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Steinberg J, Hughes S, Hui H, Allsop MJ, Egger S, David M, Caruana M, Coxeter P, Carle C, Onyeka T, Rewais I, Monroy Iglesias MJ, Vives N, Wei F, Abila DB, Carreras G, Santero M, O’Dowd EL, Lui G, Tolani MA, Mullooly M, Lee SF, Landy R, Hanley SJB, Binefa G, McShane CM, Gizaw M, Selvamuthu P, Boukheris H, Nakaganda A, Ergin I, Moraes FY, Timilshina N, Kumar A, Vale DB, Molina-Barceló A, Force LM, Campbell DJ, Wang Y, Wan F, Baker AL, Singh R, Salam RA, Yuill S, Shah R, Lansdorp-Vogelaar I, Yusuf A, Aggarwal A, Murillo R, Torode JS, Kliewer EV, Bray F, Chan KKW, Peacock S, Hanna TP, Ginsburg O, Hemelrijck MV, Sullivan R, Roitberg F, Ilbawi AM, Soerjomataram I, Canfell K. Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis. Int J Cancer 2024; 154:1394-1412. [PMID: 38083979 PMCID: PMC10922788 DOI: 10.1002/ijc.34798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/04/2023] [Accepted: 10/20/2023] [Indexed: 02/12/2024]
Abstract
While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.
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Affiliation(s)
- Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Suzanne Hughes
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Harriet Hui
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Matthew J Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sam Egger
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Michael David
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Michael Caruana
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Peter Coxeter
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Chelsea Carle
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Tonia Onyeka
- Department of Anaesthesia/Pain & Palliative Care Unit, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
- IVAN Research Institute, Enugu, Enugu Stata, Nigeria
| | - Isabel Rewais
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Maria J Monroy Iglesias
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society, and Public Health, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Nuria Vives
- Cancer Screening Unit, Institut Català d’Oncologia (ICO), Early Detection of Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
- Ciber Salud Pública (CIBERESP), Instituto Salud Carlos III, Madrid, Spain
| | - Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Marilina Santero
- Iberoamerican Cochrane Centre, IIB Sant Pau-Servei d’Epidemiologia Clínica i Salut Pública, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Emma L O’Dowd
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Gigi Lui
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | | | - Maeve Mullooly
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville MD, United States
| | - Sharon JB Hanley
- Department of Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Gemma Binefa
- Cancer Screening Unit,Cancer Prevention and Control Program, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Programme, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain
| | - Charlene M McShane
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Muluken Gizaw
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Ethiopia
- Institute for Medical Epidemiology, Biometrics and Informatics, Martin Luther University of Halle-Wittenberg, Germany
- NCD Working Group, School of Public Health, Addis Ababa University, Ethiopia
| | - Poongulali Selvamuthu
- Chennai Antiviral Research and Treatment Center and Clinical Research Site (CART CRS), Infectious Diseases Medical Center, Voluntary Health Services, Chennai, India
| | - Houda Boukheris
- University Abderrahmane Mira of Bejaia, School of Medicine, Algeria
- Departement of Epidemiology and Preventive Medicine, University Hospital of Bejaia, Algeria
| | - Annet Nakaganda
- Department of Cancer Epidemiology and Clinical Trials, Uganda Cancer Institute, Uganda
| | - Isil Ergin
- Department of Public Health, Faculty of Medicine, Ege University, Turkey
| | - Fabio Ynoe Moraes
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
| | - Nahari Timilshina
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Ashutosh Kumar
- Department of Anatomy, All India Institute of Medical Sciences-Patna, Patna, India
| | - Diama B Vale
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Brazil
| | - Ana Molina-Barceló
- Cancer and Public Health Research Unit, Biomedical Research Foundation FISABIO, Valencia, Spain
| | - Lisa M Force
- Department of Health Metrics Sciences and Department of Pediatrics, Division of Hematology/Oncology, University of Washington, United States
| | - Denise Joan Campbell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Yuqing Wang
- School of Public Health, University of Sydney, Sydney, Australia
| | - Fang Wan
- School of Public Health, University of Sydney, Sydney, Australia
| | - Anna-Lisa Baker
- School of Public Health, University of Sydney, Sydney, Australia
| | - Ramnik Singh
- School of Public Health, University of Sydney, Sydney, Australia
| | - Rehana Abdus Salam
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Susan Yuill
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Richa Shah
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Aasim Yusuf
- Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore & Peshawar, Pakistan
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, School of Hygiene and Tropical Medicine, King’s College London, London, United Kingdom
- Department of Oncology, Guy’s & St Thomas NHS Trust, London, United Kingdom
| | - Raul Murillo
- Centro Javeriano De Oncologia - Hospital Universitario San Ignacio, Bogotá, Colombia
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Julie S Torode
- Institute of Cancer Policy, King’s College London, London, United Kingdom
- Research Oncology, Bermondsey Wing, Guy’s Hospital, SE1 9RT, London, United Kingdom
| | - Erich V Kliewer
- Department of Cancer Control Research, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Kelvin KW Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Stuart Peacock
- Department of Cancer Control Research, BC Cancer Research Institute, Vancouver, British Columbia, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen’s University, Kingston, Ontario, Canada
- Department of Oncology and Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Ophira Ginsburg
- Center for Global Health, National Cancer Institute, Maryland, United States
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society, and Public Health, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Richard Sullivan
- Institute of Cancer Policy, King’s College London, London, United Kingdom
| | - Felipe Roitberg
- Department of Non-Communicable Diseases, World Health Organisation, Geneva, Switzerland
- Hospital Sírio Libanês, São Paulo, Brazil
- Rede Ebserh, Rede Brasileira de Serviços Hospitalares, Brasília, Brazil
| | | | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
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Martinuka O, Hazard D, Marateb HR, Mansourian M, Mañanas MÁ, Romero S, Rubio-Rivas M, Wolkewitz M. Methodological biases in observational hospital studies of COVID-19 treatment effectiveness: pitfalls and potential. Front Med (Lausanne) 2024; 11:1362192. [PMID: 38576716 PMCID: PMC10991758 DOI: 10.3389/fmed.2024.1362192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/20/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction This study aims to discuss and assess the impact of three prevalent methodological biases: competing risks, immortal-time bias, and confounding bias in real-world observational studies evaluating treatment effectiveness. We use a demonstrative observational data example of COVID-19 patients to assess the impact of these biases and propose potential solutions. Methods We describe competing risks, immortal-time bias, and time-fixed confounding bias by evaluating treatment effectiveness in hospitalized patients with COVID-19. For our demonstrative analysis, we use observational data from the registry of patients with COVID-19 who were admitted to the Bellvitge University Hospital in Spain from March 2020 to February 2021 and met our predefined inclusion criteria. We compare estimates of a single-dose, time-dependent treatment with the standard of care. We analyze the treatment effectiveness using common statistical approaches, either by ignoring or only partially accounting for the methodological biases. To address these challenges, we emulate a target trial through the clone-censor-weight approach. Results Overlooking competing risk bias and employing the naïve Kaplan-Meier estimator led to increased in-hospital death probabilities in patients with COVID-19. Specifically, in the treatment effectiveness analysis, the Kaplan-Meier estimator resulted in an in-hospital mortality of 45.6% for treated patients and 59.0% for untreated patients. In contrast, employing an emulated trial framework with the weighted Aalen-Johansen estimator, we observed that in-hospital death probabilities were reduced to 27.9% in the "X"-treated arm and 40.1% in the non-"X"-treated arm. Immortal-time bias led to an underestimated hazard ratio of treatment. Conclusion Overlooking competing risks, immortal-time bias, and confounding bias leads to shifted estimates of treatment effects. Applying the naïve Kaplan-Meier method resulted in the most biased results and overestimated probabilities for the primary outcome in analyses of hospital data from COVID-19 patients. This overestimation could mislead clinical decision-making. Both immortal-time bias and confounding bias must be addressed in assessments of treatment effectiveness. The trial emulation framework offers a potential solution to address all three methodological biases.
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Affiliation(s)
- Oksana Martinuka
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Derek Hazard
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Hamid Reza Marateb
- Biomedical Engineering Research Center (CREB), Automatic Control Department (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Barcelona, Spain
- Department of Artificial Intelligence, Smart University of Medical Sciences, Tehran, Iran
| | - Marjan Mansourian
- Biomedical Engineering Research Center (CREB), Automatic Control Department (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Barcelona, Spain
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Miguel Ángel Mañanas
- Biomedical Engineering Research Center (CREB), Automatic Control Department (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Sergio Romero
- Biomedical Engineering Research Center (CREB), Automatic Control Department (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
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Huang YB, Ng CJ, Chiu CH, Chaou CH, Gao SY, Chen SY. Safety and effectiveness of remdesivir for the treatment of COVID-19 patients with end-stage renal disease: A retrospective cohort study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024; 57:76-84. [PMID: 38135644 DOI: 10.1016/j.jmii.2023.12.003] [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: 09/05/2023] [Revised: 10/26/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Remdesivir has been used to treat severe coronavirus 2019 (COVID-19); however, its safety and effectiveness in patients remain unclear. This study aimed to investigate the safety and effectiveness of remdesivir in patients with COVID-19 with end-stage renal disease (ESRD). METHODS This retrospective study used the Chang Gung Research Database (CGRD) and extracted data from 21,621 adult patients with COVID-19 diagnosed between April 2021 and September 2022. The patients were divided into groups based on their remdesivir use and the presence of ESRD. The adverse effects of remdesivir and their outcomes were analyzed after propensity score matching. RESULTS To compare the adverse effects of remdesivir, propensity scores were used for one-to-one matching between patients with and without ESRD treated with remdesivir (N = 110). There were no statistically significant differences in heart rates, blood glucose levels, variations in hemoglobin levels before and after remdesivir use, or liver function between the two groups after remdesivir use. A comparison was made between patients with ESRD using remdesivir and those not using remdesivir after propensity score matching (N = 44). Although a shorter length of stay (LOS), lower intensive care unit (ICU) admission rate, and lower intubation rate were noted in the ESRD group treated with remdesivir, the difference was not statistically significant. CONCLUSION Remdesivir is safe for use in patients with COVID-19 and ESRD; no increased adverse effects were noted compared with patients without ESRD. However, the effectiveness of remdesivir use in patients with COVID-19 and ESRD remains uncertain.
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Affiliation(s)
- Yan-Bo Huang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
| | - Shi-Ying Gao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
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Casas-Rojo JM, Antón-Santos JM, Millán-Núñez-Cortés J, Gómez-Huelgas R, Ramos-Rincón JM, Rubio-Rivas M, Corrales-González MÁ, Fernández-Madera-Martínez MR, Beato-Pérez JL, Arnalich-Fernández F, Gállego-Lezaun C, Pérez-Martínez P, Molinos-Castro S, Tung-Chen Y, Madrazo M, Méndez-Bailón M, Monge-Monge D, García-García GM, García-Fenoll R, Gilabert N, Fuerte-Martínez R, Contreras-Sánchez M, Rhyman N, Peris-García J, Lumbreras-Bermejo C. Mortality reduction in older COVID-19-patients hospitalized in Spain during the second pandemic wave from the SEMI-COVID-19 Registry. Sci Rep 2023; 13:17731. [PMID: 37853011 PMCID: PMC10584827 DOI: 10.1038/s41598-023-42735-5] [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: 06/20/2022] [Accepted: 09/14/2023] [Indexed: 10/20/2023] Open
Abstract
In 2020, the COVID-19 pandemic followed a two-wave pattern in most countries. Hospital admission for COVID-19 in one wave or another could have affected mortality, especially among the older persons. The objective of this study was to evaluate whether the admission of older patients during the different waves, before SARS-CoV-2 vaccination was available, was associated with a different mortality. We compared the mortality rates of patients hospitalized during 2020 before (first wave) and after (second wave) July 7, 2020, included in the SEMI-COVID-19 Registry, a large, multicenter, retrospective cohort of patients admitted to 126 Spanish hospitals for COVID-19. A multivariate logistic regression analysis was performed to control for changes in either the patient or disease profile. As of December 26, 2022, 22,494 patients had been included (17,784 from the first wave and 4710 from the second one). Overall mortality was 20.4% in the first wave and 17.2% in the second wave (risk difference (RD) - 3.2%; 95% confidence interval (95% CI) - 4.4 to - 2.0). Only patients aged 70 and older (10,973 patients: 8571 in the first wave and 2386 in the second wave) had a significant reduction in mortality (RD - 7.6%; 95% CI - 9.7 to - 5.5) (unadjusted relative risk reduction: 21.6%). After adjusting for age, comorbidities, variables related to the severity of the disease, and treatment received, admission during the second wave remained a protective factor. In Spain, patients aged 70 years and older admitted during the second wave of the COVID-19 pandemic had a significantly lower risk of mortality, except in severely dependent persons in need of corticosteroid treatment. This effect is independent of patient characteristics, disease severity, or treatment received. This suggests a protective effect of a better standard of care, greater clinical expertise, or a lesser degree of healthcare system overload.
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Affiliation(s)
- José-Manuel Casas-Rojo
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Universidad Complutense de Madrid, Madrid, Spain
| | - Juan-Miguel Antón-Santos
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Universidad Complutense de Madrid, Madrid, Spain
| | | | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Málaga, Spain
| | - José-Manuel Ramos-Rincón
- Clinical Medicine Department, Miguel Hernandez University of Elche, Ctra N332 s/n, 03550, Sant Joan d'Alacant, Alicante, Spain.
| | - Manuel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - José-Luis Beato-Pérez
- Internal Medicine Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | - Pablo Pérez-Martínez
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Sonia Molinos-Castro
- Internal Medicine Department, Complejo Hospitalario Universitario de Santiago, A Coruña, Spain
| | - Yale Tung-Chen
- Internal Medicine Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Manuel Madrazo
- Internal Medicine Department, Hospital Universitario Doctor, Peset, Valencia, Spain
| | | | - Daniel Monge-Monge
- Internal Medicine Department, Complejo Asistencial de Segovia, Segovia, Spain
| | | | - Rosa García-Fenoll
- Internal Medicine Department. Hospital, Universitario Miguel Servet, Zaragoza, Spain
| | - Noemí Gilabert
- Internal Medicine Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Rebeca Fuerte-Martínez
- Internal Medicine Department, Hospital Universitario Infanta Sofía, SS de los Reyes, Madrid, Spain
| | | | - Nicolás Rhyman
- Internal Medicine Department, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Jorge Peris-García
- Internal Medicine Department, Hospital Universitari Sant Joan d'Alacant, Alicante, Spain
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Validation of the COVID-19-12O score for predicting readmissions/revisits in patients with SARS-CoV-2 pneumonia discharged from the emergency department. Rev Clin Esp 2023; 223:244-249. [PMID: 36870418 PMCID: PMC9979700 DOI: 10.1016/j.rceng.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
OBJECTIVE The COVID-19-12O-score has been validated to determine the risk of respiratory failure in patients hospitalized for COVID-19. Our study aims to assess whether the score is effective in patients with SARS-CoV-2 pneumonia discharged from a hospital emergency department (HED) to predict readmission and revisit. METHOD Retrospective cohort of patients with SARS-CoV-2 pneumonia discharged consecutively from an HUS of a tertiary hospital, from January 7 to February 17, 2021, where we applied the COVID-19-12O -score, with a cut-off point of 9 points to define the risk of admission or revisit. The primary outcome variable was revisit with or without hospital readmission after 30 days of discharge from HUS. RESULTS We included 77 patients, with a median age of 59 years, 63.6% men and Charlson index of 2. 9.1% had an emergency room revisit and 15.3% had a deferred hospital admission. The relative risk (RR) for emergency journal was 0.46 (0.04-4.62, 95% CI, p=0.452), and the RR for hospital readmission was 6.88 (1.20-39.49, 95% CI, p<0.005). CONCLUSIONS The COVID-19-12O -score is effective in determining the risk of hospital readmission in patients discharged from HED with SARS-CoV-2 pneumonia, but is not useful for assessing the risk of revisit.
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6
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Espinosa B, Ruso N, Ramos-Rincón J, Moreno-Pérez Ó, Llorens P. [Validation of the COVID-19-12O scale for predicting readmissions/revisits in patients with SARS-CoV-2 pneumonia discharged from the emergency department]. Rev Clin Esp 2023; 223:244-249. [PMID: 36713824 PMCID: PMC9874049 DOI: 10.1016/j.rce.2023.01.006] [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: 10/10/2022] [Accepted: 01/08/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The COVID-19-12O scale has been validated for determining the risk of respiratory failure in patients hospitalized due to COVID-19. This study aims to assess whether the scale is effective for predicting readmissions and revisits in patients with SARS-CoV-2 pneumonia discharged from a hospital emergency department (HED). METHOD This work is a retrospective cohort of consecutive patients with SARS-CoV-2 pneumonia discharged from the HED of a tertiary hospital from January 7 to February 17, 2021. The COVID-19-12O scale with a cut-off point of nine points was used to define the risk of admissions or revisits. The primary outcome variable was a revisit with or without hospital readmission after 30 days of discharge from the HED. RESULTS Seventy-seven patients were included. The median age was 59 years, 63.6% were men, and the Charlson Comorbidity Index was 2. A total of 9.1% had an emergency room revisit and 15.3% had a deferred hospital admission. The relative risk (RR) for an HED revisit was 0.46 (0.04-4.62, 95% CI p=0.452) and the RR for hospital readmission was 6.88 (1.20-39.49, 95% CI, p<0.005). CONCLUSIONS The COVID-19-12O scale is effective in determining the risk of hospital readmission in patients discharged from an HED with SARS-CoV-2 pneumonia, but is not useful for assessing the risk of revisit.
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Affiliation(s)
- B. Espinosa
- Servicio de Urgencias, Hospital General Universitario Dr. Balmis, Alicante, España,Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España,Autor para correspondencia
| | - N. Ruso
- Servicio de Urgencias, Hospital General Universitario Dr. Balmis, Alicante, España
| | - J.M. Ramos-Rincón
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España,Servicio de Medicina Interna, Hospital General Universitario Dr. Balmis, Alicante, España,Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Sant Joan d’Alacant, Alicante, España
| | - Ó. Moreno-Pérez
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España,Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Sant Joan d’Alacant, Alicante, España,Servicio de Endocrinología, Hospital General Universitario Dr. Balmis, Alicante, España
| | - P. Llorens
- Servicio de Urgencias, Hospital General Universitario Dr. Balmis, Alicante, España,Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España,Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Sant Joan d’Alacant, Alicante, España
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7
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Garcinuño S, Gil-Etayo FJ, Mancebo E, López-Nevado M, Lalueza A, Díaz-Simón R, Pleguezuelo DE, Serrano M, Cabrera-Marante O, Allende LM, Paz-Artal E, Serrano A. Effective Natural Killer Cell Degranulation Is an Essential Key in COVID-19 Evolution. Int J Mol Sci 2022; 23:ijms23126577. [PMID: 35743021 PMCID: PMC9224310 DOI: 10.3390/ijms23126577] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 02/05/2023] Open
Abstract
NK degranulation plays an important role in the cytotoxic activity of innate immunity in the clearance of intracellular infections and is an important factor in the outcome of the disease. This work has studied NK degranulation and innate immunological profiles and functionalities in COVID-19 patients and its association with the severity of the disease. A prospective observational study with 99 COVID-19 patients was conducted. Patients were grouped according to hospital requirements and severity. Innate immune cell subpopulations and functionalities were analyzed. The profile and functionality of innate immune cells differ between healthy controls and severe patients; CD56dim NK cells increased and MAIT cells and NK degranulation rates decreased in the COVID-19 subjects. Higher degranulation rates were observed in the non-severe patients and in the healthy controls compared to the severe patients. Benign forms of the disease had a higher granzymeA/granzymeB ratio than complex forms. In a multivariate analysis, the degranulation capacity resulted in a protective factor against severe forms of the disease (OR: 0.86), whereas the permanent expression of NKG2D in NKT cells was an independent risk factor (OR: 3.81; AUC: 0.84). In conclusion, a prompt and efficient degranulation functionality in the early stages of infection could be used as a tool to identify patients who will have a better evolution.
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Affiliation(s)
- Sara Garcinuño
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain; (S.G.); (F.J.G.-E.); (E.M.); (M.L.-N.); (A.L.); (D.E.P.); (M.S.); (O.C.-M.); (L.M.A.); (E.P.-A.)
| | - Francisco Javier Gil-Etayo
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain; (S.G.); (F.J.G.-E.); (E.M.); (M.L.-N.); (A.L.); (D.E.P.); (M.S.); (O.C.-M.); (L.M.A.); (E.P.-A.)
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Esther Mancebo
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain; (S.G.); (F.J.G.-E.); (E.M.); (M.L.-N.); (A.L.); (D.E.P.); (M.S.); (O.C.-M.); (L.M.A.); (E.P.-A.)
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Marta López-Nevado
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain; (S.G.); (F.J.G.-E.); (E.M.); (M.L.-N.); (A.L.); (D.E.P.); (M.S.); (O.C.-M.); (L.M.A.); (E.P.-A.)
| | - Antonio Lalueza
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain; (S.G.); (F.J.G.-E.); (E.M.); (M.L.-N.); (A.L.); (D.E.P.); (M.S.); (O.C.-M.); (L.M.A.); (E.P.-A.)
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Raquel Díaz-Simón
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Daniel Enrique Pleguezuelo
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain; (S.G.); (F.J.G.-E.); (E.M.); (M.L.-N.); (A.L.); (D.E.P.); (M.S.); (O.C.-M.); (L.M.A.); (E.P.-A.)
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Manuel Serrano
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain; (S.G.); (F.J.G.-E.); (E.M.); (M.L.-N.); (A.L.); (D.E.P.); (M.S.); (O.C.-M.); (L.M.A.); (E.P.-A.)
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Oscar Cabrera-Marante
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain; (S.G.); (F.J.G.-E.); (E.M.); (M.L.-N.); (A.L.); (D.E.P.); (M.S.); (O.C.-M.); (L.M.A.); (E.P.-A.)
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Luis M. Allende
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain; (S.G.); (F.J.G.-E.); (E.M.); (M.L.-N.); (A.L.); (D.E.P.); (M.S.); (O.C.-M.); (L.M.A.); (E.P.-A.)
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Department of Immunology, Ophthalmology and Otorhinolaryngology, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Estela Paz-Artal
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain; (S.G.); (F.J.G.-E.); (E.M.); (M.L.-N.); (A.L.); (D.E.P.); (M.S.); (O.C.-M.); (L.M.A.); (E.P.-A.)
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Department of Immunology, Ophthalmology and Otorhinolaryngology, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Antonio Serrano
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain; (S.G.); (F.J.G.-E.); (E.M.); (M.L.-N.); (A.L.); (D.E.P.); (M.S.); (O.C.-M.); (L.M.A.); (E.P.-A.)
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-652-085-293
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8
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Rubio-Rivas M, Mora-Luján JM, Formiga F, Corrales González MÁ, García Andreu MDM, Moreno-Torres V, García García GM, Alcalá Pedrajas JN, Boixeda R, Pérez-Lluna L, Cortés-Rodríguez B, Mella-Pérez C, Navas Alcántara MDLS, López Reboiro ML, Alfaro-Lara V, Pérez-Martín S, Martín-Oterino JÁ, Gracia Gutiérrez A, Martín-Urda Díez-Canseco A, Comas Casanova P, Pérez García C, Varona JF, Gómez-Huelgas R, Antón-Santos JM, Lumbreras-Bermejo C. Clusters of inflammation in COVID-19: descriptive analysis and prognosis on more than 15,000 patients from the Spanish SEMI-COVID-19 Registry. Intern Emerg Med 2022; 17:1115-1127. [PMID: 35235131 PMCID: PMC8890024 DOI: 10.1007/s11739-021-02924-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/30/2021] [Indexed: 12/15/2022]
Abstract
Uncontrolled inflammation following COVID-19 infection is an important characteristic of the most seriously ill patients. The present study aims to describe the clusters of inflammation in COVID-19 and to analyze their prognostic role. This is a retrospective observational study including 15,691 patients with a high degree of inflammation. They were included in the Spanish SEMI-COVID-19 registry from March 1, 2020 to May 1, 2021. The primary outcome was in-hospital mortality. Hierarchical cluster analysis identified 7 clusters. C1 is characterized by lymphopenia, C2 by elevated ferritin, and C3 by elevated LDH. C4 is characterized by lymphopenia plus elevated CRP and LDH and frequently also ferritin. C5 is defined by elevated CRP, and C6 by elevated ferritin and D-dimer, and frequently also elevated CRP and LDH. Finally, C7 is characterized by an elevated D-dimer. The clusters with the highest in-hospital mortality were C4, C6, and C7 (17.4% vs. 18% vs. 15.6% vs. 36.8% vs. 17.5% vs. 39.3% vs. 26.4%). Inflammation clusters were found as independent factors for in-hospital mortality. In detail and, having cluster C1 as reference, the model revealed a worse prognosis for all other clusters: C2 (OR = 1.30, p = 0.001), C3 (OR = 1.14, p = 0.178), C4 (OR = 2.28, p < 0.001), C5 (OR = 1.07, p = 0.479), C6 (OR = 2.29, p < 0.001), and C7 (OR = 1.28, p = 0.001). We identified 7 groups based on the presence of lymphopenia, elevated CRP, LDH, ferritin, and D-dimer at the time of hospital admission for COVID-19. Clusters C4 (lymphopenia + LDH + CRP), C6 (ferritin + D-dimer), and C7 (D-dimer) had the worst prognosis in terms of in-hospital mortality.
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Affiliation(s)
- Manuel Rubio-Rivas
- grid.418284.30000 0004 0427 2257Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - José María Mora-Luján
- grid.418284.30000 0004 0427 2257Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Francesc Formiga
- grid.418284.30000 0004 0427 2257Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | | | | | - Víctor Moreno-Torres
- grid.73221.350000 0004 1767 8416Department of Internal Medicine, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | | | | | - Ramon Boixeda
- Department of Internal Medicine, Mataró Hospital, Barcelona, Spain
| | - Leticia Pérez-Lluna
- grid.414561.30000 0000 9193 0174Department of Internal Medicine, Sagunto Hospital. Sagunto, Valencia, Spain
| | - Begoña Cortés-Rodríguez
- grid.459309.20000 0004 1794 9992Department of Internal Medicine, Alto Guadalquivir Hospital. Andújar, Jaén, Spain
| | - Carmen Mella-Pérez
- Department of Internal Medicine, Ferrol Clinical University Hospital, El Ferrol, La Coruña Spain
| | | | | | - Verónica Alfaro-Lara
- grid.411109.c0000 0000 9542 1158Department of Internal Medicine, Vírgen del Rocío University Hospital, Sevilla, Spain
| | | | - José Ángel Martín-Oterino
- grid.11762.330000 0001 2180 1817Department of Internal Medicine, Salamanca University Hospital, Salamanca, Spain
| | | | | | | | - Cristina Pérez García
- Department of Internal Medicine, Do Salnes Hospital, Vilagarcía de Arousa, Pontevedra, Spain
| | - José F Varona
- grid.411171.30000 0004 0425 3881Department of Internal Medicine, HM Montepríncipe University Hospital, Madrid, Spain
- grid.4795.f0000 0001 2157 7667School of Medicine, San Pablo University-CEU, Madrid, Spain
| | - Ricardo Gómez-Huelgas
- grid.10215.370000 0001 2298 7828Department of Internal Medicine, Málaga Regional University Hospital, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Málaga, Spain
- grid.413448.e0000 0000 9314 1427CIBER Obesidad Y Nutricion (CIBERobn), ISCIII, Madrid, Spain
| | - Juan-Miguel Antón-Santos
- grid.411171.30000 0004 0425 3881Department of Internal Medicine. Infanta, Cristina University Hospital, Parla, Madrid, Spain
| | - Carlos Lumbreras-Bermejo
- grid.144756.50000 0001 1945 5329Department of Internal Medicine, 12 de Octubre University Hospital, Madrid, Spain
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9
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Rubio-Rivas M, Mora-Luján JM, Formiga F, Arévalo-Cañas C, Lebrón Ramos JM, Villalba García MV, Fonseca Aizpuru EM, Díez-Manglano J, Arnalich Fernández F, Romero Cabrera JL, García García GM, Pesqueira Fontan PM, Vargas Núñez JA, Freire Castro SJ, Loureiro Amigo J, Pascual Pérez MDLR, Alcalá Pedrajas JN, Encinas-Sánchez D, Mella Pérez C, Ena J, Gracia Gutiérrez A, Esteban Giner MJ, Varona JF, Millán Núñez-Cortés J, Casas-Rojo JM. WHO Ordinal Scale and Inflammation Risk Categories in COVID-19. Comparative Study of the Severity Scales. J Gen Intern Med 2022; 37:1980-1987. [PMID: 35396659 PMCID: PMC8992782 DOI: 10.1007/s11606-022-07511-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 03/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The WHO ordinal severity scale has been used to predict mortality and guide trials in COVID-19. However, it has its limitations. OBJECTIVE The present study aims to compare three classificatory and predictive models: the WHO ordinal severity scale, the model based on inflammation grades, and the hybrid model. DESIGN Retrospective cohort study with patient data collected and followed up from March 1, 2020, to May 1, 2021, from the nationwide SEMI-COVID-19 Registry. The primary study outcome was in-hospital mortality. As this was a hospital-based study, the patients included corresponded to categories 3 to 7 of the WHO ordinal scale. Categories 6 and 7 were grouped in the same category. KEY RESULTS A total of 17,225 patients were included in the study. Patients classified as high risk in each of the WHO categories according to the degree of inflammation were as follows: 63.8% vs. 79.9% vs. 90.2% vs. 95.1% (p<0.001). In-hospital mortality for WHO ordinal scale categories 3 to 6/7 was as follows: 0.8% vs. 24.3% vs. 45.3% vs. 34% (p<0.001). In-hospital mortality for the combined categories of ordinal scale 3a to 5b was as follows: 0.4% vs. 1.1% vs. 11.2% vs. 27.5% vs. 35.5% vs. 41.1% (p<0.001). The predictive regression model for in-hospital mortality with our proposed combined ordinal scale reached an AUC=0.871, superior to the two models separately. CONCLUSIONS The present study proposes a new severity grading scale for COVID-19 hospitalized patients. In our opinion, it is the most informative, representative, and predictive scale in COVID-19 patients to date.
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Affiliation(s)
- Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain.
| | - José María Mora-Luján
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Francesc Formiga
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Coral Arévalo-Cañas
- Department of Internal Medicine, 12 de Octubre University Hospital, Madrid, Spain
| | | | | | | | | | | | - Juan Luis Romero Cabrera
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | | | - Paula M Pesqueira Fontan
- Department of Internal Medicine, Santiago de Compostela Clinical Hospital, Santiago de Compostela, La Coruña, Spain
| | | | | | - José Loureiro Amigo
- Department of Internal Medicine, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | | | | | | | - Carmen Mella Pérez
- Department of Internal Medicine, Ferrol Clinical University Hospital, Ferrol, La Coruña, Spain
| | - Javier Ena
- Department of Internal Medicine, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
| | | | | | - José F Varona
- Department of Internal Medicine, HM Montepríncipe University Hospital, Madrid, Spain.,Medicine School, San Pablo-CEU University, CEU Universities, Madrid, Spain
| | | | - José-Manuel Casas-Rojo
- Department of Internal Medicine, Infanta Cristina University Hospital, Parla, Madrid, Spain
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10
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Rubio-Rivas M, Mora-Luján JM, Montero A, Aguilar García JA, Méndez Bailón M, Fernández Cruz A, Oriol I, Teigell-Muñoz FJ, Dendariena Borque B, De la Peña Fernández A, Fernández González R, Gil Sánchez R, Fernández Fernández J, Catalán M, Cortés-Rodríguez B, Mella Pérez C, Montero Rivas L, Suárez Fuentetaja R, Ternero Vega JE, Ena J, Martin-Urda Díez-Canseco A, Pérez García C, Varona JF, Casas-Rojo JM, Millán Núñez-Cortés J. The Use of Corticosteroids or Tocilizumab in COVID-19 Based on Inflammatory Markers. J Gen Intern Med 2022; 37:168-175. [PMID: 34664188 PMCID: PMC8523009 DOI: 10.1007/s11606-021-07146-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The inflammatory cascade is the main cause of death in COVID-19 patients. Corticosteroids (CS) and tocilizumab (TCZ) are available to treat this escalation but which patients to administer it remains undefined. OBJECTIVE We aimed to evaluate the efficacy of immunosuppressive/anti-inflammatory therapy in COVID-19, based on the degree of inflammation. DESIGN A retrospective cohort study with data on patients collected and followed up from March 1st, 2020, to May 1st, 2021, from the nationwide Spanish SEMI-COVID-19 Registry. Patients under treatment with CS vs. those under CS plus TCZ were compared. Effectiveness was explored in 3 risk categories (low, intermediate, high) based on lymphocyte count, C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and D-dimer values. PATIENTS A total of 21,962 patients were included in the Registry by May 2021. Of these, 5940 met the inclusion criteria for the present study (5332 were treated with CS and 608 with CS plus TCZ). MAIN MEASURES The primary outcome of the study was in-hospital mortality. Secondary outcomes were the composite variable of in-hospital mortality, requirement for high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIMV), invasive mechanical ventilation (IMV), or intensive care unit (ICU) admission. KEY RESULTS A total of 5940 met the inclusion criteria for the present study (5332 were treated with CS and 608 with CS plus TCZ). No significant differences were observed in either the low/intermediate-risk category (1.5% vs. 7.4%, p=0.175) or the high-risk category (23.1% vs. 20%, p=0.223) after propensity score matching. A statistically significant lower mortality was observed in the very high-risk category (31.9% vs. 23.9%, p=0.049). CONCLUSIONS The prescription of CS alone or in combination with TCZ should be based on the degrees of inflammation and reserve the CS plus TCZ combination for patients at high and especially very high risk.
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Affiliation(s)
- Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - José M. Mora-Luján
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Abelardo Montero
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | | | - Manuel Méndez Bailón
- Department of Internal Medicine, San Carlos University Hospital, Complutense University, Madrid, Spain
| | - Ana Fernández Cruz
- Department of Internal Medicine, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Isabel Oriol
- Infectious Disease Unit, Department of Internal Medicine, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | | | | | | | | | | | | | - Marta Catalán
- Department of Internal Medicine, Sagunto University Hospital, Sagunto, Valencia Spain
| | | | - Carmen Mella Pérez
- Department of Internal Medicine, Ferrol Clinical University Hospital, El Ferrol, La Coruña, Spain
| | - Lorena Montero Rivas
- Department of Internal Medicine, Infanta Margarita Hospital, Cabra, Córdoba, Spain
| | | | | | - Javier Ena
- Department of Internal Medicine, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
| | | | - Cristina Pérez García
- Department of Internal Medicine, Do Salnes Hospital, Vilagarcía de Arousa, Pontevedra, Spain
| | - José F. Varona
- Department of Internal Medicine, HM Montepríncipe University Hospital, Madrid, Spain
- Department of Internal Medicine, Infanta Cristina University Hospital, Parla, Madrid Spain
| | - José Manuel Casas-Rojo
- Department of Internal Medicine, Infanta Cristina University Hospital, Parla, Madrid, Spain
| | | | - on behalf of the SEMI-COVID-19 Network
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
- Department of Internal Medicine, Costa del Sol Hospital, Marbella, Málaga, Spain
- Department of Internal Medicine, San Carlos University Hospital, Complutense University, Madrid, Spain
- Department of Internal Medicine, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
- Infectious Disease Unit, Department of Internal Medicine, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
- Department of Internal Medicine, Infanta Cristina University Hospital, Parla, Madrid, Spain
- Department of Internal Medicine, San Pedro Hospital, Logroño, Spain
- Department of Internal Medicine, Son Llàtzer University Hospital, Palma de Mallorca, Spain
- Department of Internal Medicine, Ourense University Hospital, Ourense, Spain
- Department of Internal Medicine, La Fe Hospital, Valencia, Spain
- Department of Internal Medicine, Mataró Hospital, Mataró, Barcelona, Spain
- Department of Internal Medicine, Sagunto University Hospital, Sagunto, Valencia Spain
- Department of Internal Medicine, Alto Guadalquivir Hospital, Andújar, Jaén, Spain
- Department of Internal Medicine, Ferrol Clinical University Hospital, El Ferrol, La Coruña, Spain
- Department of Internal Medicine, Infanta Margarita Hospital, Cabra, Córdoba, Spain
- Department of Internal Medicine, Monforte de Lemos Hospital, Monforte de Lemos, Lugo, Spain
- Department of Internal Medicine, Vírgen del Rocío University Hospital, Sevilla, Spain
- Department of Internal Medicine, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
- Department of Internal Medicine, Palamós Hospital, Palamós, Girona, Spain
- Department of Internal Medicine, Do Salnes Hospital, Vilagarcía de Arousa, Pontevedra, Spain
- Department of Internal Medicine, HM Montepríncipe University Hospital, Madrid, Spain
- Department of Internal Medicine, Infanta Cristina University Hospital, Parla, Madrid Spain
- Department of Internal Medicine, Gregorio Marañón General University Hospital, Madrid, Spain
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11
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Does admission acetylsalicylic acid uptake in hospitalized COVID-19 patients have a protective role? Data from the Spanish SEMI-COVID-19 Registry. Intern Emerg Med 2021. [PMID: 34843073 PMCID: PMC8628049 DOI: 10.1007/s11739-021-02870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acetylsalicylic acid (ASA) is widely used in the treatment and prevention of cardiovascular disorders. Our objective is to evaluate its possible protective role, not only in mortality but also in other aspects such as inflammation, symptomatic thrombosis, and intensive care unit (ICU) admission in hospitalized COVID-19 patients. We realized an observational retrospective cohort study of 20,641 patients with COVID-19 pneumonia collected and followed-up from Mar 1st, 2020 to May 1st, 2021, from the nationwide Spanish SEMI-COVID-19 Registry. Propensity score matching (PSM) was performed to determine whether treatment with ASA affected outcomes in COVID-19 patients. On hospital admission, 3291 (15.9%) patients were receiving ASA. After PSM, 3291 patients exposed to ASA and 2885 not-exposed patients were analyzed. In-hospital mortality was higher in the ASA group (30.4 vs. 16.9%, p < 0.001) in the global sample. After PSM, no differences were found between groups (30.4 vs. 30.3%, p = 0.938). There were no differences in inflammation, symptomatic thrombosis, or ICU admission. In conclusion, ASA intake is not associated with in-hospital mortality or any other health outcome evaluated after applying PSM analysis in a real-world large sample of hospitalized COVID-19 patients.
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12
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Rubio-Rivas M, Forero CG, Mora-Luján JM, Montero A, Formiga F, Homs NA, Albà-Albalate J, Sánchez L, Rello J, Corbella X. Beneficial and harmful outcomes of tocilizumab in severe COVID-19: A systematic review and meta-analysis. Pharmacotherapy 2021; 41:884-906. [PMID: 34558742 PMCID: PMC8661749 DOI: 10.1002/phar.2627] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022]
Abstract
Introduction The results of studies of tocilizumab (TCZ) in COVID‐19 are contradictory. Our study aims to update medical evidence from controlled observational studies and randomized clinical trials (RCTs) on the use of TCZ in hospitalized patients with COVID‐19. Methods We searched the following databases from January 1, 2020 to April 13, 2021 (date of the last search): MEDLINE database through the PubMed search engine and Scopus, using the terms (“COVID‐19" [Supplementary Concept]) AND "tocilizumab" [Supplementary Concept]). Results Sixty four studies were included in the present study: 54 were controlled observational studies (50 retrospective and 4 prospective) and 10 were RCTs. The overall results provided data from 20,616 hospitalized patients with COVID‐19: 7668 patients received TCZ in addition to standard of care (SOC) (including 1915 patients admitted to intensive care units (ICU) with reported mortality) and 12,948 patients only receiving SOC (including 4410 patients admitted to the ICU with reported mortality). After applying the random‐effects model, the hospital‐wide (including ICU) pooled mortality odds ratio (OR) of patients with COVID‐19 treated with TCZ was 0.73 (95% confidence interval (CI) = 0.56–0.93). The pooled hospital‐wide mortality OR was 1.25 (95% CI = 0.74–2.18) in patients admitted at conventional wards versus 0.66 (95% CI = 0.59–0.76) in patients admitted to the ICU. The pooled OR of hospital‐wide mortality (including ICU) of COVID‐19 patients treated with TCZ plus corticosteroids (CS) was 0.67 (95% CI = 0.54–0.84). The pooled in‐hospital mortality OR was 0.71 (95% CI = 0.35–1.42) when TCZ was early administered (≤10 days from symptom onset) versus 0.83 (95% CI 0.48–1.45) for late administration (>10 days from symptom onset). The meta‐analysis did not find significantly higher risk for secondary infections in COVID‐19 patients treated with TCZ. Conclusions TCZ prevented mortality in patients hospitalized for COVID‐19. This benefit was seen to a greater extent in patients receiving concomitant CS and when TCZ administration occurred within the first 10 days after symptom onset.
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Affiliation(s)
- Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Carlos G Forero
- School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - José María Mora-Luján
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Abelardo Montero
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Francesc Formiga
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Narcís A Homs
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Joan Albà-Albalate
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Laura Sánchez
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Jordi Rello
- School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain.,Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,CRIPS, Vall d'Hebrón Institute of Research, Barcelona, Spain
| | - Xavier Corbella
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain.,School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
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