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Bijon J, Elahi S, Dubois M, Ghazal W, Courtin R, Panthier C, Gatinel D, Saad A. Descemet's membrane endothelial keratoplasty rejection after SARS-COV2 infection or vaccination: 2-year retrospective study. J Fr Ophtalmol 2024; 47:104117. [PMID: 38696860 DOI: 10.1016/j.jfo.2024.104117] [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: 10/03/2023] [Revised: 01/07/2024] [Accepted: 01/16/2024] [Indexed: 05/04/2024]
Abstract
PURPOSE To assess the incidence of Descemet's membrane endothelial keratoplasty (DMEK) rejection potentially associated with coronavirus disease 2019 (COVID-19) infection or vaccination, and its association with known rejection risk factors during the first two years of the pandemic. METHODS This retrospective study included patients with DMEK rejection between January 2020 and December 2021. Diagnostic criteria were based on symptoms, visual acuity, and other clinical assessments. Risk factors for graft rejection were considered, and a telephone survey was conducted to identify possible preceding COVID-19 infection or vaccination. RESULTS Of 58 patients, 44 were included. Six patients (14%) reported COVID-19 infection, with one immediate endothelial graft rejection (EGR) post-infection. After vaccine availability, 13 of 36 patients had EGR at an average of 2.7 months post-vaccination. Five (38%) had immediate EGR following vaccination, four of which had concomitant risk factors for rejection. CONCLUSION Although the risk of endothelial graft rejection (EGR) associated with COVID-19 infection or vaccination appears to be extremely low, there may be a causative relationship, especially in patients with pre-existing risk factors for EGR. A temporary increase in anti-rejection treatment following COVID-19 infection or vaccination is recommended, especially in patients with pre-existing risk factors, along with closer monitoring during the subsequent 4 to 8 weeks.
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Affiliation(s)
- J Bijon
- Department of Ophthalmology, Rothschild Foundation, Paris, France
| | - S Elahi
- Department of Ophthalmology, Rothschild Foundation, Paris, France
| | - M Dubois
- Department of Ophthalmology, Rothschild Foundation, Paris, France
| | - W Ghazal
- Department of Ophthalmology, Rothschild Foundation, Paris, France
| | - R Courtin
- Department of Ophthalmology, Rothschild Foundation, Paris, France
| | - C Panthier
- Department of Ophthalmology, Rothschild Foundation, Paris, France
| | - D Gatinel
- Department of Ophthalmology, Rothschild Foundation, Paris, France
| | - A Saad
- Department of Ophthalmology, Rothschild Foundation, Paris, France.
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Madera‐Sandoval RL, Cérbulo‐Vázquez A, Arriaga‐Pizano LA, Cabrera‐Rivera GL, Basilio‐Gálvez E, Miranda‐Cruz PE, García de la Rosa MT, Prieto‐Chávez JL, Rivero‐Arredondo SV, Cruz‐Cruz A, Rodríguez‐Hernández D, Salazar‐Ríos ME, Salazar‐Ríos E, Serrano‐Molina ED, De Lira‐Barraza RC, Villanueva‐Compean AH, Esquivel‐Pineda A, Ramírez‐Montes de Oca R, Unzueta‐Marta O, Flores‐Padilla G, Anda‐Garay JC, Sánchez‐Hurtado LA, Calleja‐Alarcón S, Romero‐Gutiérrez L, Torres‐Rosas R, Bonifaz LC, Pelayo R, Márquez‐Márquez E, López‐Macías CIIIR, Ferat‐Osorio E. Potential biomarkers for fatal outcome prognosis in a cohort of hospitalized COVID-19 patients with pre-existing comorbidities. Clin Transl Sci 2023; 16:2687-2699. [PMID: 37873554 PMCID: PMC10719476 DOI: 10.1111/cts.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 10/25/2023] Open
Abstract
The difficulty in predicting fatal outcomes in patients with coronavirus disease 2019 (COVID-19) impacts the general morbidity and mortality due to severe acute respiratory syndrome-coronavirus 2 infection, as it wears out the hospital services that care for these patients. Unfortunately, in several of the candidates for prognostic biomarkers proposed, the predictive power is compromised when patients have pre-existing comorbidities. A cohort of 147 patients hospitalized for severe COVID-19 was included in a descriptive, observational, single-center, and prospective study. Patients were recruited during the first COVID-19 pandemic wave (April-November 2020). Data were collected from the clinical history whereas immunophenotyping by multiparameter flow cytometry analysis allowed us to assess the expression of surface markers on peripheral leucocyte. Patients were grouped according to the outcome in survivors or non-survivors. The prognostic value of leucocyte, cytokines or HLA-DR, CD39, and CD73 was calculated. Hypertension and chronic renal failure but not obesity and diabetes were conditions more frequent among the deceased patient group. Mixed hypercytokinemia, including inflammatory (IL-6) and anti-inflammatory (IL-10) cytokines, was more evident in deceased patients. In the deceased patient group, lymphopenia with a higher neutrophil-lymphocyte ratio (NLR) value was present. HLA-DR expression and the percentage of CD39+ cells were higher than non-COVID-19 patients but remained similar despite the outcome. Receiver operating characteristic analysis and cutoff value of NLR (69.6%, 9.4), percentage NLR (pNLR; 71.1%, 13.6), and IL-6 (79.7%, 135.2 pg/mL). The expression of HLA-DR, CD39, and CD73, as many serum cytokines (other than IL-6) and chemokines levels do not show prognostic potential, were compared to NLR and pNLR values.
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Affiliation(s)
- Ruth Lizzeth Madera‐Sandoval
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | | | - Lourdes Andrea Arriaga‐Pizano
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Graciela Libier Cabrera‐Rivera
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Posgrado en InmunologíaInstituto Politécnico NacionalCiudad de MéxicoMexico
| | - Edna Basilio‐Gálvez
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Posgrado de Ciencias Químicobiológicas, Escuela Nacional de Ciencias BiológicasInstituto Politécnico NacionalCiudad de MéxicoMexico
| | - Patricia Esther Miranda‐Cruz
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - María Teresa García de la Rosa
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Posgrado en InmunologíaInstituto Politécnico NacionalCiudad de MéxicoMexico
| | - Jessica Lashkmin Prieto‐Chávez
- Centro de Instrumentos, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Silvia Vanessa Rivero‐Arredondo
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Alonso Cruz‐Cruz
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Daniela Rodríguez‐Hernández
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - María Eugenia Salazar‐Ríos
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Enrique Salazar‐Ríos
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Esli David Serrano‐Molina
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | | | | | - Alejandra Esquivel‐Pineda
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Rubén Ramírez‐Montes de Oca
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Omar Unzueta‐Marta
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Guillermo Flores‐Padilla
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Juan Carlos Anda‐Garay
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Luis Alejandro Sánchez‐Hurtado
- Unidad de Cuidados Intensivos, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Salvador Calleja‐Alarcón
- Unidad de Cuidados Intensivos, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Laura Romero‐Gutiérrez
- Unidad de Cuidados Intensivos, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Rafael Torres‐Rosas
- Laboratorio de Inmunología, Centro de Estudios en Ciencias de la Salud y la Enfermedad, Facultad de OdontologíaUniversidad Autónoma “Benito Juárez” de Oaxaca (UABJO)Oaxaca de JuárezMexico
| | - Laura C. Bonifaz
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro SocialCiudad de MéxicoMexico
| | - Rosana Pelayo
- Centro de Investigación Biomédica de OrienteIMSSPueblaMexico
- Unidad de Educación e Investigación, IMSSCiudad de MéxicoMexico
| | | | | | - Eduardo Ferat‐Osorio
- Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro SocialCiudad de MéxicoMexico
- División de Investigación en Salud, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
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Diel R, Nienhaus A. Cost-Benefit of Real-Time Multiplex PCR Testing of SARS-CoV-2 in German Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3447. [PMID: 36834141 PMCID: PMC9960777 DOI: 10.3390/ijerph20043447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The current Omicron COVID-19 pandemic has significant morbidity worldwide. OBJECTIVE Assess the cost-benefit relation of implementing PCR point-of-care (POCT) COVID-19 testing in the emergency rooms (ERs) of German hospitals and in the case of inpatient admission due to other acute illnesses. METHODS A deterministic decision-analytic model simulated the incremental costs of using the Savanna® Multiplex RT-PCR test compared to using clinical judgement alone to confirm or exclude COVID-19 in adult patients in German ERs prior to hospitalization or just prior to discharge. Direct and indirect costs were evaluated from the hospital perspective. Nasal or nasopharyngeal swabs of patients suspected to have COVID-19 by clinical judgement, but without POCT, were sent to external labs for RT-PCR testing. RESULTS In probabilistic sensitivity analysis, assuming a COVID-19 prevalence ranging between 15.6-41.2% and a hospitalization rate between 4.3-64.3%, implementing the Savanna® test saved, on average, €107 as compared to applying the clinical-judgement-only strategy. A revenue loss of €735 can be avoided when SARS-CoV-2 infection in patients coming unplanned to the hospital due to other acute illnesses are excluded immediately by POCT. CONCLUSIONS Using highly sensitive and specific PCR-POCT in patients suspected of COVID-19 infection at German ERs may significantly reduce hospital expenditures.
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Affiliation(s)
- Roland Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Airway Research Center North (ARCN), 24015 Kiel, Germany
- Lung Clinic Grosshansdorf, Germany, Airway Disease Center North (ARCN), German Center for Lung Research (DZL), 22949 Großhansdorf, Germany
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany
| | - Albert Nienhaus
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany
- Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Estrada-Serrano M, García-Covarrubias L, García-Covarrubias A, Hernández-Rivera JC, Santos-Mansur A. [Risk factors at admission associated with intubation in patients with COVID-19]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:68-74. [PMID: 36542549 PMCID: PMC10396005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/08/2022] [Indexed: 12/24/2022]
Abstract
Background Intubation rates up to 33% have been found in patients diagnosed with COVID-19. Some cohorts have reported the presence of dyspnea in 84.1% of intubated patients, being this the only symptom associated with intubation. Oxygen saturation < 90% and increased respiratory rate have also been described as predictors of intubation. Objective To analyze the risk factors associated with intubation in patients hospitalized for COVID-19 at their admission. Material and methods An observational, retrospective, analytical, cross-sectional study was carried out. The universe of study consisted of patients over 18 years of age hospitalized due to a diagnosis of SARS-CoV-2 virus infection from April 1, 2020 to April 31, 2021 in the Hospital de Especialidades (Specialties Hospital) "Dr. Bernardo Sepúlveda Gutiérrez" at the National Medical Center. Results The mean age of intubated patients was 59.17 years (95% confidence interval [95% CI] -9.994 to -3.299, p < 0.001). Overall, 76.7% (230) of patients had a history of one or more preexisting comorbidities, including hypertension in 42.3% (127), obesity in 36.7% (110), and diabetes mellitus in 34.3% (103). Conclusions The main clinical characteristics of patients hospitalized for COVID-19 in our center who required intubation are very similar to those observed in different centers, including male sex, age over 50 years and obesity, which were the most common.
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Affiliation(s)
- Mayra Estrada-Serrano
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades “Dr. Bernardo Sepúlveda Gutiérrez”, Servicio de Cirugía de Cabeza y Cuello. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Luis García-Covarrubias
- Secretaría de Salud, Hospital General de México “Dr. Eduardo Liceaga”, Departamento de Cirugía. Ciudad de México, MéxicoSecretaría de SaludMéxico
| | - Aldo García-Covarrubias
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades “Dr. Bernardo Sepúlveda Gutiérrez”, Servicio de Gastrocirugía. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Juan Carlos Hernández-Rivera
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades “Dr. Bernardo Sepúlveda Gutiérrez”, Servicio de Gastrocirugía. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Adriana Santos-Mansur
- Secretaría de Salud, Hospital General de México “Dr. Eduardo Liceaga”, Departamento de Cirugía. Ciudad de México, MéxicoSecretaría de SaludMéxico
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Winkler ML, Hooper DC, Shenoy ES. Infection Prevention and Control of Severe Acute Respiratory Syndrome Coronavirus 2 in Health Care Settings. Infect Dis Clin North Am 2022; 36:309-326. [PMID: 35636902 PMCID: PMC8806155 DOI: 10.1016/j.idc.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The authors describe infection prevention and control approaches to severe acute respiratory syndrome coronavirus 2 in the health care setting, including a review of the chain of transmission and the hierarchy of controls, which are cornerstones of infection control and prevention. The authors also discuss lessons learned from nosocomial transmission events.
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Affiliation(s)
- Marisa L. Winkler
- Infection Control Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 334, Boston, MA 02114, USA,Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA,Corresponding author. Massachusetts General Hospital, 55 Fruit Street, Bulfinch 334, Boston, MA, 02114
| | - David C. Hooper
- Infection Control Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 334, Boston, MA 02114, USA,Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Erica S. Shenoy
- Infection Control Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 334, Boston, MA 02114, USA,Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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Struyf T, Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MM, Spijker R, Hooft L, Emperador D, Domen J, Tans A, Janssens S, Wickramasinghe D, Lannoy V, Horn SRA, Van den Bruel A. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19. Cochrane Database Syst Rev 2022; 5:CD013665. [PMID: 35593186 PMCID: PMC9121352 DOI: 10.1002/14651858.cd013665.pub3] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND COVID-19 illness is highly variable, ranging from infection with no symptoms through to pneumonia and life-threatening consequences. Symptoms such as fever, cough, or loss of sense of smell (anosmia) or taste (ageusia), can help flag early on if the disease is present. Such information could be used either to rule out COVID-19 disease, or to identify people who need to go for COVID-19 diagnostic tests. This is the second update of this review, which was first published in 2020. OBJECTIVES To assess the diagnostic accuracy of signs and symptoms to determine if a person presenting in primary care or to hospital outpatient settings, such as the emergency department or dedicated COVID-19 clinics, has COVID-19. SEARCH METHODS We undertook electronic searches up to 10 June 2021 in the University of Bern living search database. In addition, we checked repositories of COVID-19 publications. We used artificial intelligence text analysis to conduct an initial classification of documents. We did not apply any language restrictions. SELECTION CRITERIA Studies were eligible if they included people with clinically suspected COVID-19, or recruited known cases with COVID-19 and also controls without COVID-19 from a single-gate cohort. Studies were eligible when they recruited people presenting to primary care or hospital outpatient settings. Studies that included people who contracted SARS-CoV-2 infection while admitted to hospital were not eligible. The minimum eligible sample size of studies was 10 participants. All signs and symptoms were eligible for this review, including individual signs and symptoms or combinations. We accepted a range of reference standards. DATA COLLECTION AND ANALYSIS Pairs of review authors independently selected all studies, at both title and abstract, and full-text stage. They resolved any disagreements by discussion with a third review author. Two review authors independently extracted data and assessed risk of bias using the QUADAS-2 checklist, and resolved disagreements by discussion with a third review author. Analyses were restricted to prospective studies only. We presented sensitivity and specificity in paired forest plots, in receiver operating characteristic (ROC) space and in dumbbell plots. We estimated summary parameters using a bivariate random-effects meta-analysis whenever five or more primary prospective studies were available, and whenever heterogeneity across studies was deemed acceptable. MAIN RESULTS We identified 90 studies; for this update we focused on the results of 42 prospective studies with 52,608 participants. Prevalence of COVID-19 disease varied from 3.7% to 60.6% with a median of 27.4%. Thirty-five studies were set in emergency departments or outpatient test centres (46,878 participants), three in primary care settings (1230 participants), two in a mixed population of in- and outpatients in a paediatric hospital setting (493 participants), and two overlapping studies in nursing homes (4007 participants). The studies did not clearly distinguish mild COVID-19 disease from COVID-19 pneumonia, so we present the results for both conditions together. Twelve studies had a high risk of bias for selection of participants because they used a high level of preselection to decide whether reverse transcription polymerase chain reaction (RT-PCR) testing was needed, or because they enrolled a non-consecutive sample, or because they excluded individuals while they were part of the study base. We rated 36 of the 42 studies as high risk of bias for the index tests because there was little or no detail on how, by whom and when, the symptoms were measured. For most studies, eligibility for testing was dependent on the local case definition and testing criteria that were in effect at the time of the study, meaning most people who were included in studies had already been referred to health services based on the symptoms that we are evaluating in this review. The applicability of the results of this review iteration improved in comparison with the previous reviews. This version has more studies of people presenting to ambulatory settings, which is where the majority of assessments for COVID-19 take place. Only three studies presented any data on children separately, and only one focused specifically on older adults. We found data on 96 symptoms or combinations of signs and symptoms. Evidence on individual signs as diagnostic tests was rarely reported, so this review reports mainly on the diagnostic value of symptoms. Results were highly variable across studies. Most had very low sensitivity and high specificity. RT-PCR was the most often used reference standard (40/42 studies). Only cough (11 studies) had a summary sensitivity above 50% (62.4%, 95% CI 50.6% to 72.9%)); its specificity was low (45.4%, 95% CI 33.5% to 57.9%)). Presence of fever had a sensitivity of 37.6% (95% CI 23.4% to 54.3%) and a specificity of 75.2% (95% CI 56.3% to 87.8%). The summary positive likelihood ratio of cough was 1.14 (95% CI 1.04 to 1.25) and that of fever 1.52 (95% CI 1.10 to 2.10). Sore throat had a summary positive likelihood ratio of 0.814 (95% CI 0.714 to 0.929), which means that its presence increases the probability of having an infectious disease other than COVID-19. Dyspnoea (12 studies) and fatigue (8 studies) had a sensitivity of 23.3% (95% CI 16.4% to 31.9%) and 40.2% (95% CI 19.4% to 65.1%) respectively. Their specificity was 75.7% (95% CI 65.2% to 83.9%) and 73.6% (95% CI 48.4% to 89.3%). The summary positive likelihood ratio of dyspnoea was 0.96 (95% CI 0.83 to 1.11) and that of fatigue 1.52 (95% CI 1.21 to 1.91), which means that the presence of fatigue slightly increases the probability of having COVID-19. Anosmia alone (7 studies), ageusia alone (5 studies), and anosmia or ageusia (6 studies) had summary sensitivities below 50% but summary specificities over 90%. Anosmia had a summary sensitivity of 26.4% (95% CI 13.8% to 44.6%) and a specificity of 94.2% (95% CI 90.6% to 96.5%). Ageusia had a summary sensitivity of 23.2% (95% CI 10.6% to 43.3%) and a specificity of 92.6% (95% CI 83.1% to 97.0%). Anosmia or ageusia had a summary sensitivity of 39.2% (95% CI 26.5% to 53.6%) and a specificity of 92.1% (95% CI 84.5% to 96.2%). The summary positive likelihood ratios of anosmia alone and anosmia or ageusia were 4.55 (95% CI 3.46 to 5.97) and 4.99 (95% CI 3.22 to 7.75) respectively, which is just below our arbitrary definition of a 'red flag', that is, a positive likelihood ratio of at least 5. The summary positive likelihood ratio of ageusia alone was 3.14 (95% CI 1.79 to 5.51). Twenty-four studies assessed combinations of different signs and symptoms, mostly combining olfactory symptoms. By combining symptoms with other information such as contact or travel history, age, gender, and a local recent case detection rate, some multivariable prediction scores reached a sensitivity as high as 90%. AUTHORS' CONCLUSIONS Most individual symptoms included in this review have poor diagnostic accuracy. Neither absence nor presence of symptoms are accurate enough to rule in or rule out the disease. The presence of anosmia or ageusia may be useful as a red flag for the presence of COVID-19. The presence of cough also supports further testing. There is currently no evidence to support further testing with PCR in any individuals presenting only with upper respiratory symptoms such as sore throat, coryza or rhinorrhoea. Combinations of symptoms with other readily available information such as contact or travel history, or the local recent case detection rate may prove more useful and should be further investigated in an unselected population presenting to primary care or hospital outpatient settings. The diagnostic accuracy of symptoms for COVID-19 is moderate to low and any testing strategy using symptoms as selection mechanism will result in both large numbers of missed cases and large numbers of people requiring testing. Which one of these is minimised, is determined by the goal of COVID-19 testing strategies, that is, controlling the epidemic by isolating every possible case versus identifying those with clinically important disease so that they can be monitored or treated to optimise their prognosis. The former will require a testing strategy that uses very few symptoms as entry criterion for testing, the latter could focus on more specific symptoms such as fever and anosmia.
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Affiliation(s)
- Thomas Struyf
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jonathan J Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Jacqueline Dinnes
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Clare Davenport
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Mariska Mg Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - René Spijker
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Lotty Hooft
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Julie Domen
- Department of Primary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Anouk Tans
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | | | | | | | - Sebastiaan R A Horn
- Department of Primary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ann Van den Bruel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Diaz Badial P, Bothorel H, Kherad O, Dussoix P, Tallonneau Bory F, Ramlawi M. A new screening tool for SARS-CoV-2 infection based on self-reported patient clinical characteristics: the COV 19-ID score. BMC Infect Dis 2022; 22:187. [PMID: 35209872 PMCID: PMC8867452 DOI: 10.1186/s12879-022-07164-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 02/16/2022] [Indexed: 01/08/2023] Open
Abstract
Background While several studies aimed to identify risk factors for severe COVID-19 cases to better anticipate intensive care unit admissions, very few have been conducted on self-reported patient symptoms and characteristics, predictive of RT-PCR test positivity. We therefore aimed to identify those predictive factors and construct a predictive score for the screening of patients at admission. Methods This was a monocentric retrospective analysis of clinical data from 9081 patients tested for SARS-CoV-2 infection from August 1 to November 30 2020. A multivariable logistic regression using least absolute shrinkage and selection operator (LASSO) was performed on a training dataset (60% of the data) to determine associations between self-reported patient characteristics and COVID-19 diagnosis. Regression coefficients were used to construct the Coronavirus 2019 Identification score (COV19-ID) and the optimal threshold calculated on the validation dataset (20%). Its predictive performance was finally evaluated on a test dataset (20%). Results A total of 2084 (22.9%) patients were tested positive to SARS-CoV-2 infection. Using the LASSO model, COVID-19 was independently associated with loss of smell (Odds Ratio, 6.4), fever (OR, 2.7), history of contact with an infected person (OR, 1.7), loss of taste (OR, 1.5), muscle stiffness (OR, 1.5), cough (OR, 1.5), back pain (OR, 1.4), loss of appetite (OR, 1.3), as well as male sex (OR, 1.05). Conversely, COVID-19 was less likely associated with smoking (OR, 0.5), sore throat (OR, 0.9) and ear pain (OR, 0.9). All aforementioned variables were included in the COV19-ID score, which demonstrated on the test dataset an area under the receiver-operating characteristic curve of 82.9% (95% CI 80.6%–84.9%), and an accuracy of 74.2% (95% CI 74.1%–74.3%) with a high sensitivity (80.4%, 95% CI [80.3%–80.6%]) and specificity (72.2%, 95% CI [72.2%–72.4%]). Conclusions The COV19-ID score could be useful in early triage of patients needing RT-PCR testing thus alleviating the burden on laboratories, emergency rooms, and wards. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07164-1.
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Affiliation(s)
- Pablo Diaz Badial
- Department of Emergency Medicine, La Tour Hospital, 1217, Geneva, Switzerland
| | - Hugo Bothorel
- Research Department, La Tour Hospital, 1217, Geneva, Switzerland.
| | - Omar Kherad
- Department of Internal Medicine, La Tour Hospital and University of Geneva, 1217, Geneva, Switzerland
| | - Philippe Dussoix
- Department of Emergency Medicine, La Tour Hospital, 1217, Geneva, Switzerland
| | | | - Majd Ramlawi
- Department of Emergency Medicine, La Tour Hospital, 1217, Geneva, Switzerland
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Gérardin P, Maillard O, Bruneau L, Accot F, Legrand F, Poubeau P, Manaquin R, Andry F, Bertolotti A, Levin C. Differentiating COVID-19 and dengue from other febrile illnesses in co-epidemics: Development and internal validation of COVIDENGUE scores. Travel Med Infect Dis 2021; 45:102232. [PMID: 34896649 PMCID: PMC8656151 DOI: 10.1016/j.tmaid.2021.102232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this cohort study was to develop two scores able to differentiate coronavirus 2019 (COVID-19) from dengue and other febrile illnesses (OFIs). METHODS All subjects suspected of COVID-19 who attended the SARS-CoV-2 testing center of Saint-Pierre hospital, Reunion, between March 23 and May 10, 2020, were assessed for identifying predictors of both infectious diseases from a multinomial logistic regression model. Two scores were developed after weighting the odd ratios then validated by bootstrapping. RESULTS Over 49 days, 80 COVID-19, 60 non-severe dengue and 872 OFIs were diagnosed. The translation of the best fit model yielded two scores composed of 11 criteria: contact with a COVID-19 positive case (+3 points for COVID-19; 0 point for dengue), return from travel abroad within 15 days (+3/-1), previous individual episode of dengue (+1/+3), active smoking (-3/0), body ache (0/+5), cough (0/-2), upper respiratory tract infection symptoms (-1/-1), anosmia (+7/-1), headache (0/+5), retro-orbital pain (-1/+5), and delayed presentation (>3 days) to hospital (+1/0). The area under the receiver operating characteristic curve was 0.79 (95%CI 0.76-0.82) for COVID-19 score and 0.88 (95%CI 0.85-0.90) for dengue score. Calibration was satisfactory for COVID-19 score and excellent for dengue score. For predicting COVID-19, sensitivity was 97% at the 0-point cut-off and specificity 99% at the 10-point cut-off. For predicting dengue, sensitivity was 97% at the 3-point cut-off and specificity 98% at the 11-point cut-off. CONCLUSIONS COVIDENGUE scores proved discriminant to differentiate COVID-19 and dengue from OFIs in the context of SARS-CoV-2 testing center during a co-epidemic.
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Affiliation(s)
- Patrick Gérardin
- Centre for Clinical Investigation - Clinical Epidemiology (CIC 1410), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion.
| | - Olivier Maillard
- Centre for Clinical Investigation - Clinical Epidemiology (CIC 1410), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
| | - Léa Bruneau
- Department of Public Health and Research Support, Centre Hospitalier Universitaire de La Réunion, Saint Denis, Reunion
| | - Frédéric Accot
- COVID-19 Testing Centre, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
| | - Florian Legrand
- COVID-19 Testing Centre, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; City to Hospital Outpatient Clinic for the Care of COVID-19, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
| | - Patrice Poubeau
- COVID-19 Testing Centre, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; City to Hospital Outpatient Clinic for the Care of COVID-19, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
| | - Rodolphe Manaquin
- COVID-19 Testing Centre, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; City to Hospital Outpatient Clinic for the Care of COVID-19, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
| | - Fanny Andry
- COVID-19 Testing Centre, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; City to Hospital Outpatient Clinic for the Care of COVID-19, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
| | - Antoine Bertolotti
- Centre for Clinical Investigation - Clinical Epidemiology (CIC 1410), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; COVID-19 Testing Centre, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
| | - Cécile Levin
- COVID-19 Testing Centre, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; City to Hospital Outpatient Clinic for the Care of COVID-19, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
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Ortíz-Barrios MA, Coba-Blanco DM, Alfaro-Saíz JJ, Stand-González D. Process Improvement Approaches for Increasing the Response of Emergency Departments against the COVID-19 Pandemic: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8814. [PMID: 34444561 PMCID: PMC8392152 DOI: 10.3390/ijerph18168814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has strongly affected the dynamics of Emergency Departments (EDs) worldwide and has accentuated the need for tackling different operational inefficiencies that decrease the quality of care provided to infected patients. The EDs continue to struggle against this outbreak by implementing strategies maximizing their performance within an uncertain healthcare environment. The efforts, however, have remained insufficient in view of the growing number of admissions and increased severity of the coronavirus disease. Therefore, the primary aim of this paper is to review the literature on process improvement interventions focused on increasing the ED response to the current COVID-19 outbreak to delineate future research lines based on the gaps detected in the practical scenario. Therefore, we applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to perform a review containing the research papers published between December 2019 and April 2021 using ISI Web of Science, Scopus, PubMed, IEEE, Google Scholar, and Science Direct databases. The articles were further classified taking into account the research domain, primary aim, journal, and publication year. A total of 65 papers disseminated in 51 journals were concluded to satisfy the inclusion criteria. Our review found that most applications have been directed towards predicting the health outcomes in COVID-19 patients through machine learning and data analytics techniques. In the overarching pandemic, healthcare decision makers are strongly recommended to integrate artificial intelligence techniques with approaches from the operations research (OR) and quality management domains to upgrade the ED performance under social-economic restrictions.
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Affiliation(s)
- Miguel Angel Ortíz-Barrios
- Department of Productivity and Innovation, Universidad de la Costa CUC, Barranquilla 081001, Colombia; (D.M.C.-B.); (D.S.-G.)
| | - Dayana Milena Coba-Blanco
- Department of Productivity and Innovation, Universidad de la Costa CUC, Barranquilla 081001, Colombia; (D.M.C.-B.); (D.S.-G.)
| | - Juan-José Alfaro-Saíz
- Research Centre on Production Management and Engineering, Universitat Politècnica de València, 46022 Valencia, Spain;
| | - Daniela Stand-González
- Department of Productivity and Innovation, Universidad de la Costa CUC, Barranquilla 081001, Colombia; (D.M.C.-B.); (D.S.-G.)
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Monárrez-Espino J, Zubía-Nevárez CI, Reyes-Silva L, Castillo-Palencia JP, Castañeda-Delgado JE, Herrera van-Oostdam AS, López-Hernández Y. Clinical Factors Associated with COVID-19 Severity in Mexican Patients: Cross-Sectional Analysis from a Multicentric Hospital Study. Healthcare (Basel) 2021; 9:healthcare9070895. [PMID: 34356272 PMCID: PMC8307927 DOI: 10.3390/healthcare9070895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022] Open
Abstract
(1) Background: Latin America has been harshly hit by SARS-CoV-2, but reporting from this region is still incomplete. This study aimed at identifying and comparing clinical characteristics of patients with COVID-19 at different stages of disease severity. (2) Methods: Cross-sectional multicentric study. Individuals with nasopharyngeal PCR were categorized into four groups: (1) negative, (2) positive, not hospitalized, (3) positive, hospitalized with/without supplementary oxygen, and (4) positive, intubated. Clinical and laboratory data were compared, using group 1 as the reference. Multivariate multinomial logistic regression was used to compare adjusted odds ratios. (3) Results: Nine variables remained in the model, explaining 76% of the variability. Men had increased odds, from 1.90 (95%CI 0.87–4.15) in the comparison of 2 vs. 1, to 3.66 (1.12–11.9) in 4 vs. 1. Diabetes and obesity were strong predictors. For diabetes, the odds for groups 2, 3, and 4 were 1.56 (0.29–8.16), 12.8 (2.50–65.8), and 16.1 (2.87–90.2); for obesity, these were 0.79 (0.31–2.05), 3.38 (1.04–10.9), and 4.10 (1.16–14.4), respectively. Fever, myalgia/arthralgia, cough, dyspnea, and neutrophilia were associated with the more severe COVID-19 group. Anosmia/dysgeusia were more likely to occur in group 2 (25.5; 2.51–259). (4) Conclusion: The results point to relevant differences in clinical and laboratory features of COVID-19 by level of severity that can be used in medical practice.
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Affiliation(s)
- Joel Monárrez-Espino
- Department of Health Research, Christus Muguerza del Parque Hospital, Chihuahua 31000, Mexico;
- Vice Presidency of Health Sciences, Medical Specialties Program, University of Monterrey, San Pedro Garza García 66238, Mexico;
- Correspondence: (J.M.-E.); (Y.L.-H.); Tel.: +52-614-4397-932 (J.M.-E.)
| | - Carolina Ivette Zubía-Nevárez
- Vice Presidency of Health Sciences, Medical Specialties Program, University of Monterrey, San Pedro Garza García 66238, Mexico;
| | - Lorena Reyes-Silva
- Department of Health Research, Christus Muguerza del Parque Hospital, Chihuahua 31000, Mexico;
| | - Juan Pablo Castillo-Palencia
- General Hospital of Soledad de Graciano Sánchez, San Luis Potosí Health Services, Soledad de Graciano Sánchez 78435, Mexico;
| | | | | | - Yamilé López-Hernández
- Metabolomics and Proteomics Laboratory, Mexican Council of Science and Technology, Zacatecas Autonomous University, Zacatecas 98000, Mexico
- Correspondence: (J.M.-E.); (Y.L.-H.); Tel.: +52-614-4397-932 (J.M.-E.)
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Nagamine T. Beware of traumatic anosmia in COVID-19 pandemic. CAN J EMERG MED 2021; 23:567-568. [PMID: 33881763 PMCID: PMC8057940 DOI: 10.1007/s43678-021-00135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Takahiko Nagamine
- Sunlight Brain Research Center, 4-13-18 Jiyugaoka, Hofu, Yamaguchi, 747-0066, Japan. .,Department of Emergency Medicine, Matsumoto Surgical Hospital, Hofu, Yamaguchi, Japan.
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