, Calvo-Alcántara MJ, Alvaro-Meca A, Estévez JC, Basanta M, Ruiz S, Matáix ÁL, Bienzóbas C, Cosano L, Silva AP, Salas P, Gullón P, Franco M, Arribas JR, Molero JM, Hernán MA. Three Years of the Coronavirus Disease 2019 Pandemic in a European Region: A Population-Based Longitudinal Assessment in Madrid Between 2020 and 2022. Open Forum Infect Dis 2024; 11:ofad635. [PMID: 38173846 PMCID: PMC10763997 DOI: 10.1093/ofid/ofad635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
Background Our objective was to assess the health impact of coronavirus disease 2019 (COVID-19) during 2020-2022 in the Madrid region. Methods We included all individuals registered in the Madrid Health System Registry as of 31 December 2019, and followed them until 31 December 2022. Using a unique personal identifier, we linked the databases of primary care, hospitals, pharmacies, certified laboratories performing diagnostic tests, vaccines, and mortality. Results Of 6 833 423 individuals, 21.4% had a confirmed COVID-19 diagnosis, and 1.5% had a COVID-19 hospitalization (primary diagnosis). Thirty-day mortality was 1.6% for confirmed COVID-19 (from 11.4% in first semester 2020 to 0.4% in first semester 2022). Thirty-day mortality was 10.8% for COVID-19 hospitalizations (from 14.0% in first semester 2020 to 6.0% in second semester 2022). There were 24 073 deaths within 30 days of a confirmed COVID-19 diagnosis. Advanced age, male sex, higher socioeconomic deprivation, and comorbidities were associated with higher mortality. Conclusions By linking administrative and clinical databases, we characterized the burden of the COVID-19 pandemic in Madrid over 3 years. Our analysis proposes a high-level framework for comparisons of the burden of COVID-19 across areas worldwide.
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Affiliation(s)
- Juan Berenguer
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | | | - Alejandro Alvaro-Meca
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain
| | - José C Estévez
- Gerencia Asistencial de Atención Primaria, Madrid, Spain
| | - Miguel Basanta
- Dirección General de Sistemas de Información y Equipamientos Sanitarios, Madrid, Spain
| | - Sergio Ruiz
- Gerencia Asistencial de Atención Primaria, Madrid, Spain
| | - Ángel L Matáix
- Subdirección General de Farmacia y Productos Sanitarios, Madrid, Spain
| | - César Bienzóbas
- Dirección General de Inspección y Ordenación Sanitaria, Madrid, Spain
| | - Lourdes Cosano
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Aura P Silva
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Salas
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pedro Gullón
- Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Manuel Franco
- Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - José R Arribas
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Infectious Diseases, Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
- Instituto de Investigación Hospital Universitario La Paz, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Miguel A Hernán
- CAUSALab, Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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Kubiliute I, Vitkauskaite M, Urboniene J, Svetikas L, Zablockiene B, Jancoriene L. Clinical characteristics and predictors for in-hospital mortality in adult COVID-19 patients: A retrospective single center cohort study in Vilnius, Lithuania. PLoS One 2023; 18:e0290656. [PMID: 37624796 PMCID: PMC10456157 DOI: 10.1371/journal.pone.0290656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The COVID-19 infection had spread worldwide causing many deaths. Mortality rates and patients' characteristics varied within and between countries, making it important to understand the peculiarities of different populations. The aim of this study was to identify the main predictors associated with in-hospital mortality due to COVID-19 in Vilnius, Lithuania. MATERIALS AND METHODS This was a retrospective observational cohort study conducted at Vilnius University Hospital Santaros Clinics, Lithuania. The study included SARS-CoV-2 positive patients aged over 18 years and hospitalized between March 2020 and May 2021. Depersonalized data were retrieved from electronic medical records. The predictive values of laboratory parameters were evaluated using ROC analysis. Multivariable binary logistic regression was performed to reveal predictors of in-hospital mortality due to COVID-19. RESULTS Among 2794 patients, 54.4% were male, the age median was 59 years (IQR 48-70), 47.4% had at least one comorbidity. The most common comorbidities were arterial hypertension (36.9%) and diabetes mellitus (13.7%). Overall, 12.7% of patients died. Multivariable regression revealed that age (OR 1.04, 95%CI 1.02-1.06), congestive heart failure (OR 3.06, 95%CI 1.96-4.77), obesity (OR 3.90, 95%CI 2.12-7.16), COPD (OR 2.92, 95%CI 1.12-7.60), previous stroke (OR 5.80, 95%CI 2.07-16.21), urea >7.01 mmol/l (OR 2.32, 95%CI 1.47-3.67), AST/ALT >1.49 (OR 1.54, 95%CI 1.08-2.21), LDH >452.5 U/l (OR 2.60, 95%CI 1.74-3.88), CRP >92.68 mg/l (OR 1.58, 95%CI 1.06-2.35), IL-6 >69.55 ng/l (OR 1.62, 95%CI 1.10-2.40), and troponin I >18.95 ng/l (OR 2.04, 95%CI 1.38-3.02), were associated with increased risk for in-hospital mortality in COVID-19 patients. CONCLUSIONS Age, congestive heart failure, obesity, COPD, prior stroke, and increased concentration of urea, LDH, CRP, IL-6, troponin I, ALT to AST ratio were identified to be the predictors for in-hospital mortality of COVID-19 patients.
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Affiliation(s)
- Ieva Kubiliute
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Jurgita Urboniene
- Center of Infectious Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Linas Svetikas
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Birute Zablockiene
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ligita Jancoriene
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Walekhwa AW, Nakazibwe B, Nantongo M, Wafula ST, Bulafu D, Ayugi B, Nankabirwa C, Nsereko G, Nalweyiso MD, Tindyebwa T, Mayega RW, Ekiri AB, Bagenda D, Musenero M, Mugisha L. COVID-19 second wave and clinical characteristics of cases in Uganda: A retrospective cross-sectional survey of confirmed SARS-CoV-2 cases, March-June 2021. Epidemiol Infect 2023; 151:e142. [PMID: 37489514 PMCID: PMC10894928 DOI: 10.1017/s0950268823001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/25/2023] [Accepted: 06/12/2023] [Indexed: 07/26/2023] Open
Abstract
We conducted a retrospective cross-sectional population-based survey among recovered COVID-19 cases in Uganda to establish the case presentations of the second wave SARS-CoV-2 infections. We interviewed 1,120 recovered COVID-19 cases from 10 selected districts in Uganda. We further conducted 38 key informant interviews with members of the COVID-19 District Taskforce and 19 in-depth interviews among COVID-19 survivors from March to June 2021. Among them, 62% were aged 39 years and below and 51.5% were female with 90.9% under home-based care management. Cases were more prevalent among businesspeople (25.9%), students (16.2%), farmers (16.1%), and health workers (12.4%). Being asymptomatic was found to be associated with not seeking healthcare (APR 2, P < 0.001). The mortality rate was 3.6% mostly among the elderly (6.3%) and 31.3% aged 40 years and above had comorbidities of high blood pressure, diabetes, and asthma. Being asymptomatic, or under home-based care management (HBCM), working/operating/studying at schools, and not being vaccinated were among the major drivers of the second wave of the resurgence of COVID19 in Uganda. Managing future COVID-19 waves calls for proactive efforts for improving homebased care services, ensuring strict observation of SOPs in schools, and increasing the uptake of COVID-19 vaccination.
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Affiliation(s)
- Abel Wilson Walekhwa
- Science, Technology and Innovation Secretariat- Office of the President, Kampala, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Brenda Nakazibwe
- Science, Technology and Innovation Secretariat- Office of the President, Kampala, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Mary Nantongo
- Science, Technology and Innovation Secretariat- Office of the President, Kampala, Uganda
| | | | - Douglas Bulafu
- Makerere University School of Public Health, Kampala, Uganda
| | - Brenda Ayugi
- Makerere University School of Public Health, Kampala, Uganda
| | - Caroline Nankabirwa
- Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity, Kampala, Uganda
| | | | - Martha Dorcas Nalweyiso
- Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity, Kampala, Uganda
| | - Tonny Tindyebwa
- Makerere University School of Public Health, Kampala, Uganda
- Ministry of Health, Kampala, Uganda
| | | | | | | | - Monica Musenero
- Science, Technology and Innovation Secretariat- Office of the President, Kampala, Uganda
| | - Lawrence Mugisha
- Science, Technology and Innovation Secretariat- Office of the President, Kampala, Uganda
- Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity, Kampala, Uganda
- Ecohealth Research Group, Conservation and Ecosystem Health Alliance (CEHA), Kampala, Uganda
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Tang MHE, Ng KL, Edslev SM, Ellegaard K, Stegger M, Alexandersen S. Comparative subgenomic mRNA profiles of SARS-CoV-2 Alpha, Delta and Omicron BA.1, BA.2 and BA.5 sub-lineages using Danish COVID-19 genomic surveillance data. EBioMedicine 2023; 93:104669. [PMID: 37348163 PMCID: PMC10281627 DOI: 10.1016/j.ebiom.2023.104669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has rapidly spread worldwide in the population since it was first detected in late 2019. The transcription and replication of coronaviruses, although not fully understood, is characterised by the production of genomic length RNA and shorter subgenomic RNAs to make viral proteins and ultimately progeny virions. Observed levels of subgenomic RNAs differ between sub-lineages and open reading frames but their biological significance is presently unclear. METHODS Using a large and diverse panel of virus sequencing data produced as part of the Danish COVID-19 routine surveillance together with information in electronic health registries, we assessed the association of subgenomic RNA levels with demographic and clinical variables of the infected individuals. FINDINGS Our findings suggest no significant statistical relationship between levels of subgenomic RNAs and host-related factors. INTERPRETATION Differences between lineages and subgenomic ORFs may be related to differences in target cell tropism, early virus replication/transcription kinetics or sequence features. FUNDING The author(s) received no specific funding for this work.
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Affiliation(s)
- Man-Hung Eric Tang
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Kim Lee Ng
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Sofie Marie Edslev
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Kirsten Ellegaard
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Marc Stegger
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Soren Alexandersen
- Division of Diagnostic Preparedness, Statens Serum Institut, Copenhagen, Denmark.
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7
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Koppe U, Schilling J, Stecher M, Rüthrich MM, Marquis A, Diercke M, Haselberger M, Koll CEM, Niebank M, Ruehe B, Borgmann S, Grabenhenrich L, Hellwig K, Pilgram L, Spinner CD, Paerisch T. Disease severity in hospitalized COVID-19 patients: comparing routine surveillance with cohort data from the LEOSS study in 2020 in Germany. BMC Infect Dis 2023; 23:89. [PMID: 36765274 PMCID: PMC9912207 DOI: 10.1186/s12879-023-08035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/27/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION Studies investigating risk factors for severe COVID-19 often lack information on the representativeness of the study population. Here, we investigate factors associated with severe COVID-19 and compare the representativeness of the dataset to the general population. METHODS We used data from the Lean European Open Survey on SARS-CoV-2 infected patients (LEOSS) of hospitalized COVID-19 patients diagnosed in 2020 in Germany to identify associated factors for severe COVID-19, defined as progressing to a critical disease stage or death. To assess the representativeness, we compared the LEOSS cohort to cases of hospitalized patients in the German statutory notification data of the same time period. Descriptive methods and Poisson regression models were used. RESULTS Overall, 6672 hospitalized patients from LEOSS and 132,943 hospitalized cases from the German statutory notification data were included. In LEOSS, patients above 76 years were less likely represented (34.3% vs. 44.1%). Moreover, mortality was lower (14.3% vs. 21.5%) especially among age groups above 66 years. Factors associated with a severe COVID-19 disease course in LEOSS included increasing age, male sex (adjusted risk ratio (aRR) 1.69, 95% confidence interval (CI) 1.53-1.86), prior stem cell transplantation (aRR 2.27, 95% CI 1.53-3.38), and an elevated C-reactive protein at day of diagnosis (aRR 2.30, 95% CI 2.03-2.62). CONCLUSION We identified a broad range of factors associated with severe COVID-19 progression. However, the results may be less applicable for persons above 66 years since they experienced lower mortality in the LEOSS dataset compared to the statutory notification data.
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Affiliation(s)
- Uwe Koppe
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany.
| | - Julia Schilling
- grid.13652.330000 0001 0940 3744Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Melanie Stecher
- grid.6190.e0000 0000 8580 3777Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.452463.2German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Maria Madeleine Rüthrich
- grid.275559.90000 0000 8517 6224Centre for Emergency Medicine, University Hospital Jena, Jena, Germany
| | - Adine Marquis
- grid.13652.330000 0001 0940 3744Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Michaela Diercke
- grid.13652.330000 0001 0940 3744Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | | | - Carolin E. M. Koll
- grid.6190.e0000 0000 8580 3777Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.452463.2German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Michaela Niebank
- grid.13652.330000 0001 0940 3744Centre for Biological Threats and Special Pathogens, Robert Koch-Institute, Berlin, Germany
| | - Bettina Ruehe
- grid.13652.330000 0001 0940 3744Centre for Biological Threats and Special Pathogens, Robert Koch-Institute, Berlin, Germany
| | - Stefan Borgmann
- grid.492033.f0000 0001 0058 5377Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany
| | - Linus Grabenhenrich
- grid.13652.330000 0001 0940 3744Department for Methods Development, Research Infrastructure and Information Technology, Robert Koch Institute, Berlin, Germany
| | - Kerstin Hellwig
- grid.5570.70000 0004 0490 981XDepartment of Neurology, Catholic Hospital Bochum St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Lisa Pilgram
- grid.6363.00000 0001 2218 4662Department of Nephrology and Medical Intensive Care, Charité, Universitätsmedizin Berlin, Berlin, Germany ,grid.7839.50000 0004 1936 9721Department of Internal Medicine, Hematology and Oncology, Goethe University, Frankfurt, Frankfurt, Germany
| | - Christoph D. Spinner
- grid.6936.a0000000123222966Department of Internal Medicine II, School of Medicine, University Hospital Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Paerisch
- grid.13652.330000 0001 0940 3744Centre for Biological Threats and Special Pathogens, Robert Koch-Institute, Berlin, Germany
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8
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Sex differences in D-dimer and critical illness in patients with COVID-19: A systematic review and meta-analysis. Res Pract Thromb Haemost 2023; 7:100042. [PMID: 36685003 PMCID: PMC9840223 DOI: 10.1016/j.rpth.2023.100042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/23/2022] [Accepted: 12/09/2022] [Indexed: 01/15/2023] Open
Abstract
Background Observed sex differences in COVID-19 outcomes suggest that men are more likely to experience critical illness and mortality. Thrombosis is common in severe COVID-19, and D-dimer is a significant marker for COVID-19 severity and mortality. It is unclear whether D-dimer levels differ between men and women, and the effect of D-dimer levels on disease outcomes remains under investigation. Objectives We aimed to evaluate the sex difference in the D-dimer level among hospitalized patients with COVID-19 and the effect of sex and D-dimer level on disease outcomes. Methods We meta-analyzed articles reporting D-dimer levels in men and women hospitalized for COVID-19, until October 2021, using random effects. Primary outcomes were mortality, critical illness, and thrombotic complications. Results In total, 11,682 patients from 10 studies were analyzed (N = 5606 men (55.7%), N = 5176 women (44.3%)). Men had significantly higher odds of experiencing mortality (odds ratios (OR) = 1.41, 95% CI: [1.25, 1.59], P ≤ .001, I2 = 0%) and critical illness (OR = 1.76, 95% CI: [1.43, 2.18], P ≤ .001, I2 = 61%). The mean D-dimer level was not significantly different between men and women (MD = 0.08, 95% CI: [-0.23, 0.40], P = .61, I2 = 52%). In the subgroup analysis, men had significantly higher odds of experiencing critical illness compared with women in both the "higher" (P = .006) and "lower" (P = .001) D-dimer subgroups. Conclusion Men have significantly increased odds of experiencing poor COVID-19 outcomes compared with women. No sex difference was found in the D-dimer level between men and women with COVID-19. The diversity in D-dimer reporting impacts data interpretation and requires further attention.
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Cerdan de las Heras J, Andersen SL, Matthies S, Sandreva TV, Johannesen CK, Nielsen TL, Fuglebjerg N, Catalan-Matamoros D, Hansen DG, Fischer TK. Hospitalisation at Home of Patients with COVID-19: A Qualitative Study of User Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1287. [PMID: 36674043 PMCID: PMC9858642 DOI: 10.3390/ijerph20021287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Hospitalisation at Home (HaH) is a new model providing hospital-level care at home as a substitute for traditional care. Biometric monitoring and digital communication are crucial, but little is known about user perspectives. We aim to explore how in-patients with severe COVID-19 infection and clinicians engage with and experience communication and self-monitoring activities following the HaH model. A qualitative study based on semi-structured interviews of patients and clinicians participating in the early development phase of HaH were conducted. We interviewed eight clinicians and six patients. Five themes emerged from clinicians: (1) staff fear and concerns, (2) workflow, (3) virtual closeness, (4) patient relatives, and (5) future HaH models; four themes emerged from patients: (1) transition to home, (2) joint responsibility, (3) acceptability of technologies, and (4) relatives. Despite technical problems, both patients and clinicians were enthusiastic about the conceptual HaH idea. If appropriately introduced, treatment based on self-monitoring and remote communication was perceived acceptable for the patients; however, obtaining vitals at night was an overwhelming challenge. HaH is generally acceptable, perceived patient-centred, influencing routine clinical workflow, role and job satisfaction. Therefore, it calls for educational programs including more perspective than issues related to technical devices.
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Affiliation(s)
- Jose Cerdan de las Heras
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
| | - Signe Lindgård Andersen
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
| | - Sophie Matthies
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
| | | | - Caroline Klint Johannesen
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
- Department of Virology and Microbiological Special Diagnostics, Statens Serum Institut, 2300 Copenhagen, Denmark
| | - Thyge Lynghøj Nielsen
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
| | - Natascha Fuglebjerg
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
| | | | - Dorte Gilså Hansen
- Institute of Public Health, Research Unit of General Practice, University of Southern Denmark, 5230 Odense, Denmark
| | - Thea K. Fischer
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
- Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
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10
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Zinellu A, Mangoni AA. A systematic review and meta-analysis of the association between the neutrophil, lymphocyte, and platelet count, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio and COVID-19 progression and mortality. Expert Rev Clin Immunol 2022; 18:1187-1202. [PMID: 36047369 DOI: 10.1080/1744666x.2022.2120472] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Severe manifestations of coronavirus disease 2019 (COVID-19) are associated with alterations in blood cells that regulate immunity, inflammation, and hemostasis. We conducted an updated systematic review and meta-analysis of the association between the neutrophil, lymphocyte, and platelet count, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), and COVID-19 progression and mortality. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published between January 2020 and June 2022. RESULTS In 71 studies reporting the investigated parameters within 48 hours of admission, higher NLR (HR 1.21, 95% CI 1.16 to 1.27, p < 0.0001), relative neutrophilia (HR 1.62, 95% CI 1.46 to 1.80, p < 0.0001), relative lymphopenia (HR 1.62, 95% CI 1.27 to 2.08, p < 0.001), and relative thrombocytopenia (HR 1.74, 95% CI 1.36 to 2.22, p < 0.001), but not PLR (p = 0.11), were significantly associated with disease progression and mortality. Between-study heterogeneity was large-to-extreme. The magnitude and direction of the effect size were not modified in sensitivity analysis. CONCLUSIONS NLR and neutrophil, lymphocyte, and platelet count significantly discriminate COVID-19 patients with different progression and survival outcomes. (PROSPERO registration number: CRD42021267875).
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
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11
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The cross-scale correlations between individuals and nations in COVID-19 mortality. Sci Rep 2022; 12:13895. [PMID: 35974130 PMCID: PMC9380985 DOI: 10.1038/s41598-022-18179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 08/08/2022] [Indexed: 01/08/2023] Open
Abstract
It is challenging to quantitatively clarify the determining medical and social factors of COVID-19 mortality, which varied by 2 to 3 orders of magnitude across countries. Here, we present evidence that the temporal evolution of mortality follows a logistic law for 54 countries in four waves. A universal linear law is found between the early mortality growth time and the epidemic duration, one of the most important quantities, with a factor of 7.3 confirmed by data. Saturation mortality is found to have a power law relationship with median age and bed occupancy, which quantitatively explains the great variation in mortality based on the two key thresholds of median age (= 38) and bed occupancy (= 22%). We predict that deaths will be reduced by 38.5% when the number of beds is doubled for countries with older populations. Facing the next wave of the epidemic, this model can make early predictions on the epidemic duration and hospital bed demand.
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12
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Santos RS, Barros DS, Moraes TM, Hayashi CY, Ralio RB, Minenelli FF, van Zon K, Ripardo JP. Clinical characteristics and outcomes of hospitalized patients with COVID-19 in a Brazilian hospital: a retrospective study of the first and second waves. IJID REGIONS 2022; 3:189-195. [PMID: 35720152 PMCID: PMC9007747 DOI: 10.1016/j.ijregi.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 12/15/2022]
Abstract
This study describes the characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) in a Brazilian hospital. Characteristics from the first and second waves were compared. The number of cases was higher in the second wave, but hospitalizations were lower, compared with the first wave. Admission and death rates were slightly lower in the study hospital compared with national rates. This study can help managers to plan resources needed for the treatment of patients with COVID-19.
Objectives To describe clinical characteristics, hospitalization flow and outcomes in a cohort of patients with coronavirus disease 2019 (COVID-19) in a Brazilian hospital in the first and second waves of the pandemic. Methods This retrospective, observational study included patients with confirmed COVID-19 who were evaluated in the emergency department (ED) between 1 March 2020 and 30 June 2021. Descriptive statistics have been used to report clinical characteristics, admissions and outcomes. Comparison between the two waves was inferred using hypothesis test techniques. Results During the study period, 7723 (86.54%) patients were evaluated in the ED, of which 1908 (24.70%) were admitted. Of these, 476 (24.95%) patients were initially allocated to the intensive care unit (ICU) and 1432 (75.05%) to the general ward. Of the patients initially allocated to the general ward, 349 (24.37%) were later transferred to the ICU. One hundred and fifty-eight patients were intubated (19.15% of ICU admissions) and 110 patients died (5.77% of all admissions). In the second wave, the admission rates decreased in both the ICU (from 13.84% to 9.56%; P<0.01) and the general ward (from 22.41% to 17.16%; P<0.01). The average age in the second wave decreased from 44.06 to 41.87 years (P<0.01). Patients with severe symptoms, such as dyspnoea, decreased from 25.51% to 13.13% (P<0.01) in the second wave. The death rate among admitted patients decreased by 17.84% (from 6.52% to 5.38%; P<0.01). Conclusion Despite the greater number of patients in the second wave, the admission and death rates were lower compared with the first wave. The mean age of patients was lower in the second wave, and patients arrived at the hospital with less severe symptoms compared with the first wave.
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13
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Buttenschøn HN, Lynggaard V, Sandbøl SG, Glassou EN, Haagerup A. Comparison of the clinical presentation across two waves of COVID-19: a retrospective cohort study. BMC Infect Dis 2022; 22:423. [PMID: 35505306 PMCID: PMC9063242 DOI: 10.1186/s12879-022-07413-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Only a few studies have performed comprehensive comparisons between hospitalized patients from different waves of COVID-19. Thus, we aimed to compare the clinical characteristics and laboratory data of patients admitted to the western part of Denmark during the first and second waves of COVID-19 in 2020. Furthermore, we aimed to identify risk factors for critical COVID-19 disease and to describe the available information on the sources of infection. METHODS We performed a retrospective study of medical records from 311 consecutive hospitalized patients, 157 patients from wave 1 and 154 patients from wave 2. The period from March 7 to June 30, 2020, was considered wave 1, and the period from July 1st to December 31, 2020, was considered wave 2. Data are presented as the total study population, as a comparison between waves 1 and 2, and as a comparison between patients with and without critical COVID-19 disease (nonsurvivors and patients admitted to the intensive care unit (ICU)). RESULTS Patients admitted during the first COVID-19 wave experienced a more severe course of disease than patients admitted during wave 2. Admissions to the ICU and fatal disease were significantly higher among patients admitted during wave 1 compared to wave 2. The percentage of patients infected at hospital decreased in wave 2 compared to wave 1, whereas more patients were infected at home during wave 2. We found no significant differences in sociodemographics, lifestyle information, or laboratory data in the comparison of patients from waves 1 and 2. However, age, sex, smoking status, comorbidities, fever, and dyspnea were identified as risk factors for critical COVID-19 disease. Furthermore, we observed significantly increased levels of C-reactive protein and creatinine, and lower hemoglobin levels among patients with critical disease. CONCLUSIONS At admission, patients were more severely ill during wave 1 than during wave 2, and the outcomes were worse during wave 1. We confirmed previously identified risk factors for critical COVID-19 disease. In addition, we found that most COVID-19 infections were acquired at home.
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Affiliation(s)
- Henriette Nørmølle Buttenschøn
- NIDO
- Centre for Research and Education, Gødstrup Hospital, Hospitalsparken 25, 7400, Herning, Denmark. .,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Vibeke Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, NIDO
- Centre for Research and Education, Gødstrup Hospital, Hospitalsparken 25, 7400, Herning, Denmark
| | - Susanne Gundersborg Sandbøl
- NIDO
- Centre for Research and Education, Gødstrup Hospital, Hospitalsparken 25, 7400, Herning, Denmark.,Department of Quality, NIDO
- Centre for Research and Education, Gødstrup Hospital, Hospitalsparken 25, 7400, Herning, Denmark
| | - Eva Natalia Glassou
- Department of Quality, NIDO
- Centre for Research and Education, Gødstrup Hospital, Hospitalsparken 25, 7400, Herning, Denmark
| | - Annette Haagerup
- NIDO
- Centre for Research and Education, Gødstrup Hospital, Hospitalsparken 25, 7400, Herning, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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14
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Ryrsø CK, Dungu AM, Hegelund MH, Jensen AV, Sejdic A, Faurholt-Jepsen D, Krogh-Madsen R, Lindegaard B. Body composition, physical capacity, and immuno-metabolic profile in community-acquired pneumonia caused by COVID-19, influenza, and bacteria: a prospective cohort study. Int J Obes (Lond) 2022; 46:817-824. [PMID: 34987205 PMCID: PMC8729099 DOI: 10.1038/s41366-021-01057-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/01/2021] [Accepted: 12/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Different pathogens can cause community-acquired pneumonia (CAP); however, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) has re-emphasized the vital role of respiratory viruses as a cause of CAP. The aim was to explore differences in metabolic profile, body composition, physical capacity, and inflammation between patients hospitalized with CAP caused by different etiology. METHODS A prospective study of Danish patients hospitalized with CAP caused by SARS-CoV-2, influenza, or bacteria. Fat (FM) and fat-free mass (FFM) were assessed with bioelectrical impedance analysis. Physical activity and capacity were assessed using questionnaires and handgrip strength. Plasma (p)-glucose, p-lipids, hemoglobin A1c (HbA1c), p-adiponectin, and cytokines were measured. RESULTS Among 164 patients with CAP, etiology did not affect admission levels of glucose, HbA1c, adiponectin, or lipids. Overall, 15.2% had known diabetes, 6.1% had undiagnosed diabetes, 51.3% had pre-diabetes, 81% had hyperglycemia, and 60% had low HDL-cholesterol, with no difference between groups. Body mass index, FM, and FFM were similar between groups, with 73% of the patients being characterized with abdominal obesity, although waist circumference was lower in patients with COVID-19. Physical capacity was similar between groups. More than 80% had low handgrip strength and low physical activity levels. Compared to patients with influenza, patients with COVID-19 had increased levels of interferon (IFN)-γ (mean difference (MD) 4.14; 95% CI 1.36-12.58; p = 0.008), interleukin (IL)-4 (MD 1.82; 95% CI 1.12-2.97; p = 0.012), IL-5 (MD 2.22; 95% CI 1.09-4.52; p = 0.024), and IL-6 (MD 2.41; 95% CI 1.02-5.68; p = 0.044) and increased IFN-γ (MD 6.10; 95% CI 2.53-14.71; p < 0.001) and IL-10 (MD 2.68; 95% CI 1.53-4.69; p < 0.001) compared to patients with bacterial CAP, but no difference in IL-1β, tumor necrosis factor-α, IL-8, IL-18, IL-12p70, C-reactive protein, and adiponectin. CONCLUSION Despite higher inflammatory response in patients with COVID-19, metabolic profile, body composition, and physical capacity were similar to patients with influenza and bacterial CAP.
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Affiliation(s)
- Camilla Koch Ryrsø
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark.,Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Arnold Matovu Dungu
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maria Hein Hegelund
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Vestergaard Jensen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Adin Sejdic
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rikke Krogh-Madsen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
| | - Birgitte Lindegaard
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark. .,Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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15
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Lugli G, Ottaviani MM, Botta A, Ascione G, Bruschi A, Cagnazzo F, Zammarchi L, Romagnani P, Portaluri T. The Impact of the SARS-CoV-2 Pandemic on Healthcare Provision in Italy to non-COVID Patients: a Systematic Review. Mediterr J Hematol Infect Dis 2022; 14:e2022012. [PMID: 35070219 PMCID: PMC8746940 DOI: 10.4084/mjhid.2022.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Italy has been one of the countries most affected by the SARS-CoV-2 pandemic, and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. Therefore, we investigated the management of non-COVID-19 patients across all medical specialities in Italy. METHODS A PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from February 20 to June 25 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialities combined with our geographical focus (Italy) and COVID-19. RESULTS Of the 4643 potentially eligible studies identified by the search, 247 were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialities have been affected by the re-organization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine. CONCLUSIONS Our work highlights the changes in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyse future directions for the healthcare system in the case of new pandemic scenarios.
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Affiliation(s)
- Gianmarco Lugli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Matteo Maria Ottaviani
- Department of Neurosurgery, University Politecnica delle Marche, Ancona, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Guido Ascione
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Alessandro Bruschi
- Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Infectious and Tropical Disease, University Hospital Careggi, Florence, Italy
| | - Paola Romagnani
- Nephrology and Dialysis Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Tommaso Portaluri
- IN Srl, Udine, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
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16
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Barry M, Alotaibi M, Almohaya A, Aldrees A, AlHijji A, Althabit N, Alhasani S, Akkielah L, AlRajhi A, Nouh T, Temsah MH, Al-Tawfiq JA. Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospital. J Infect Public Health 2021; 14:1658-1665. [PMID: 34627061 PMCID: PMC8485705 DOI: 10.1016/j.jiph.2021.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has resulted in millions of deaths, including more than 6000 deaths in the Kingdom of Saudi Arabia (KSA). Identifying key predictors of intensive care unit (ICU) admission and mortality among infected cases would help in identifying individuals at risk to optimize their care. We aimed to determine factors of poor outcomes in hospitalized patients with COVID-19 in a large academic hospital in Riyadh, KSA that serves as a Middle East Respiratory Syndrome coronavirus (MERS-CoV) referral center. METHODS This is a single-center retrospective cohort study of hospitalized patients between March 15 and August 31, 2020. The study was conducted at King Saud University Medical City (KSUMC). COVID-19 infection was confirmed using real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-COV-2. Demographic data, clinical characteristics, laboratory, radiological features, and length of hospital stay were obtained. Poor outcomes were, admission to ICU, need for invasive mechanical ventilation (IMV), and in-hospital all-cause mortality. RESULTS Out of 16,947 individuals tested in KSUMC, 3480 (20.5%) tested positive for SARS-CoV-2 and of those 743 patients (21%) were hospitalized. There were 62% males, 77% were younger than 65 years. Of all cases, 204 patients (28%) required ICU admission, 104 (14%) required IMV, and 117 (16%) died in hospital. In bivariate analysis, multiple factors were associated with mortality among COVID-19 patients. Further multivariate analysis revealed the following factors were associated with mortality: respiratory rate more than 24/min and systolic blood pressure <90 mmHg in the first 24h of presentation, lymphocyte count <1 × 109/L and aspartate transaminase level >37 units/L in the first 48 h of presentation, while a RT-PCR cycle threshold (Ct) value ≤24 was a predictor for IMV. CONCLUSION Variable factors were identified as predictors of different outcomes among COVID-19 patients. The only predictor of IMV was a low initial Ct values of SARS-CoV-2 PCR. The presence of tachypnea, hypotension, lymphopenia, and elevated AST in the first 48h of presentation were independently associated with mortality. This study provides possible independent predictors of mortality and invasive mechanical ventilation. The data may be helpful in the early identification of high-risk COVID-19 patients in areas endemic with MERS-CoV.
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Affiliation(s)
- Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Muath Alotaibi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulellah Almohaya
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Internal Medicine Department, Ad-Dariya Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulwahab Aldrees
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ali AlHijji
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Althabit
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sara Alhasani
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Layan Akkielah
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz AlRajhi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Thamer Nouh
- Trauma and Acute Care Surgery Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamad-Hani Temsah
- Critical Care Unit, Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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17
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Birtay T, Bahadir S, Kabacaoglu E, Yetiz O, Demirci MF, Genctoy G. Prognosis of patients hospitalized with a diagnosis of COVID-19 pneumonia in a tertiary hospital in Turkey. Ann Saudi Med 2021; 41:327-335. [PMID: 34873938 PMCID: PMC8650597 DOI: 10.5144/0256-4947.2021.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND SARS-CoV2/COVID-19 emerged in China and caused a global pandemic in 2020. The mortality rate has been reported to be between 0% and 14.6% in all patients. In this study, we determined the clinical and laboratory parameters of COVID-19 related morbidity and mortality in our hospital. OBJECTIVES Investigate the relationship between demographic, clinical, and laboratory parameters on COVID-19-related morbidity and mortality. DESIGN Retrospective observational study. SETTINGS Tertiary care hospital. PATIENTS AND METHODS Patients diagnosed with COVID-19 pneumonia from March until the end of December were included in the study. MAIN OUTCOME MEASURES The relationship between demographic, clinical, and laboratory parameters and the morbidity and mortality rates of patients diagnosed with COVID-19. SAMPLE SIZE 124 patients RESULTS: The mortality rate was 9.6% (12/124). Coronary artery disease (P<.0001) diabetes mellitus (P=.04) fever (>38.3°C) at presentation (P=.04) hypertension (P<.0001), and positive smoking history (P<.0001) were significantly associated with mortality. Patients who died were older, had a higher comorbid disease index, pneumonia severity index, fasting blood glucose, baseline serum creatinine, D-dimer, and had lower baseline haemoglobin, SaO2, percentage of lymphocyte counts and diastolic blood pressure. Patients admitted to the ICU were older, had a higher comorbidity disease index, pneumonia severity index, C-reactive protein, WBC, D-dimer, creatinine, number of antibiotics used, longer O2 support duration, lower hemoglobin, lymphocyte (%), and baseline SaO2 (%). CONCLUSIONS Our results were consistent with much of the reported data. We suggest that the frequency, dosage, and duration of steroid treatment should be limited. LIMITATIONS Low patient number, uncertain reason of mortality, no standard treatment regimen, limited treatment options, like ECMO. CONFLICT OF INTEREST None.
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Affiliation(s)
- Tayfun Birtay
- From the Department of Anesthesia, Baskent University, Antalya, Turkey
| | - Suzan Bahadir
- From the Department of Anesthesia, Baskent University, Antalya, Turkey
| | - Ebru Kabacaoglu
- From the Department of Chest Diseases, Baskent University, Antalya, Turkey
| | - Ozgur Yetiz
- From the Department of Anesthesia, Baskent University, Antalya, Turkey
| | | | - Gultekin Genctoy
- From the Department of Nephrology, Baskent University, Antalya, Turkey
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18
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Magunia H, Lederer S, Verbuecheln R, Gilot BJ, Koeppen M, Haeberle HA, Mirakaj V, Hofmann P, Marx G, Bickenbach J, Nohe B, Lay M, Spies C, Edel A, Schiefenhövel F, Rahmel T, Putensen C, Sellmann T, Koch T, Brandenburger T, Kindgen-Milles D, Brenner T, Berger M, Zacharowski K, Adam E, Posch M, Moerer O, Scheer CS, Sedding D, Weigand MA, Fichtner F, Nau C, Prätsch F, Wiesmann T, Koch C, Schneider G, Lahmer T, Straub A, Meiser A, Weiss M, Jungwirth B, Wappler F, Meybohm P, Herrmann J, Malek N, Kohlbacher O, Biergans S, Rosenberger P. Machine learning identifies ICU outcome predictors in a multicenter COVID-19 cohort. Crit Care 2021; 25:295. [PMID: 34404458 PMCID: PMC8370055 DOI: 10.1186/s13054-021-03720-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/01/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Intensive Care Resources are heavily utilized during the COVID-19 pandemic. However, risk stratification and prediction of SARS-CoV-2 patient clinical outcomes upon ICU admission remain inadequate. This study aimed to develop a machine learning model, based on retrospective & prospective clinical data, to stratify patient risk and predict ICU survival and outcomes. METHODS A Germany-wide electronic registry was established to pseudonymously collect admission, therapeutic and discharge information of SARS-CoV-2 ICU patients retrospectively and prospectively. Machine learning approaches were evaluated for the accuracy and interpretability of predictions. The Explainable Boosting Machine approach was selected as the most suitable method. Individual, non-linear shape functions for predictive parameters and parameter interactions are reported. RESULTS 1039 patients were included in the Explainable Boosting Machine model, 596 patients retrospectively collected, and 443 patients prospectively collected. The model for prediction of general ICU outcome was shown to be more reliable to predict "survival". Age, inflammatory and thrombotic activity, and severity of ARDS at ICU admission were shown to be predictive of ICU survival. Patients' age, pulmonary dysfunction and transfer from an external institution were predictors for ECMO therapy. The interaction of patient age with D-dimer levels on admission and creatinine levels with SOFA score without GCS were predictors for renal replacement therapy. CONCLUSIONS Using Explainable Boosting Machine analysis, we confirmed and weighed previously reported and identified novel predictors for outcome in critically ill COVID-19 patients. Using this strategy, predictive modeling of COVID-19 ICU patient outcomes can be performed overcoming the limitations of linear regression models. Trial registration "ClinicalTrials" (clinicaltrials.gov) under NCT04455451.
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Affiliation(s)
- Harry Magunia
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany.
| | - Simone Lederer
- Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Raphael Verbuecheln
- Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Bryant Joseph Gilot
- Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Michael Koeppen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany
| | - Helene A Haeberle
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany
| | - Valbona Mirakaj
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany
| | - Pascal Hofmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Johannes Bickenbach
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Boris Nohe
- Center for Anaesthesia, Intensive Care and Emergency Medicine, Zollernalb Klinikum, Balingen, Germany
| | - Michael Lay
- Center for Anaesthesia, Intensive Care and Emergency Medicine, Zollernalb Klinikum, Balingen, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin , Germany
| | - Andreas Edel
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin , Germany
| | - Fridtjof Schiefenhövel
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin , Germany
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Tim Rahmel
- Department of Anesthesiology, Intensive Care Medicine/Pain Therapy, Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Christian Putensen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Timur Sellmann
- Department of Anesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus Bethesda, Duisburg, Germany
- Chair of Anesthesiology 1, Witten/Herdecke University, Wuppertal, Germany
| | - Thea Koch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timo Brandenburger
- Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Marc Berger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Elisabeth Adam
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Matthias Posch
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
| | - Onnen Moerer
- Center for Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Christian S Scheer
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Daniel Sedding
- Department Cardiology, Angiology and Intensive Care Medicine, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Falk Fichtner
- Department of Anesthesiology and Intensive Care, Leipzig University Hospital, Leipzig, Germany
| | - Carla Nau
- Department of Anesthesiology and Intensive Care, University Medical Center Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
| | - Florian Prätsch
- Department of Anaesthesiology and Intensive Care Therapy, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Thomas Wiesmann
- University Hospital Marburg, UKGM, Philipps University Marburg, Marburg, Germany
| | - Christian Koch
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Giessen and Marburg, Justus-Liebig University Giessen, Giessen, Germany
| | - Gerhard Schneider
- Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Lahmer
- Klinik Und Poliklinik Für Innere Medizin II, Klinikum Rechts Der Isar der, Technischen Universität München, Munich, Germany
| | - Andreas Straub
- Department for Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, St. Elisabethen Klinikum, Ravensburg, Germany
| | - Andreas Meiser
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Hospital Medical Center, Homburg/Saar, Germany
| | - Manfred Weiss
- Department of Anesthesiology and Intensive Care Medicine, Ulm University, Ulm, Germany
| | - Bettina Jungwirth
- Department of Anesthesiology and Intensive Care Medicine, Ulm University, Ulm, Germany
| | - Frank Wappler
- Department of Anaesthesiology and Intensive Care Medicine, Cologne-Merheim Medical Centre, Witten/Herdecke University, Cologne-Merheim, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, University Wuerzburg, Wuerzburg, Germany
| | - Johannes Herrmann
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, University Wuerzburg, Wuerzburg, Germany
| | - Nisar Malek
- Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
| | - Oliver Kohlbacher
- Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Department of Computer Science, Institute for Bioinformatics and Medical Informatics, University of Tübingen, Tübingen, Germany
| | - Stephanie Biergans
- Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany.
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19
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van Veenendaal N, van der Meulen IC, Onrust M, Paans W, Dieperink W, van der Voort PHJ. Six-Month Outcomes in COVID-19 ICU Patients and Their Family Members: A Prospective Cohort Study. Healthcare (Basel) 2021; 9:healthcare9070865. [PMID: 34356243 PMCID: PMC8305246 DOI: 10.3390/healthcare9070865] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/25/2022] Open
Abstract
Background: The COVID-19 pandemic has resulted in a major influx of intensive care unit (ICU) admissions. Currently, there is limited knowledge on the long-term outcomes of COVID-19 ICU-survivors and the impact on family members. This study aimed to gain an insight into the long-term physical, social and psychological functioning of COVID-19 ICU-survivors and their family members at three- and six-months following ICU discharge. Methods: A single-center, prospective cohort study was conducted among COVID-19 ICU-survivors and their family members. Participants received questionnaires at three and six months after ICU discharge. Physical functioning was evaluated using the MOS Short-Form General Health Survey, Clinical Frailty Scale and spirometry tests. Social functioning was determined using the McMaster Family Assessment Device and return to work. Psychological functioning was assessed using the Hospital Anxiety and Depression Scale. Results: Sixty COVID-19 ICU-survivors and 78 family members participated in this study. Physical functioning was impaired in ICU-survivors as reflected by a score of 33.3 (IQR 16.7–66.7) and 50 (IQR 16.7–83.3) out of 100 at 3- and 6-month follow-ups, respectively. Ninety percent of ICU-survivors reported persistent symptoms after 6 months. Social functioning was impaired since 90% of COVID-19 ICU-survivors had not reached their pre-ICU work level 6 months after ICU-discharge. Psychological functioning was unaffected in COVID-19 ICU-survivors. Family members experienced worse work status in 35% and 34% of cases, including a decrease in work rate among 18.3% and 7.4% of cases at 3- and 6-months post ICU-discharge, respectively. Psychologically, 63% of family members reported ongoing impaired well-being due to the COVID-19-related mandatory physical distance from their relatives. Conclusion: COVID-19 ICU-survivors suffer from a prolonged disease burden, which is prominent in physical and social functioning, work status and persisting symptoms among 90% of patients. Family members reported a reduction in return to work and impaired well-being. Further research is needed to extend the follow-up period and study the effects of standardized rehabilitation in COVID-19 patients and their family members.
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Affiliation(s)
- Nadine van Veenendaal
- Department of Critical Care, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (N.v.V.); (M.O.); (W.P.); (W.D.); (P.H.J.v.d.V.)
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Ingeborg C. van der Meulen
- Department of Critical Care, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (N.v.V.); (M.O.); (W.P.); (W.D.); (P.H.J.v.d.V.)
- School of Nursing, Professorship Nursing Diagnosis, Hanze University of Applied Science, P.O. Box 3109, 9701 DC Groningen, The Netherlands
- Correspondence: ; Tel.: +31-50-5952297
| | - Marisa Onrust
- Department of Critical Care, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (N.v.V.); (M.O.); (W.P.); (W.D.); (P.H.J.v.d.V.)
- School of Nursing, Professorship Nursing Diagnosis, Hanze University of Applied Science, P.O. Box 3109, 9701 DC Groningen, The Netherlands
| | - Wolter Paans
- Department of Critical Care, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (N.v.V.); (M.O.); (W.P.); (W.D.); (P.H.J.v.d.V.)
- School of Nursing, Professorship Nursing Diagnosis, Hanze University of Applied Science, P.O. Box 3109, 9701 DC Groningen, The Netherlands
| | - Willem Dieperink
- Department of Critical Care, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (N.v.V.); (M.O.); (W.P.); (W.D.); (P.H.J.v.d.V.)
- School of Nursing, Professorship Nursing Diagnosis, Hanze University of Applied Science, P.O. Box 3109, 9701 DC Groningen, The Netherlands
| | - Peter H. J. van der Voort
- Department of Critical Care, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (N.v.V.); (M.O.); (W.P.); (W.D.); (P.H.J.v.d.V.)
- TIAS School for Business and Society, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
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20
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Johnsen S, Sattler SM, Miskowiak KW, Kunalan K, Victor A, Pedersen L, Andreassen HF, Jørgensen BJ, Heebøll H, Andersen MB, Marner L, Hædersdal C, Hansen H, Ditlev SB, Porsbjerg C, Lapperre TS. Descriptive analysis of long COVID sequelae identified in a multidisciplinary clinic serving hospitalised and non-hospitalised patients. ERJ Open Res 2021; 7:00205-2021. [PMID: 34345629 PMCID: PMC8091683 DOI: 10.1183/23120541.00205-2021] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/20/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There are emerging data of long-term effects of coronavirus disease 2019 (COVID-19) comprising a diversity of symptoms. The aim of this study was to systematically describe and measure pulmonary and extra-pulmonary post-COVID-19 complications in relation to acute COVID-19 severity. METHODS Patients attending a standard of care 3 months post-hospitalisation follow-up visit and those referred by their general practitioner because of persistent post-COVID-19 symptoms were included. Patients underwent symptomatic, quality of life, pulmonary (lung function and high-resolution computed tomography (HRCT)), cardiac (high-resolution ECG), physical (1-min sit and stand test (1-MSTST), handgrip strength, cardiopulmonary exercise testing (CPET)) and cognitive evaluations. RESULTS All 34 hospitalised and 22 out of 23 non-hospitalised patients had ≥1 complaint or abnormal finding at follow-up. Overall, 67% of patients were symptomatic (Medical Research Council (MRC) ≥2 or COPD assessment test (CAT) ≥10), with no difference between hospitalised versus non-hospitalised patients. Pulmonary function (forced expiratory volume in 1 s (FEV1) or diffusing capacity of the lung for carbon monoxide (D LCO)) <80% of predicted) was impaired in 68% of patients. D LCO was significantly lower in those hospitalised compared to non-hospitalised (70.1±18.0 versus 80.2±11.2% predicted, p=0.02). Overall, 53% had an abnormal HRCT (predominantly ground-glass opacities) with higher composite computed tomography (CT) scores in hospitalised versus non-hospitalised patients (2.3 (0.1-4.8) and 0.0 (0.0-0.3), p<0.001). 1-MSTST was below the 25th percentile in almost half of patients, but no signs of cardiac dysfunction were found. Cognitive impairments were present in 59-66% of hospitalised and 31-44% of non-hospitalised patients (p=0.08). CONCLUSION Three months after COVID-19 infection, patients were still symptomatic and demonstrated objective respiratory, functional, radiological and cognitive abnormalities, which were more prominent in hospitalised patients. Our study underlines the importance of multidimensional management strategies in these patients.
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Affiliation(s)
- Stine Johnsen
- Dept of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
- These authors contributed equally
| | - Stefan M. Sattler
- Dept of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
- Biomedical Institute, Copenhagen University, Copenhagen, Denmark
- These authors contributed equally
| | | | - Keerthana Kunalan
- Dept of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | - Alan Victor
- Dept of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | - Lars Pedersen
- Dept of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | - Helle Frost Andreassen
- Dept of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | | | - Hanne Heebøll
- Dept of Radiology, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | - Michael Brun Andersen
- Dept of Radiology, Copenhagen University Hospital at Herlev/Gentofte, Copenhagen, Denmark
| | - Lisbeth Marner
- Dept of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Carsten Hædersdal
- Dept of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik Hansen
- Respiratory Research Unit, Dept of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
- Respiratory Research Unit, Dept of Respiratory Medicine, Copenhagen University Hospital at Hvidovre, Copenhagen, Denmark
| | - Sisse Bolm Ditlev
- Respiratory Research Unit, Dept of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | - Celeste Porsbjerg
- Dept of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
- Respiratory Research Unit, Dept of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | - Thérèse S. Lapperre
- Dept of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
- Dept of Pulmonology, University Hospital Antwerp, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
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21
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Divanoglou A, Samuelsson APK, Sjödahl PER, Andersson C, Levi PR. Rehabilitation needs and mortality associated with the Covid-19 pandemic: a population-based study of all hospitalised and home-healthcare individuals in a Swedish healthcare region. EClinicalMedicine 2021; 36:100920. [PMID: 34095795 PMCID: PMC8164661 DOI: 10.1016/j.eclinm.2021.100920] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/19/2021] [Accepted: 05/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This first report of the Linköping Covid-19 Study (LinCoS) aimed at determination of Covid-19-associated mortality, impairments, activity and participation limitations denoting rehabilitation needs four months after discharge from hospital. METHODS An ambidirectional population-based cohort study including all confirmed Covid-19 cases admitted to hospital during 1/03-31/05 and those living in home healthcare settings identified through a regional registry and evaluated through medical records, including WHO Clinical Progression Scale (CPS). All patients discharged from hospital were followed-up by structured telephone interview at 4 months post-discharge. Respondents indicated any new or aggravated persisting problems in any of 25 body functions and 12 activity/participation items and rated them for impact on daily life. FINDINGS Out of 734 hospitalised patients, 149 were excluded, 125 died, and 460 were alive at 4-month follow-up of whom 433 (94.1%) were interviewed. In total, 40% reported impairments and activity/participation limitations affecting daily life and warranted further multi-professional rehabilitation assessment, predominantly those with severe disease and a considerable proportion of those with moderate disease. Cognitive and affective impairments were equally common in all groups and were reported by 20-40% of cases. Limb weakness was reported by 31%, with CPS 7-9 being four times more likely to report this problem as compared to CPS 4-5. 26% of those working or studying reported difficulties returning to these activities, this being 3.5 times more likely in CPS 7-9 as compared to CPS 4-5. 25% reported problems walking >1 km, with CPS 7-9 over three times more likely to report this as compared to the other two sub-groups. 90-day mortality rate of Covid-19 associated deaths was 15.1%. INTERPRETATION Most rehabilitation needs after Covid-19 involved higher cerebral dysfunction both in patients with moderate and severe disease. This should be considered when designing services aiming at minimizing long-term disability. FUNDING ALF grant and Region Östergötland.
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Affiliation(s)
- Anestis Divanoglou
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring sciences, Linköping University, S-58185, Linköping, Sweden
| | - Assoc. Prof Kersti Samuelsson
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring sciences, Linköping University, S-58185, Linköping, Sweden
| | - Prof. Emer. Rune Sjödahl
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, S-58185, Linköping, Sweden
| | - Christer Andersson
- Department of Orthopedics, Linköping University Hospital, S-58185, Linköping, Sweden
| | - Prof. Richard Levi
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring sciences, Linköping University, S-58185, Linköping, Sweden
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