Mortality-associated Risk Factors in Hospitalized COVID-19 Patients in Japan: Findings of the CLOT-COVID Study

Incidence and risk factors of COVID-19-associated pulmonary aspergillosis in severe cases: A single-center study from Japan

OBJECTIVE

Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a serious complication in patients with severe COVID-19. This study investigated the incidence and risk factors for CAPA in patients with severe COVID-19 at Osaka Public University Hospital from April 2020 to November 2021.

METHODS

This retrospective study involved patients with CAPA patients requiring invasive ventilation who were diagnosed according to the European Confederation of Medical Mycology and the International Society of Human and Animal Mycology criteria. Patients were classified into the CAPA and non-CAPA groups. Data collected included age, sex, body mass index, smoking history, underlying disease, length of hospital stay, steroid and other drug use, extracorporeal membrane oxygenation use, and outcome. Univariate analysis was used to identify risk factors associated with CAPA.

RESULTS

Of the 256 COVID-19 patients, 187 required invasive ventilation, and eight were diagnosed with CAPA. The incidence of CAPA among COVID-19 patients requiring ventilator management was 4.28 %. Tracheostomy was performed in seven patients, and Aspergillus spp. was detected in six, of whom four were confirmed to have A. fumigatus. CAPA mortality was high, with six of eight patients dying. Univariate analysis showed COPD (P = 0.04) and chronic liver disease (P = 0.04) as common comorbidities. β-D-glucan positivity, tracheostomy, prolonged hospitalization, prolonged steroid use, and death (P < 0.01) were more prevalent in the CAPA group.

CONCLUSIONS

When bronchoscopy is unfeasible, early diagnosis using serum Aspergillus antigen measurement and imaging is essential, particularly for patients with COPD, liver disease, or risk factors like prolonged hospitalization or steroid use post-COVID-19 treatment.

Regional risk factors associated with adverse outcomes of COVID-19 infection among the older adult: A systematic review and meta-analysis

The rapid global spread of Coronavirus Disease 2019 (COVID-19) has resulted in millions of infections and deaths, particularly impacting older adults. This study systematically analyzes risk factors reported in different geographical regions such as Asia and Europe that are associated with adverse outcomes in older adults with COVID-19. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched five databases up to December 2023 and conducted meta-analyses of odds ratios for 27 risk factors reported in at least two studies using R software (version 4.3.2). Our meta-analysis identified 19 risk factors linked to adverse outcomes, with many of them common across regions, particularly in Asia and Europe. Key factors include old age (above 65 years), male gender, symptoms such as fever and dyspnea, and comorbidities like dementia, chronic obstructive pulmonary disease (COPD), chronic heart disease, hypertension, chronic kidney disease, and malnutrition. Laboratory biomarkers such as low oxygen saturation, thrombocytopenia, and elevated D-dimer were also associated with adverse outcomes. COVID-19 patients in Asia and Europe who are older adults, male, or have specific symptoms combined with underlying health conditions are at an increased risk of progressing to severe illness or mortality.

Thrombosis and Anticoagulation Strategies in Patients with COVID-19 Including Japanese Perspective

Coronavirus disease 2019 (COVID-19) has become a major health problem worldwide since 2020. Although the main pathophysiology of COVID-19 is a respiratory infectious disease, it could also cause cardiovascular complications, including thrombosis. Thus, anticoagulation therapy has been thought to help prevent thrombosis, leading to improved survival. However, to date, several aspects of the optimal anticoagulation strategies for COVID-19 remain unclear. Considering the status of COVID-19-related thrombosis and some domestic issues in Japan, the optimal anticoagulation strategies for COVID-19 might have to be based on Japanese domestic clinical data considering racial difference. Racial disparities in terms of thromboembolic risk have been well known in the pre-COVID-19 era, and the risk of COVID-19-associated thrombosis depending on race could be an important issue. Considering a potential higher risk of bleeding with anticoagulation therapy in the Asian population, it might be important to maintain a good balance between the risks of thrombosis and bleeding. Latest evidences of COVID-19-related thrombosis and anticoagulation strategies, including some domestic issues in Japan, showed a different status of COVID-19-related thrombosis in Japan from that in Western countries, suggesting the potential benefit of different anticoagulation strategies, specifically for the Japanese population. Although these insights could be useful for the consideration of anticoagulation strategies for the Japanese population, the final decision should be based on balancing the benefits and risks of anticoagulation therapy in each patient.

COVID-induced thyroid autoimmunity

Breakdown of self-tolerance to thyroid antigens (thyroperoxidase, thyroglobulin and the thyrotropin-receptor) is the driver of thyroid autoimmunity. It has been suggested that infectious disease might trigger autoimmune thyroid disease (AITD). Involvement of the thyroid has been reported during severe acute respiratory syndrome virus 2 (SARS-CoV-2) infection, in the form of subacute thyroiditis in subjects with mild coronavirus disease 19 disease (COVID-19) and of painless, destructive thyroiditis in hospitalized patients with severe infection. In addition, cases of AITD, both Graves' disease (GD) and Hashimoto's thyroiditis (HT), have been reported in association with (SARS-CoV-2) infection. In this review, we focus on the relationship between SARS-CoV-2 infection and occurrence of AITD. Nine cases of GD strictly related to SARS-CoV-2 infection and only three cases of HT associated to COVID-19 infection have been reported. No study has demonstrated a role of AITD as a risk factor for a poor prognosis of COVID-19 infection.