Can early treatment of patients with risk factors contribute to managing the COVID-19 pandemic?

The association between vitamin D intake with inflammatory and biochemical indices and mortality in critically ill patients with COVID-19: A case-control study

BACKGROUND

The coronavirus disease-2019 (COVID-19) has become a worldwide health issue with widespread hospitalization and dependence on the intensive care unit (ICU). Vitamin D has a key role in modulating immune cells and modulating the inflammatory responses. This study aimed to investigate the association of vitamin D supplementation with inflammatory, biochemical, and mortality indices in critically ill patients with COVID-19.

METHODS

This case-control study was conducted on critically ill COVID-19 patients hospitalized in the ICU including the survived >30 day patients as the case group and dead patients as the control group. The status of vitamin D supplementation and inflammatory and biochemical indices of the patients were retrieved from the medical records. Logistic regression method was used to assess the association between 30 days survival and vitamin D supplement intake.

RESULTS

Compared to the group of COVID-19 patients who died in <30 day, the survived patients had a lower eosinophile level (2.2 ± 0.5 vs. 6 ± 0.0, p < .001) and higher vitamin D supplementation duration (9 ± 4.4 vs. 3.3 ± 1.9 day, p = .001). Vitamin D supplementation had a positive association with survival in COVID-19 patients (OR: 1.98, 95% CI: 1.15-3.40, p < .05). The association remained significant after adjustments fot age, sex, underlying diseases, and smoking.

CONCLUSION

Vitamin D supplementation in critically ill patients with COVID-19 has the potential to increase survivability within the first 30 days of hospitalization.

The association of COVID-19 severity and susceptibility and genetic risk factors: A systematic review of the literature

BACKGROUND

COVID-19 is associated with several risk factors such as distinct ethnicities (genetic ancestry), races, sexes, age, pre-existing comorbidities, smoking, and genetics. The authors aim to evaluate the correlation between variability in the host genetics and the severity and susceptibility towards COVID-19 in this study.

METHODS

Following the PRISMA guidelines, we retrieved all the relevant articles published until September 15, 2021, from two online databases: PubMed and Scopus.

FINDINGS

High-risk HLA haplotypes, higher expression of ACE polymorphisms, and several genes of cellular proteases such as TMPRSS2, FURIN, TLL-1 increase the risk of susceptibility and severity of COVID-19. In addition, upregulation of several genes encoding for both innate and acquired immune systems proteins, mainly CCR5, IFNs, TLR, DPPs, and TNF, positively correlate with COVID-19 severity. However, reduced expression or polymorphisms in genes affecting TLR and IFNλ increase COVID-19 severity.

CONCLUSION

Higher expression, polymorphisms, mutations, and deletions of several genes are linked with the susceptibility, severity, and clinical outcomes of COVID-19. Early treatment and vaccination of individuals with genetic predisposition could help minimize the severity and mortality associated with COVID-19.

Role of leukocytes and systemic inflammation indexes (NLR, PLR, MLP, dNLR, NLPR, AISI, SIR-I, and SII) on admission predicts in-hospital mortality in non-elderly and elderly COVID-19 patients

Background

Systemic inflammation indices, including neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), derived neutrophil/lymphocyte ratio (dNLR), neutrophil/lymphocyte*platelet ratio (NLPR), aggregate index of systemic inflammation (AISI), systemic inflammation response index (SIR-I), and systemic inflammation index (SII) are well-expressed inflammatory indices that have been used to predict the severity and mortality of various inflammatory diseases. This study aimed to investigate the role of systemic inflammatory markers in predicting mortality in non-elderly and elderly COVID-19 patients.

Methods

In a retrospective study, laboratory parameters were examined for 1,792 COVID-19 patients (elderly = 710 and non-elderly = 1,082). The ability of inflammatory markers to distinguish the severity of COVID-19 was determined by receiver operating characteristic (ROC) analysis, and survival probability was determined by the mean of Kaplan–Meier curves, with the endpoint being death.

Results

In the non-survivor non-elderly and elderly patients, the parameters PLR, MLR, dNLR, NLPR, AISI, SIR-I, and SII were significantly higher than in the surviving patients. WBC count (HR = 4.668, 95% CI = 1.624 to 13.413, P &lt; 0.01), neutrophil count (HR = 6.395, 95% CI = 2.070 to 19.760, P &lt; 0.01), dNLR (HR = 0.390, 95% CI = 0.182 to 0.835, P &lt; 0.05), and SII (HR = 10.725, 95% CI = 1.076 to 106.826, P &lt; 0.05) were significantly associated with survival. On the other hand, in elderly patients, it was found that WBC count (HR = 4.076, 95% CI = 2.176 to 7.637, P &lt; 0.001) and neutrophil count (HR = 2.412, 95% CI = 1.252 to 4.647, P &lt; 0.01) were significantly associated with survival.

Conclusion

WBC count and neutrophil count in non-elderly and elderly patients, were reliable predictors of mortality.

‎Factors associated with coronavirus disease 2019 infection severity among a sample of Lebanese adults: Data from a cross‐sectional study

Background and Aims

Identification of factors responsible for severe illness related to coronavirus disease 2019 (COVID‐19) could help in the early management of patients with high risk, especially in developing countries with poor medical care systems. To date, no data have been published concerning the factors associated with COVID‐19 severity in Lebanon. In this study, we aimed at investigating the relation between sociodemographic variables, health status, and the clinical outcomes of COVID‐19 in a sample of Lebanese adults.

Methods

In our cross‐sectional study, 1052 patients (563 male and 489 female, with the median age of 42.83 ± 17.88 years), tested positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) between January and March 2021, were recruited from a hospital in Byblos, Lebanon. Basic demographic data, medical history, clinical data, and selfreported symptoms related to COVID‐19 were collected. Clinical classification of COVID‐19 severity was carried out according to the WHO interim guidance on May 27, 2020. Multi and bivariate regression analysis were performed.

Results

When comparing patients with moderate symptoms versus mild, the results showed that older age (aOR = 1.05; 95% CI: 1.03–1.06) and having dyslipidemia (aOR = 1.89; 95% CI: 1.01–3.49) were significantly associated with higher odds of having moderate symptoms. When comparing patients with severe symptoms versus mild, older age (aOR = 1.08; 95% CI: 1.06–1.10), higher body mass index (aOR = 1.09; 95% CI: 1.04–1.15) and having respiratory diseases (aOR = 2.57; 95% CI: 1.03–6.36) were significantly associated with higher odds of having severe symptoms, whereas female gender (aOR = 0.56; 95% CI: 0.32–0.98) was significantly associated with lower odds of having severe symptoms compared to males. Finally, when comparing patients with severe symptoms versus moderate, older age (aOR = 1.03; 95% CI: 1.01–1.05) was found to be significantly associated with higher odds of having severe symptoms.

Conclusion

Identification of risk factors may contribute to a better understanding of the COVID‐19 pathogenesis and provide clinical reference for early prognosis and management of patients.

Severe Acute Respiratory Syndrome Coronavirus 2 Diagnostic Tests for Border Screening During the Very Early Phase of Coronavirus Disease 2019 Pandemic: A Systematic Review and Meta-Analysis

Diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during border screening among returning residents and prioritized travelers during the early phase of a pandemic can reduce the risk of importation and transmission in the community. This study aimed to compare the accuracy of various SARS-CoV-2 diagnostics and assess their potential utility as border screening for infection and immunity. Systematic literature searches were conducted in six electronic databases for studies reporting SARS-CoV-2 diagnostics (up to April 30, 2020). Meta-analysis and methodological assessment were conducted for all included studies. The performance of the diagnostic tests was evaluated with pooled sensitivity, specificity, and their respective 95% confidence intervals. A total of 5,416 unique studies were identified and 95 studies (at least 29,785 patients/samples) were included. Nucleic acid amplification tests (NAAT) consistently outperformed all other diagnostic methods regardless of the selected viral genes with a pooled sensitivity of 98% and a pooled specificity of 99%. Point-of-care (POC) serology tests had moderately high pooled sensitivity (69%), albeit lower than laboratory-based serology tests (89%), but both had high pooled specificity (96-98%). Serology tests were more sensitive for sampling collected at ≥ 7 days than ≤ 7 days from the disease symptoms onset. POC NAAT and POC serology tests are suitable for detecting infection and immunity against the virus, respectively as border screening. Independent validation in each country is highly encouraged with the preferred choice of diagnostic tool/s.

Age-Related Risk Factors and Complications of Patients With COVID-19: A Population-Based Retrospective Study

Objective: To study the differences in clinical characteristics, risk factors, and complications across age-groups among the inpatients with the coronavirus disease 2019 (COVID-19). Methods: In this population-based retrospective study, we included all the positive hospitalized patients with COVID-19 at Wuhan City from December 29, 2019 to April 15, 2020, during the first pandemic wave. Multivariate logistic regression analyses were used to explore the risk factors for death from COVID-19. Canonical correlation analysis (CCA) was performed to study the associations between comorbidities and complications. Results: There are 36,358 patients in the final cohort, of whom 2,492 (6.85%) died. Greater age (odds ration [OR] = 1.061 [95% CI 1.057-1.065], p < 0.001), male gender (OR = 1.726 [95% CI 1.582-1.885], p < 0.001), alcohol consumption (OR = 1.558 [95% CI 1.355-1.786], p < 0.001), smoking (OR = 1.326 [95% CI 1.055-1.652], p = 0.014), hypertension (OR = 1.175 [95% CI 1.067-1.293], p = 0.001), diabetes (OR = 1.258 [95% CI 1.118-1.413], p < 0.001), cancer (OR = 1.86 [95% CI 1.507-2.279], p < 0.001), chronic kidney disease (CKD) (OR = 1.745 [95% CI 1.427-2.12], p < 0.001), and intracerebral hemorrhage (ICH) (OR = 1.96 [95% CI 1.323-2.846], p = 0.001) were independent risk factors for death from COVID-19. Patients aged 40-80 years make up the majority of the whole patients, and them had similar risk factors with the whole patients. For patients aged <40 years, only cancer (OR = 17.112 [95% CI 6.264-39.73], p < 0.001) and ICH (OR = 31.538 [95% CI 5.213-158.787], p < 0.001) were significantly associated with higher odds of death. For patients aged >80 years, only age (OR = 1.033 [95% CI 1.008-1.059], p = 0.01) and male gender (OR = 1.585 [95% CI 1.301-1.933], p < 0.001) were associated with higher odds of death. The incidence of most complications increases with age, but arrhythmias, gastrointestinal bleeding, and sepsis were more common in younger deceased patients with COVID-19, with only arrhythmia reaching statistical difference (p = 0.039). We found a relatively poor correlation between preexisting risk factors and complications. Conclusions: Coronavirus disease 2019 are disproportionally affected by age for its clinical manifestations, risk factors, complications, and outcomes. Prior complications have little effect on the incidence of extrapulmonary complications.

Treatment adherence of COVID-19 patients getting medication at home

Introduction: Turkey has adopted outpatient treatment of COVID-19 since the beginning of the pandemic. In the outpatient treatment of COVID-19 in Turkey, only hydroxychloroquine was initially used, favipiravir was added to the treatment, and finally, hydroxychloroquine was removed from the treatment and only favipiravir was used. Our study aims to examine the adherence to the recommended treatment of people diagnosed with COVID-19 who have received outpatient treatment without hospitalization and their attitudes and declared behaviors towards using the medications they were given free of charge. Methods: This follow-up study was conducted between February 15, 2021, and May 15, 2021, by telephone survey method in the Lüleburgaz District of Kırklareli City. The study participants were 4368 people who were diagnosed with COVID-19 with a positive PCR test in Lüleburgaz District between February 15 and May 15, 2021, and were given hydroxychloroquine and/or favipiravir drugs for home use after being deemed suitable for outpatient treatment according to the guidelines of the Republic of Turkey Ministry of Health. Results: 88.1% (n = 3849) of the survey respondents reported using the given medications regularly, while 11.9% (n = 519) did not use them regularly. The most important socio demographic factor affecting the regular use was age, and the patient-centered factor was the sense of trust. Conclusion: In the fight against COVID-19, measures to increase the sense of trust of patients who are expected to adhere to the treatments should be considered a priority.

Haematological malignancies implications during the times of the COVID-19 pandemic

The COVID-19 pandemic has complicated current healthcare services for cancer patients. Patients with haematological malignancies specifically seem vulnerable to SARS-CoV-2 infection due to their immunosuppressed status. The COVID-19 pandemic influences every step of the assessment and treatment of a haematological malignancy. Clinicians must adhere to strict policies to not spread the virus to their patients while they must also adjust their workflow for maximum productivity. These difficulties accentuate the ever-present need to improve the healthcare services for cancer patients. This improvement is needed not only to combat the problems that arose from the COVID-19 pandemic but also to establish a framework for the management of patients with haematological malignancies in potential future pandemics.

Evaluation of the Risk of Clinical Deterioration among Inpatients with COVID-19

This study aims to assess the risk of severe forms of COVID-19, based on clinical, laboratory, and imaging markers in patients initially admitted to the ward. This is a retrospective observational study, with data from electronic medical records of inpatients, with laboratory confirmation of COVID-19, between March and September 2020, in a hospital from Juiz de Fora-MG, Brazil. Participants (n = 74) were separated into two groups by clinical evolution: those who remained in the ward and those who progressed to the ICU. Mann-Whitney U test was taken for continuous variables and the chi-square test or Fisher's exact test for categorical variables. Comparing the proposed groups, lower values of lymphocytes (p = <0.001) and increases in serum creatinine (p = 0.009), LDH (p = 0.057), troponin (p = 0.018), IL-6 (p = 0.053), complement C4 (p = 0.040), and CRP (p = 0.053) showed significant differences or statistical tendency for clinical deterioration. The average age of the groups was 47.9 ± 16.5 and 66.5 ± 7.3 years (p = 0.001). Hypertension (p = 0.064), heart disease (p = 0.048), and COPD (p = 0.039) were more linked to ICU admission, as well as the presence of tachypnea on admission (p = 0.051). Ground-glass involvement >25% of the lung parenchyma or pleural effusion on chest CT showed association with evolution to ICU (p = 0.027), as well as bilateral opacifications (p = 0.030) when compared to unilateral ones. Laboratory, clinical, and imaging markers may have significant relation with worse outcomes and the need for intensive treatment, being helpful as predictive factors.

Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19

BACKGROUND

Hypercoagulability may be a key mechanism of death in patients with coronavirus disease 2019 (COVID-19).

OBJECTIVE

To evaluate the incidence of venous thromboembolism (VTE) and major bleeding in critically ill patients with COVID-19 and examine the observational effect of early therapeutic anticoagulation on survival.

DESIGN

In a multicenter cohort study of 3239 critically ill adults with COVID-19, the incidence of VTE and major bleeding within 14 days after intensive care unit (ICU) admission was evaluated. A target trial emulation in which patients were categorized according to receipt or no receipt of therapeutic anticoagulation in the first 2 days of ICU admission was done to examine the observational effect of early therapeutic anticoagulation on survival. A Cox model with inverse probability weighting to adjust for confounding was used.

SETTING

67 hospitals in the United States.

PARTICIPANTS

Adults with COVID-19 admitted to a participating ICU.

MEASUREMENTS

Time to death, censored at hospital discharge, or date of last follow-up.

RESULTS

Among the 3239 patients included, the median age was 61 years (interquartile range, 53 to 71 years), and 2088 (64.5%) were men. A total of 204 patients (6.3%) developed VTE, and 90 patients (2.8%) developed a major bleeding event. Independent predictors of VTE were male sex and higher D-dimer level on ICU admission. Among the 2809 patients included in the target trial emulation, 384 (11.9%) received early therapeutic anticoagulation. In the primary analysis, during a median follow-up of 27 days, patients who received early therapeutic anticoagulation had a similar risk for death as those who did not (hazard ratio, 1.12 [95% CI, 0.92 to 1.35]).

LIMITATION

Observational design.

CONCLUSION

Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in the target trial emulation.

PRIMARY FUNDING SOURCE

None.

An observational study to develop a scoring system and model to detect risk of hospital admission due to COVID-19

BACKGROUND

COVID-19 has caused an unprecedented global health emergency. The strains of such a pandemic can overwhelm hospital capacity. Efficient clinical decision-making is crucial for proper healthcare resource utilization in this crisis. Using observational study data, we set out to create a predictive model that could anticipate which COVID-19 patients would likely be admitted and developed a scoring tool that could be used in the clinical setting and for population risk stratification.

METHODS

We retrospectively evaluated data from COVID-19 patients across a network of 6 hospitals in northeastern Pennsylvania. Analysis was limited to age, gender, and historical variables. After creating a variable importance plot, we chose a selection of the best predictors to train a logistic regression model. Variable selection was done using a lasso regularization technique. Using the coefficients in our logistic regression model, we then created a scoring tool and validated the score on a test set data.

RESULTS

A total of 6485 COVID-19 patients were included in our analysis, of which 707 were hospitalized. The biggest predictors of patient hospitalization included age, a history of hypertension, diabetes, chronic heart disease, gender, tobacco use, and chronic kidney disease. The logistic regression model demonstrated an AUC of 0.81. The coefficients for our logistic regression model were used to develop a scoring tool. Low-, intermediate-, and high-risk patients were deemed to have a 3.5%, 26%, and 38% chance of hospitalization, respectively. The best predictors of hospitalization included age (odds ratio [OR] = 1.03, confidence interval [CI] = 1.02-1.03), diabetes (OR = 2.08, CI = 1.69-2.57), hypertension (OR = 2.36, CI = 1.90-2.94), chronic heart disease (OR = 1.53, CI = 1.22-1.91), and male gender (OR = 1.32, CI = 1.11-1.58).

CONCLUSIONS

Using retrospective observational data from a 6-hospital network, we determined risk factors for admission and developed a predictive model and scoring tool for use in the clinical and population setting that could anticipate admission for COVID-19 patients.

Safety and efficacy of Favipiravir in moderate to severe SARS-CoV-2 pneumonia

BACKGROUND

We examined the safety and efficacy of a treatment protocol containing Favipiravir for the treatment of SARS-CoV-2.

METHODS

We did a multicenter randomized open-labeled clinical trial on moderate to severe cases infections of SARS-CoV-2. Patients with typical ground glass appearance on chest computerized tomography scan (CT scan) and oxygen saturation (SpO₂) of less than 93% were enrolled. They were randomly allocated into Favipiravir (1.6 gr loading, 1.8 gr daily) and Lopinavir/Ritonavir (800/200 mg daily) treatment regimens in addition to standard care. In-hospital mortality, ICU admission, intubation, time to clinical recovery, changes in daily SpO₂ after 5 min discontinuation of supplemental oxygen, and length of hospital stay were quantified and compared in the two groups.

RESULTS

380 patients were randomly allocated into Favipiravir (193) and Lopinavir/Ritonavir (187) groups in 13 centers. The number of deaths, intubations, and ICU admissions were not significantly different (26, 27, 31 and 21, 17, 25 respectively). Mean hospital stay was also not different (7.9 days [SD = 6] in the Favipiravir and 8.1 [SD = 6.5] days in Lopinavir/Ritonavir groups) (p = 0.61). Time to clinical recovery in the Favipiravir group was similar to Lopinavir/Ritonavir group (HR = 0.94, 95% CI 0.75 - 1.17) and likewise the changes in the daily SpO₂ after discontinuation of supplemental oxygen (p = 0.46) CONCLUSION: Adding Favipiravir to the treatment protocol did not reduce the number of ICU admissions or intubations or In-hospital mortality compared to Lopinavir/Ritonavir regimen. It also did not shorten time to clinical recovery and length of hospital stay.

Estimated Impact of Public and Private Sector COVID-19 Diagnostics and Treatments on US Healthcare Resource Utilization

INTRODUCTION

Coronavirus disease 2019 (COVID-19) has imposed a considerable burden on the United States (US) health system, with particular concern over healthcare capacity constraints.

METHODS

We modeled the impact of public and private sector contributions to developing diagnostic testing and treatments on COVID-19-related healthcare resource use.

RESULTS

We estimated that public sector contributions led to at least 30% reductions in COVID-19-related healthcare resource utilization. Private sector contributions to expanded diagnostic testing and treatments led to further reductions in mortality (- 44%), intensive care unit (ICU) and non-ICU hospital beds (- 30% and - 28%, respectively), and ventilator use (- 29%). The combination of lower diagnostic test sensitivity and proportions of patients self-isolating may exacerbate case numbers, and policies that encourage self-isolating should be considered.

CONCLUSION

While mechanisms exist to facilitate research, development, and patient access to diagnostic testing, future policies should focus on ensuring equitable patient access to both diagnostic testing and treatments that, in turn, will alleviate COVID-19-related resource constraints.

SARS-CoV-2 infection: molecular mechanisms of severe outcomes to suggest therapeutics

Introduction:The year 2020 was defined by the 29,903 base pairs of RNA that codes for the SARS-CoV-2 genome. SARS-CoV-2 infects humans to cause COVID-19, spreading from patient-to-patient yet impacts patients very divergently.Areas covered: Within this review, we address the known molecular mechanisms and supporting data for COVID-19 clinical course and pathology, clinical risk factors and molecular signatures, therapeutics of severe COVID-19, and reinfection/vaccination. Literature and published datasets were reviewed using PubMed, Google Scholar, and NCBI SRA tools. The combination of exaggerated cytokine signaling, pneumonia, NETosis, pyroptosis, thrombocytopathy, endotheliopathy, multiple organ dysfunction syndrome (MODS), and acute respiratory distress syndrome (ARDS) create a positive feedback loop of severe damage in patients with COVID-19 that impacts the entire body and may persist for months following infection. Understanding the molecular pathways of severe COVID-19 opens the door for novel therapeutic design. We summarize the current insights into pathology, risk factors, secondary infections, genetics, omics, and drugs being tested to treat severe COVID-19.Expert opinion: A growing level of support suggests the need for stronger integration of biomarkers and precision medicine to guide treatment strategies of severe COVID-19, where each patient has unique outcomes and thus require guided treatment.