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Maimunah U, Maharani ARK, Soegiarto G, Rahniayu A, Gunawan VA, Wiratama PA, Djuanda SN, Supriadi S, Marhana IA, Semedi BP, Lefi A, Kusumastuti EH, Suyanto E, Lilihata JG, Anggoro A, Rinjani LGP, Rosyid AN, Wahyu D, Fauziah D, Rahaju AS, Kurniasari N, Ariani G, Nugroho GMS, Yandi IKR, Nugraha RA. Correlation between interleukin-6 expression in post-mortem core liver biopsy and degree of liver injury in patients with fatal COVID-19. NARRA J 2023; 3:e463. [PMID: 38455630 PMCID: PMC10919438 DOI: 10.52225/narra.v3i3.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/04/2023] [Indexed: 03/09/2024]
Abstract
Excessive release of interleukin-6 (IL-6) during the progression of coronavirus disease 2019 (COVID-19) induces cytokine storms, resulting in multi-organ damages including liver injury, similar in nature with mechanism of viral hepatitis. Systemic IL-6 has been associated with the incidence of liver injury among COVID-19 patients; however, studies on IL-6 expression in the liver tissue are completely lacking. The aim of this study was to measure the IL-6 expression in the liver tissues and to determine its correlation with the degree of liver injury in fatal COVID-19 patients. Through this first cross-sectional study, IL-6 expression was measured through immunohistochemical staining and the degree of liver injury was identified based on level of serum alanine aminotransferase (ALT). The Spearman correlation test was used to identify the correlation between IL-6 expression and the degree of liver injury. A total of 47 deceased COVID-19 patients were included and IL-6 expression was observed in all post-mortem liver specimens, ranging from mild to strong expression. Liver injury at various degrees (mild to severe) was found in more than half (59.5%) of the cases. The Spearman correlation analysis suggested a statistically insignificant correlation between liver IL-6 expression and the degree of liver injury (r=0.152; p=0.309). In conclusion, even IL-6 expression was observed in all post-mortem liver specimens, there was an insignificant correlation between IL-6 expression in the liver tissue with the degree of liver injury among fatal COVID-19 patients, suggesting that IL-6 was not the only main factor contributing to liver damage in COVID-19 patients.
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Affiliation(s)
- Ummi Maimunah
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Andi RK. Maharani
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Gatot Soegiarto
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Alphania Rahniayu
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Pathology Anatomy, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Vania A. Gunawan
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Priangga A. Wiratama
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Pathology Anatomy, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Stephanie N. Djuanda
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Pathology Anatomy, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Supriadi Supriadi
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Isnin A. Marhana
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Pulmonology and Respiratory Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Bambang P. Semedi
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Anesthesiology and Reanimation, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia;
| | - Achmad Lefi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Cardiology and Vascular Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Etty H. Kusumastuti
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Pathology Anatomy, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Edi Suyanto
- Department of Forensics and Medicolegal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Forensics and Medicolegal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Jilientasia G. Lilihata
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Anesthesiology and Reanimation, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia;
| | - Adhitri Anggoro
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Pulmonology and Respiratory Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Lalu GP. Rinjani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Cardiology and Vascular Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Alfian N. Rosyid
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Pulmonology and Respiratory Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Dwi Wahyu
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Pulmonology and Respiratory Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Dyah Fauziah
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Pathology Anatomy, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Anny S. Rahaju
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Pathology Anatomy, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Nila Kurniasari
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Pathology Anatomy, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Grace Ariani
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Pathology Anatomy, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Gilang MS. Nugroho
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Pulmonology and Respiratory Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - I KR. Yandi
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Pulmonology and Respiratory Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ricardo A. Nugraha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Cardiology and Vascular Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Mouliou DS. C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians. Diseases 2023; 11:132. [PMID: 37873776 PMCID: PMC10594506 DOI: 10.3390/diseases11040132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.
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Gili A, Caminiti M, Lupi C, Zichichi S, Minicucci I, Pezzotti P, Primieri C, Bietta C, Stracci F. Socio-Economic Factors Associated with Ethnic Disparities in SARS-CoV-2 Infection and Hospitalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6521. [PMID: 37569061 PMCID: PMC10418672 DOI: 10.3390/ijerph20156521] [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: 06/12/2023] [Revised: 07/15/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND There is evidence that non-Italians presented higher incidence of infection and worse health outcomes if compared to native populations in the COVID-19 pandemic. The aim of the study was to compare Italian- and non-Italian-born health outcomes, accounting for socio-economic levels. METHODS We analyzed data relative to 906,463 people in Umbria (Italy) from 21 February 2020 to 31 May 2021. We considered the National Deprivation Index, the Urban-Rural Municipalities Index and the Human Development Index (HDI) of the country of birth. We used a multilevel logistic regression model to explore the influence of these factors on SARS-CoV-2 infection and hospitalization rates. Diagnosis in the 48 h preceding admission was an indicator of late diagnosis among hospitalized cases. RESULTS Overall, 54,448 persons tested positive (6%), and 9.7% of them were hospitalized. The risk of hospital admission was higher among non-Italians and was inversely related to the HDI of the country of birth. A diagnosis within 48 h before hospitalization was more frequent among non-Italians and correlated to the HDI level. CONCLUSIONS COVID-19 had unequal health outcomes among the population in Umbria. Reduced access to primary care services in the non-Italian group could explain our findings. Policies on immigrants' access to primary healthcare need to be improved.
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Affiliation(s)
- Alessio Gili
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Marta Caminiti
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Chiara Lupi
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Salvatore Zichichi
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Ilaria Minicucci
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00162 Rome, Italy
| | - Chiara Primieri
- Epidemiology Unit, Department of Preventive Medicine, Local Health Unit 1, 06126 Perugia, Italy
| | - Carla Bietta
- Epidemiology Unit, Department of Preventive Medicine, Local Health Unit 1, 06126 Perugia, Italy
| | - Fabrizio Stracci
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
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Pappa E, Gourna P, Galatas G, Manti M, Romiou A, Panagiotou L, Chatzikyriakou R, Trakas N, Feretzakis G, Christopoulos C. The prognostic utility of serum thyrotropin in hospitalized Covid-19 patients: statistical and machine learning approaches. Endocrine 2023; 80:86-92. [PMID: 36445619 PMCID: PMC9707250 DOI: 10.1007/s12020-022-03264-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the prognostic value of serum TSH in Greek patients with COVID-19 and compare it with that of commonly used prognostic biomarkers. METHODS Retrospective study of 128 COVID-19 in patients with no history of thyroid disease. Serum TSH, albumin, CRP, ferritin, and D-dimers were measured at admission. Outcomes were classified as "favorable" (discharge from hospital) and "adverse" (intubation or in-hospital death of any cause). The prognostic performance of TSH and other indices was assessed using binary logistic regression, machine learning classifiers, and ROC curve analysis. RESULTS Patients with adverse outcomes had significantly lower TSH compared to those with favorable outcomes (0.61 versus 1.09 mIU/L, p < 0.001). Binary logistic regression with sex, age, TSH, albumin, CRP, ferritin, and D-dimers as covariates showed that only albumin (p < 0.001) and TSH (p = 0.006) were significantly predictive of the outcome. Serum TSH below the optimal cut-off value of 0.5 mIU/L was associated with an odds ratio of 4.13 (95% C.I.: 1.41-12.05) for adverse outcome. Artificial neural network analysis showed that the prognostic importance of TSH was second only to that of albumin. However, the prognostic accuracy of low TSH was limited, with an AUC of 69.5%, compared to albumin's 86.9%. A Naïve Bayes classifier based on the combination of serum albumin and TSH levels achieved high prognostic accuracy (AUC 99.2%). CONCLUSION Low serum TSH is independently associated with adverse outcome in hospitalized Greek patients with COVID-19 but its prognostic utility is limited. The integration of serum TSH into machine learning classifiers in combination with other biomarkers enables outcome prediction with high accuracy.
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Affiliation(s)
- E Pappa
- First Department of Internal Medicine, "Sismanoglio-A. Fleming" General Hospital, Athens, 15126, Greece.
| | - P Gourna
- First Department of Internal Medicine, "Sismanoglio-A. Fleming" General Hospital, Athens, 15126, Greece
| | - G Galatas
- First Department of Internal Medicine, "Sismanoglio-A. Fleming" General Hospital, Athens, 15126, Greece
| | - M Manti
- First Department of Internal Medicine, "Sismanoglio-A. Fleming" General Hospital, Athens, 15126, Greece
| | - A Romiou
- First Department of Internal Medicine, "Sismanoglio-A. Fleming" General Hospital, Athens, 15126, Greece
| | - L Panagiotou
- First Department of Internal Medicine, "Sismanoglio-A. Fleming" General Hospital, Athens, 15126, Greece
| | - R Chatzikyriakou
- Department of Hematology, "Sismanoglio-A. Fleming" General Hospital, Athens, 15126, Greece
| | - N Trakas
- Department of Biochemistry, "Sismanoglio-A. Fleming" General Hospital, Athens, 15126, Greece
| | - G Feretzakis
- School of Science and Technology, Hellenic Open University, Patras, 26335, Greece
- Department of Quality Control, Research, and Continuing Education, "Sismanoglio-A. Fleming" General Hospital, Athens, 15126, Greece
| | - C Christopoulos
- First Department of Internal Medicine, "Sismanoglio-A. Fleming" General Hospital, Athens, 15126, Greece
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Parameters to Predict the Outcome of Severe and Critical COVID-19 Patients when Admitted to the Hospital. J Clin Med 2023; 12:jcm12041323. [PMID: 36835858 PMCID: PMC9959673 DOI: 10.3390/jcm12041323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Manifestations of COVID-19 are diverse and range from asymptomatic to severe, critical illness and death. Cases requiring hospital care (in severe and critical illnesses) are associated with comorbidities and hyperactivation of the immune system. Therefore, in this exploratory observational study, we analyzed which parameters are associated with mortality. We evaluated: demographic characteristics (age, sex and comorbidities), laboratory data (albumin, leukocytes, lymphocytes, platelets, ferritin), days of hospital stay, interleukins (IL-2, IL-6, IL-7, IL-10, IL-17) and sP-selectin in 40 Mexican patients admitted to medical emergencies with a confirmed diagnosis of COVID-19, a complete clinical record, and who signed the informed consent. Twenty severe (they required intermediate care with non-invasive ventilation) and twenty critically ill patients (they required mechanical ventilation) were classified, and these were subsequently compared with healthy and recovered subjects. A significant difference was found between the hospitalized groups in the parameters of age, ferritin, days of hospital stay and death with p values = 0.0145, p = 0.0441, p = 0.0001 and p = 0.0001, respectively. In the determination of cytokines and P-selectin, a significant difference was found between the following groups: recovered patients and healthy volunteers compared with hospitalized patients in severe and critical condition. Importantly, IL-7 remained elevated one year later in recovered patients. Taken together, these values determined at the time of hospital admission could be useful to monitor patients closely and evaluate in-hospital progress, hospital discharge, and out-of-hospital progress.
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Mazzalai E, Giannini D, Tosti ME, D’Angelo F, Declich S, Jaljaa A, Caminada S, Turatto F, De Marchi C, Gatta A, Angelozzi A, Marchetti G, Pizzarelli S, Marceca M. Risk of Covid-19 Severe Outcomes and Mortality in Migrants and Ethnic Minorities Compared to the General Population in the European WHO Region: a Systematic Review. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2023; 24:1-31. [PMID: 36647529 PMCID: PMC9833641 DOI: 10.1007/s12134-023-01007-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/13/2023]
Abstract
The Covid-19 pandemic has had a major impact on migrants and ethnic minorities (MEMs). Socio-economic factors and legal, administrative and language barriers are among the reasons for this increased susceptibility. The aim of the study is to investigate the impact of Covid-19 on MEMs compared to the general population in terms of serious outcomes. We conducted a systematic review collecting studies on the impact of Covid-19 on MEMs compared to the general population in the WHO European Region regarding hospitalisation, intensive care unit (ICU) admission and mortality, published between 01/01/2020 and 19/03/2021. Nine researchers were involved in selection, study quality assessment and data extraction. Of the 82 studies included, 15 of the 16 regarding hospitalisation for Covid-19 reported an increased risk for MEMs compared to the white and/or native population and 22 out of the 28 studies focusing on the ICU admission rates found an increased risk for MEMs. Among the 65 studies on mortality, 43 report a higher risk for MEMs. An increased risk of adverse outcomes was reported for MEMs. Social determinants of health are among the main factors involved in the genesis of health inequalities: a disadvantaged socio-economic status, a framework of structural racism and asymmetric access to healthcare are linked to increased susceptibility to the consequences of Covid-19. These findings underline the need for policymakers to consider the socio-economic barriers when designing prevention plans. Supplementary Information The online version contains supplementary material available at 10.1007/s12134-023-01007-x.
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Affiliation(s)
- Elena Mazzalai
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Dara Giannini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Maria Elena Tosti
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Franca D’Angelo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Silvia Declich
- Italian Society of Migration Medicine (SIMM), Rome, Italy
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Anissa Jaljaa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Susanna Caminada
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Federica Turatto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Chiara De Marchi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Angela Gatta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Aurora Angelozzi
- Department for Organisational Development, Local Health Unit Roma 1, Rome, Italy
| | - Giulia Marchetti
- Italian Society of Migration Medicine (SIMM), Rome, Italy
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Scilla Pizzarelli
- Knowledge Unit, Documentation and Library, Istituto Superiore di Sanità, Rome, Italy
| | - Maurizio Marceca
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
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R Mohamed E, Ragab D, Taeimah M, Shaltoot H. Risk factors of intensive care admission and mortality in a cohort of 111 Egyptian COVID-19 patients. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2121479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Enas R Mohamed
- Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dina Ragab
- Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Taeimah
- Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Heba Shaltoot
- Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Shrestha AB, Sapkota UH, Shrestha S, Aryal M, Chand S, Thapa S, Chowdhury F, Salman A, Shrestha S, Shah S, Jaiswal V. Association of hypernatremia with outcomes of COVID-19 patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32535. [PMID: 36595846 PMCID: PMC9794240 DOI: 10.1097/md.0000000000032535] [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] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to assess the association of hypernatremia with the outcomes of COVID-19 patients. METHODS We performed a systematic literature search on PubMed, Google Scholar, and Science Direct until October 2021 and found a total of 131 papers. With meticulous screening finally, 17 papers met the inclusion criteria. COVID-19 patients with sodium levels greater than the reference level were the study population and the outcome of interest was the poor outcome; such as mortality, mechanical ventilation, intensive care unit (ICU) admission, and prolonged hospital stay. The pooled estimate was calculated as the odds ratio (OR). RESULTS There were 19,032 patients with hypernatremia in the 17 studies included. An overall random effect meta-analysis showed that hypernatremia was associated with mortality (OR: 3.18 [1.61, 6.28], P < .0001, I2 = 91.99%), prolong hospitalization (OR: 1.97 [1.37, 2.83], P < .001, I2 = 0.00%) and Ventilation (OR: 5.40 [1.89, 15.42], P < .001, I2 = 77.35%), ICU admission (OR: 3.99 [0.89, 17.78], P = .07, I2 = 86.79%). Meta-regression analysis showed the association of age with the ICU outcome of hypernatremia patients. Whereas, other parameters like male, hypertension, chronic kidney disease, and diabetes mellitus did not significantly influence the odds ratio. CONCLUSION Hypernatremia was markedly associated with poor outcomes in patients with COVID-19. Hence, a blood ionogram is warranted and special attention must be given to hypernatremia COVID-19 patients.
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Affiliation(s)
- Abhigan Babu Shrestha
- M Abdur Rahim Medical College, Dinajpur, Bangladesh
- * Correspondence: Abhigan Babu Shrestha, M Abdur Rahim Medical College, Dinajpur, Bangladesh (e-mail: )
| | | | | | - Manjil Aryal
- M Abdur Rahim Medical College, Dinajpur, Bangladesh
| | | | - Sangharsha Thapa
- Department of Neurology, Jacobs School of Biomedical Sciences, University of Buffalo, Buffalo
| | | | | | - Shumneva Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Sangam Shah
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Kılınç Toker A, Çelik İ, Toker İ, Eren E. Quick COVID-19 Severity Index, CURB-65 and Quick SOFA Scores Comparison in Predicting Mortality and Risk Factors of COVID-19 Patients. ARCHIVES OF IRANIAN MEDICINE 2022; 25:443-449. [DOI: 10.34172/aim.2022.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/04/2021] [Indexed: 11/06/2022]
Abstract
Background: This study aimed to investigate CURB-65, quick COVID-19 Severity Index (qCSI) and quick Sepsis Related Organ Failure Assessment (qSOFA) scores in predicting mortality and risk factors for death in patients with COVID-19. Methods: We retrospectively analyzed a total of 1919 cases for whom the rRT-PCR assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive. For mortality risk factors, univariate and multivariate logistic regression analyses were used. Receiver operator characteristics (ROC) analysis and Kaplan-Meier survival analysis were performed for CURB-65, qCSI and qSOFA scores. Results: The patients’ average age was 45.7 (21.6) years. Male patients accounted for 51.7% (n=992). In univariate analysis, some clinical variables including age over 65 years and comorbid diseases such as hypertension, chronic kidney disease, malignancy, lymphopenia, troponin, lactate dehydrogenase (LDH) and fibrinogen elevation were associated with the mortality rate. In multivariate logistic regression analysis: Neutrophil lymphocyte ratio (NLR) 3.3 and above (OR, 9.1; 95% CI, 1.9–42), C-reactive protein (CRP)30 mg/L and above (OR, 4.1; 95% CI, 1.2–13.6), D-dimer 1000 ng/mL and above (OR, 4; 95% CI, 1.5–10.7) and age (OR, 1.11; 95% CI, 1.04–1.18-year increase) were identified as risk factors for mortality among COVID-19 patients. The CURB-65 and qCSI scores exhibited a high degree of discrimination in mortality prediction (AUC values were 0.928 and 0.865, respectively). Also, the qSOFA score had a moderate discriminant power (AUC value was 0.754). Conclusion: CURB-65 and qSCI scores had a high discriminatory power to predict mortality. Also, this study identified CURB-65, qCSI and qSOFA scores, NLR, CRP, D-dimer level, and annual age increase as important mortality risk factors.
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Affiliation(s)
- Ayşin Kılınç Toker
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - İlhami Çelik
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - İbrahim Toker
- Department of Emergency Medicine, University of Health Sciences Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Esma Eren
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences Kayseri City Training and Research Hospital, Kayseri, Turkey
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Concas G, Barone M, Francavilla R, Cristofori F, Dargenio VN, Giorgio R, Dargenio C, Fanos V, Marcialis MA. Twelve Months with COVID-19: What Gastroenterologists Need to Know. Dig Dis Sci 2022; 67:2771-2791. [PMID: 34333726 PMCID: PMC8325547 DOI: 10.1007/s10620-021-07158-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 07/06/2021] [Indexed: 02/07/2023]
Abstract
Corona virus disease-19 (COVID-19) is the latest global pandemic. COVID-19 is mainly transmitted through respiratory droplets and, apart from respiratory symptoms, patients often present with gastrointestinal symptoms and liver involvement. Given the high percentage of COVID-19 patients that present with gastrointestinal symptoms (GIS), in this review, we report a practical up-to-date reference for the physician in their clinical practice with patients affected by chronic gastrointestinal (GI) diseases (inflammatory bowel disease, coeliac disease, chronic liver disease) at the time of COVID-19. First, we summarised data on the origin and pathogenetic mechanism of SARS-CoV-2. Then, we performed a literature search up to December 2020 examining clinical manifestations of GI involvement. Next, we illustrated and summarised the most recent guidelines on how to adhere to GI procedures (endoscopy, liver biopsy, faecal transplantation), maintaining social distance and how to deal with immunosuppressive treatment. Finally, we focussed on some special conditions such as faecal-oral transmission and gut microbiota. The rapid accumulation of information relating to this condition makes it particularly essential to revise the literature to take account of the most recent publications for medical consultation and patient care.
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Affiliation(s)
- Giulia Concas
- School of Paediatrics, University of Cagliari, 09124 Cagliari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, University Hospital “Policlinico”, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Ruggiero Francavilla
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Fernanda Cristofori
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Vanessa Nadia Dargenio
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Rossella Giorgio
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Costantino Dargenio
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria, University of Cagliari, Cagliari, 09124 Cagliari, Italy
| | - Maria Antonietta Marcialis
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria, University of Cagliari, Cagliari, 09124 Cagliari, Italy
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11
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TÜRKMEN E, ALTINDAL M, TARAN F, KURUOĞLU T, DEVECİ A, AKPUNAR M, AÇIKGÖZ SB, KÖKSAL N. Predictors and outcome of hyponatremia in patients with COVID 19: a single-center experience. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1080704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction/Aim: Hyponatremia (serum sodium 0.001) were the independent predictors of hyponatremia at the time of admission. The median length of hospital stay (LOS) was longer in patients with hyponatremia than patients with normonatremia (10 days vs. 8 days, p < 0.001). In multivariate analysis, hyponatremia was significantly associated with ICU admission or the need for mechanical ventilation (adjusted OR, 1.72; 95% confidence interval [95% CI], 1.03 to 2.85; p = 0.036). The severity of pneumonia, hemoglobin and lactate dehydrogenase levels, neutrophil-to-lymphocyte ratio (NLR), and body temperature were also associated with ICU admission or the need for mechanical ventilation. The oxygen saturation, male sex, serum albumin, NLR, and the ICU admission but not the hyponatremia on admission were significantly related to mortality.
Conclusion: Hyponatremia on admission, even when mild, predicts a worse outcome in COVID-19 patients, and it should be considered in risk stratification.
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12
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Degarege A, Naveed Z, Kabayundo J, Brett-Major D. Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis. Pathogens 2022; 11:563. [PMID: 35631084 PMCID: PMC9147100 DOI: 10.3390/pathogens11050563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA; (Z.N.); (J.K.); (D.B.-M.)
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13
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Otal Y, Avcıoglu G, Haydar FG. A new biomarker in severe pneumonia associated with coronavirus disease 2019: hypoalbuminemia. A prospective study. SAO PAULO MED J 2022; 140:378-383. [PMID: 35507997 PMCID: PMC9671240 DOI: 10.1590/1516-3180.2021.0066.r2.16082021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/16/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Effective triage and early detection are very important for controlling and treating coronavirus disease 2019 (COVID-19). Thus, the relationships between hypoalbuminemia and other acute-phase reactants in such cases need to be evaluated. OBJECTIVES To investigate the importance of albumin levels in cases of severe pneumonia due to COVID-19. DESIGN AND SETTING Prospective study conducted in Ankara City Hospital (a stage 3 hospital), Turkey. METHODS Data from 122 patients diagnosed with pneumonia due to COVID-19 who were admitted to this hospital were analyzed statistically in comparison with date from 60 healthy controls. Three groups were established: healthy controls, intubated patients and non-intubated patients. Lung tomography scans from the patients were examined one-by-one. Real-time polymerase chain reaction (RT-PCR) test results were recorded. RESULTS Albumin levels were statistically significantly lower in the intubated and non-intubated groups than in the control group, in comparing the three groups (P < 0.01). The other acute-phase reactants, i.e. neutrophil-to-lymphocyte ratio and C-reactive protein levels, were significantly higher in the intubated and non-intubated groups than in the control group (P < 0.05). Albumin levels were also significantly lower in the intubated group than in the non-intubated group (P = 0.02). No differences were detected with regard to other parameters (P > 0.05). CONCLUSIONS Hypoalbuminemia may constitute a biomarker indicating the severity of pneumonia due to COVID-19.
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Affiliation(s)
- Yavuz Otal
- MD. Physician, Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey.
| | - Gamze Avcıoglu
- MD. Physician, Department of Medical Biochemistry, Karadeniz Ereğli State Hospital, Zonguldak, Turkey.
| | - Fadime Gullu Haydar
- MD. Physician, Department of General Surgery, Ankara City Hospital, Ankara, Turkey.
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14
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Clinical and prognostic significance of C-reactive protein to albumin ratio in hospitalized coronavirus disease 2019 (COVID-19) patients : Data on 2309 patients from a tertiary center and validation in an independent cohort. Wien Klin Wochenschr 2022; 134:377-384. [PMID: 35038003 PMCID: PMC8761839 DOI: 10.1007/s00508-021-01999-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/18/2021] [Indexed: 12/15/2022]
Abstract
C‑reactive protein (CRP) and albumin are inflammation sensitive parameters that are regulated by interleukin‑6 inflammatory pathways. The CRP to albumin ratio (CAR) integrates these two into a potent clinical parameter whose clinical and prognostic association in the context of coronavirus disease 2019 (COVID-19) have not been well defined. We aimed to investigate the clinical and prognostic significance of CAR in the context of COVID-19 infection.We retrospectively analyzed 2309 consecutive COVID-19 patients hospitalized at a tertiary level hospital in the period from March 2020 to March 2021 who had baseline data for a CAR assessment. Findings were validated in an independent cohort of 1155 patients hospitalized from March 2021 to June 2021.The majority of patients (85.8%) had severe or critical COVID-19 on admission. Median CRP, albumin and CAR levels were 91 mg/L, 32 g/L and 2.92, respectively. Higher CAR was associated with a tendency for respiratory deterioration during hospitalization, increased requirement of high-flow oxygen treatment and mechanical ventilation, higher occurrence of bacteriemia, higher occurrence of deep venous thrombosis, lower occurrence of myocardial infarction, higher 30-day mortality and higher postdischarge mortality rates. We defined and validated four CAR prognostic categories (< 1.0, 1.0-2.9, 3.0-5.9 and ≥ 6.0) with distinct 30-day survival. In the series of multivariate Cox regression models we could demonstrate robust prognostic properties of CAR that was associated with inferior 30-day survival independently of COVID-19 severity, age and comorbidities and additionally independently of COVID-19 severity, CURB-65 and VACO index in both development and validation cohorts.The CAR seems to have a good potential to improve prognostication of hospitalized COVID-19 patients.
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15
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Mosquera‐Sulbaran JA, Pedreañez A, Carrero Y, Callejas D. C-reactive protein as an effector molecule in Covid-19 pathogenesis. Rev Med Virol 2021; 31:e2221. [PMID: 34773448 PMCID: PMC7995022 DOI: 10.1002/rmv.2221] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 01/08/2023]
Abstract
The current pandemic caused by SARS‐CoV‐2 virus infection is known as Covid‐19 (coronavirus disease 2019). This disease can be asymptomatic or can affect multiple organ systems. Damage induced by the virus is related to dysfunctional activity of the immune system, but the activity of molecules such as C‐reactive protein (CRP) as a factor capable of inducing an inflammatory status that may be involved in the severe evolution of the disease, has not been extensively evaluated. A systematic review was performed using the NCBI‐PubMed database to find articles related to Covid‐19 immunity, inflammatory response, and CRP published from December 2019 to December 2020. High levels of CRP were found in patients with severe evolution of Covid‐19 in which several organ systems were affected and in patients who died. CRP activates complement, induces the production of pro‐inflammatory cytokines and induces apoptosis which, together with the inflammatory status during the disease, can lead to a severe outcome. Several drugs can decrease the level or block the effect of CRP and might be useful in the treatment of Covid‐19. From this review it is reasonable to conclude that CRP is a factor that can contribute to severe evolution of Covid‐19 and that the use of drugs able to lower CRP levels or block its activity should be evaluated in randomized controlled clinical trials.
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Affiliation(s)
- Jesús A. Mosquera‐Sulbaran
- Instituto de Investigaciones Clinicas “Dr. Americo Negrette”Facultad de MedicinaUniversidad del ZuliaMaracaiboVenezuela
| | - Adriana Pedreañez
- Catedra de InmunologiaEscuela de BioanalisisFacultad de MedicinaUniversidad del ZuliaMaracaiboVenezuela
| | - Yenddy Carrero
- Facultad de Ciencias de la SaludCarrera de MedicinaUniversidad Tecnica de AmbatoAmbatoEcuador
| | - Diana Callejas
- Facultad de Ciencias de la SaludDepartamento de Ciencias BiologicasUniversidad Tecnica de ManabiPortoviejoEcuador
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16
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Goyal D, Inada-Kim M, Mansab F, Iqbal A, McKinstry B, Naasan AP, Millar C, Thomas S, Bhatti S, Lasserson D, Burke D. Improving the early identification of COVID-19 pneumonia: a narrative review. BMJ Open Respir Res 2021; 8:8/1/e000911. [PMID: 34740942 PMCID: PMC8573292 DOI: 10.1136/bmjresp-2021-000911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022] Open
Abstract
Delayed presentation of COVID-19 pneumonia increases the risk of mortality and need for high-intensity healthcare. Conversely, early identification of COVID-19 pneumonia grants an opportunity to intervene early and thus prevent more complicated, protracted and less successful hospital admissions. To improve the earlier detection of COVID-19 pneumonia in the community we provide a narrative review of current evidence examining the clinical parameters associated with early disease progression. Through an evolving literature review, we examined: the symptoms that may suggest COVID-19 progression; the timing of deterioration; the utility of basic observations, clinical examination and chest X-ray; the value of postexertion oxygen saturations; and the use of CRP to monitor disease progression. We go on to discuss the challenges in monitoring the COVID-19 patient in the community and discuss thresholds for further assessment. Confusion, persistent fever and shortness of breath were identified as worrying symptoms suggestive of COVID-19 disease progression necessitating urgent clinical contact. Importantly, a significant proportion of COVID-19 pneumonia patients appear not to suffer dyspnoea despite severe disease. Patients with this asymptomatic hypoxia seem to have a poorer prognosis. Such patients may present with other signs of hypoxia: severe fatigue, exertional fatigue and/or altered mental status. We found duration of symptoms to be largely unhelpful in determining risk, with evidence of deterioration at any point in the disease. Basic clinical parameters (pulse, respiratory rate, blood pressure, temperature and oxygen saturations (SpO2)) are likely of high value in detecting the deteriorating community COVID-19 patient and/or COVID-19 mimickers/complications (eg, sepsis, bacterial pneumonia and pulmonary embolism). Of these, SpO2 carried the greatest utility in detecting COVID-19 progression. CRP is an early biochemical parameter predictive of disease progression and used appropriately is likely to contribute to the early identification of COVID-19 pneumonia. Identifying progressive COVID-19 in the community is feasible using basic clinical questions and measurements. As such, if we are to limit the mortality, morbidity and the need for complicated, protracted admissions, monitoring community COVID-19 cases for signs of deterioration to facilitate early intervention is a viable strategy.
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Affiliation(s)
- Daniel Goyal
- Department of Acute Internal Medicine, Gibraltar Health Authority, Gibraltar, Gibraltar
| | - Matthew Inada-Kim
- Department of Infection, Antimicrobial Resistance and Deterioration, NHS England, Redditch, Worcestershire, UK.,Department of Acute Medicine, Hampshire Hospitals NHS Foundation Trust, Winchester, Hampshire, UK
| | - Fatam Mansab
- Department of Public Health, Gibraltar Health Authority, Gibraltar, Gibraltar
| | - Amir Iqbal
- Department of Covid-19 Remote Monitoring of Patients During Response & Recovery, NHS Grampian, Aberdeen, Aberdeen, UK
| | - Brian McKinstry
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Adeeb P Naasan
- Department of General Medicine, Islands Hospital, Oban, UK
| | - Colin Millar
- Department of General Medicine, Islands Hospital, Oban, UK
| | - Stephen Thomas
- Department of Respiratory Medicine, Raigmore Hospital, Inverness, Highland, UK
| | - Sohail Bhatti
- Department of Public Health, Gibraltar Health Authority, Gibraltar, Gibraltar
| | - Daniel Lasserson
- Hospital at Home, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK.,Department of Ambulatory Medicine, University of Warwick, Coventry, West Midlands, UK
| | - Derek Burke
- Department of Clinical Governance, Gibraltar Health Authority, Gibraltar, Gibraltar
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17
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Aging whole blood transcriptome reveals candidate genes for SARS-CoV-2-related vascular and immune alterations. J Mol Med (Berl) 2021; 100:285-301. [PMID: 34741638 PMCID: PMC8571664 DOI: 10.1007/s00109-021-02161-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 10/08/2021] [Accepted: 10/25/2021] [Indexed: 12/18/2022]
Abstract
Abstract The risk of severe COVID-19 increases with age as older patients are at highest risk. Thus, there is an urgent need to identify how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interacts with blood components during aging. We investigated the whole blood transcriptome from the Genotype-Tissue Expression (GTEx) database to explore differentially expressed genes (DEGs) translated into proteins interacting with viral proteins during aging. From 22 DEGs in aged blood, FASLG, CTSW, CTSE, VCAM1, and BAG3 were associated with immune response, inflammation, cell component and adhesion, and platelet activation/aggregation. Males and females older than 50 years old overexpress FASLG, possibly inducing a hyperinflammatory cascade. The expression of cathepsins (CTSW and CTSE) and the anti-apoptotic co-chaperone molecule BAG3 also increased throughout aging in both genders. By exploring single-cell RNA-sequencing data from peripheral blood of SARS-CoV-2-infected patients, we found FASLG and CTSW expressed in natural killer cells and CD8 + T lymphocytes, whereas BAG3 was expressed mainly in CD4 + T cells, naive T cells, and CD14 + monocytes. In addition, T cell exhaustion was associated with increased expression of CCL4L2 and DUSP4 over blood aging. LAG3, PDCD1, TIGIT, VCAM1, HLA-DRA, and TOX also increased in individuals aged 60–69 years old; conversely, the RGS2 gene decreased with aging. We further identified a distinct gene expression profile associated with type I interferon signaling following blood aging. These results revealed changes in blood molecules potentially related to SARS-CoV-2 infection throughout aging, emphasizing them as therapeutic candidates for aggressive clinical manifestation of COVID-19. Key messages • Prediction of host-viral interactions in the whole blood transcriptome during aging. • Expression levels of FASLG, CTSW, CTSE, VCAM1, and BAG3 increase in aged blood. • Blood interactome reveals targets involved with immune response, inflammation, and blood clots. • SARS-CoV-2-infected patients with high viral load showed FASLG overexpression. • Gene expression profile associated with T cell exhaustion and type I interferon signaling were affected with blood aging. Supplementary Information The online version contains supplementary material available at 10.1007/s00109-021-02161-4.
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18
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Arnau-Barrés I, Pascual-Dapena A, López-Montesinos I, Gómez-Zorrilla S, Sorlí L, Herrero M, Nogués X, Navarro-Valls C, Ibarra B, Canchucaja L, da Costa Venancio E, Blasco-Hernando F, Cruz J, Vázquez O, Miralles R, García-Giralt N, Güerri-Fernández R. Severe Hypoalbuminemia at Admission Is Strongly Associated with Worse Prognosis in Older Adults with SARS-CoV-2 Infection. J Clin Med 2021; 10:jcm10215134. [PMID: 34768653 PMCID: PMC8584930 DOI: 10.3390/jcm10215134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Serum albumin levels have been associated with prognosis in several conditions among older adults. The aim of this study is to assess the prognostic value in mortality of serum albumin in older adults with SARS-CoV-2 infection. Methods. Cohort observational study with consecutive older-adults (≥65 years old), with confirmed SARS-CoV-2 infection admitted to a university hospital between March–May 2020. A logistic regression model was fitted to assess the impact of albumin levels on in-hospital mortality adjusted by potential confounders. Results. Among a total of 840 patients admitted to the hospital, 405 (48%) were older adults with a total of 92 deaths (23%) among them. Those who died were older, had more comorbidities, higher inflammation status and lower levels of serum albumin at admission [3.10 g/dL (0.51) vs. 3.45 g/dL (0.45); p < 0.01. Serum albumin levels at admission were negatively correlated with inflammatory markers such as C-Reactive protein (Pearson Coeff −0.4634; p < 0.001) or IL-6 (Pearson’s Coeff −0.244; p = 0.006) at admission but also to other clinical outcomes such time to clinical stability (Pearson’s Coeff −0.259; p < 0.001). Severe hypoalbuminemia associated with increased risk of mortality was defined as ≤3 g/dL at admission according to the AUC/ROC analysis (0.72 95% CI 0.63–0.81) In a multivariate logistic regression model adjusting by age, inflammation, comorbidities and severity at admission severe hypoalbuminemia was a strong predictor of in-hospital mortality (OR 2.18 95% CI 1.03–4.62; p = 0.039). Conclusion. Severe hypoalbuminemia with ≤3 g/dL is an independent risk factor for mortality among older adults with SARS-CoV-2 infection. There is a consistent correlation between albumin levels and inflammatory biomarkers. Further studies are needed to determine whether the supplementation of albumin as coadjuvant treatment will have a positive impact on the prognosis of this infection.
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Affiliation(s)
- Isabel Arnau-Barrés
- Department of Geriatrics, Hospital del Mar, 08003 Barcelona, Spain; (I.A.-B.); (M.H.); (B.I.); (L.C.); (E.d.C.V.); (O.V.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (A.P.-D.); (R.M.)
| | - Ana Pascual-Dapena
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (A.P.-D.); (R.M.)
- Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Inmaculada López-Montesinos
- Department of Infectious Diseases, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (I.L.-M.); (S.G.-Z.); (L.S.); (C.N.-V.); (F.B.-H.); (J.C.)
| | - Silvia Gómez-Zorrilla
- Department of Infectious Diseases, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (I.L.-M.); (S.G.-Z.); (L.S.); (C.N.-V.); (F.B.-H.); (J.C.)
| | - Luisa Sorlí
- Department of Infectious Diseases, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (I.L.-M.); (S.G.-Z.); (L.S.); (C.N.-V.); (F.B.-H.); (J.C.)
| | - Marta Herrero
- Department of Geriatrics, Hospital del Mar, 08003 Barcelona, Spain; (I.A.-B.); (M.H.); (B.I.); (L.C.); (E.d.C.V.); (O.V.)
| | - Xavier Nogués
- Department of Internal Medicine, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (X.N.); (N.G.-G.)
| | - Claudia Navarro-Valls
- Department of Infectious Diseases, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (I.L.-M.); (S.G.-Z.); (L.S.); (C.N.-V.); (F.B.-H.); (J.C.)
| | - Beatriz Ibarra
- Department of Geriatrics, Hospital del Mar, 08003 Barcelona, Spain; (I.A.-B.); (M.H.); (B.I.); (L.C.); (E.d.C.V.); (O.V.)
| | - Lizzeth Canchucaja
- Department of Geriatrics, Hospital del Mar, 08003 Barcelona, Spain; (I.A.-B.); (M.H.); (B.I.); (L.C.); (E.d.C.V.); (O.V.)
| | - Elizabeth da Costa Venancio
- Department of Geriatrics, Hospital del Mar, 08003 Barcelona, Spain; (I.A.-B.); (M.H.); (B.I.); (L.C.); (E.d.C.V.); (O.V.)
| | - Fabiola Blasco-Hernando
- Department of Infectious Diseases, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (I.L.-M.); (S.G.-Z.); (L.S.); (C.N.-V.); (F.B.-H.); (J.C.)
| | - Juany Cruz
- Department of Infectious Diseases, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (I.L.-M.); (S.G.-Z.); (L.S.); (C.N.-V.); (F.B.-H.); (J.C.)
| | - Olga Vázquez
- Department of Geriatrics, Hospital del Mar, 08003 Barcelona, Spain; (I.A.-B.); (M.H.); (B.I.); (L.C.); (E.d.C.V.); (O.V.)
| | - Ramón Miralles
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (A.P.-D.); (R.M.)
| | - Natalia García-Giralt
- Department of Internal Medicine, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (X.N.); (N.G.-G.)
| | - Robert Güerri-Fernández
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (A.P.-D.); (R.M.)
- Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- Department of Infectious Diseases, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (I.L.-M.); (S.G.-Z.); (L.S.); (C.N.-V.); (F.B.-H.); (J.C.)
- Correspondence: ; Tel.: +34-932483251
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19
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Özdemir İH, Özlek B, Özen MB, Gündüz R, Çetin N, Özlek E, Yıldız BS, Bilge AR. Prognostic value of C-reactive protein/albumin ratio in hypertensive COVID-19 patients. Clin Exp Hypertens 2021; 43:683-689. [PMID: 34225505 DOI: 10.1080/10641963.2021.1937205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the relationship between the C-reactive protein/albumin ratio and the prognosis of hypertensive COVID-19 patients. METHODS It was designed as a single center retrospective study. PCR positive COVID-19 patients who were followed up in the intensive care unit (ICU) and received antihypertensive treatment were included in the study. The patients were divided into two groups as survivor and non-survivor. C-reactive protein/albumin (CAR) ratios of the patients were compared. The cut-off value was determined as a mortality predictor. The effect of CAR on mortality was evaluated using Logistic Regression analysis. RESULTS 281 patients were included in the study. Groups consisted of 135 (non-survivor) and 146 (survivor) patients. CAR was significantly higher in the non-survivor group (p<0.001). The area under the ROC curve for CAR for mortality was 0.807, with sensitivity of 0.71 and specificity of 0.71. The cut-off value for CAR was calculated as 56.62. In logistic regression analysis, CAR increases mortality 4.9 times compared to the cut-off value. CONCLUSION CAR is a powerful and independent prognostic marker for predicting mortality and disease progression in hypertensive COVID-19 patients.
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Affiliation(s)
| | - Bülent Özlek
- Department of Cardiology, Mugla Sitki Kocman University Faculty of Medicine, Mugla, TURKEY
| | | | - Ramazan Gündüz
- Department of Cardiology, Manisa City Hospital, Manisa, TURKEY
| | - Nurullah Çetin
- Department of Cardiology, Celal Bayar University Faculty of Medicine, Manisa, TURKEY
| | - Eda Özlek
- Department of Cardiology, Mugla Sitki Kocman University Faculty of Medicine, Mugla, TURKEY
| | - Bekir Serhat Yıldız
- Department of Cardiology, Celal Bayar University Faculty of Medicine, Manisa, TURKEY
| | - Ali Rıza Bilge
- Department of Cardiology, Celal Bayar University Faculty of Medicine, Manisa, TURKEY
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20
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Karampoor S, Hesamizadeh K, Shams Z, Ghafari Novin A, Farahmand M, Zahednasab H, Mirzaei R, Zamani F, Hajibaba M, Bouzari B, Laali A, Tabibzadeh A, Hadi Karbalaie Niya M, Keyvani H. The role of lovastatin in the attenuation of COVID-19. Int Immunopharmacol 2021; 101:108192. [PMID: 34607230 PMCID: PMC8461262 DOI: 10.1016/j.intimp.2021.108192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/05/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023]
Abstract
The mounting evidence regarding the pathogenesis of COVID-19 indicated that the cytokine storm has an axial role in the severity of this disease, which may lead to thrombotic complications, acute respiratory distress syndrome (ARDS), and myocardial damage, among other consequences. It has recently been demonstrated that statins are known to have anti-viral, anti-inflammatory, anti-thrombotic, and immunomodulatory features; however, their advantage has not been evaluated in COVID-19. This study aimed to investigate the protective effects of lovastatin in intensive care unit (ICU) patients with COVID-19. The case-control study consists of 284 ICU patients, which classified into three groups as follows: 1) the patients who no received lovastatin as a control (92 patients), 2) patients received 20 mg per day lovastatin (99 patients), and 3) patients received 40 mg per day lovastatin (93 patients). Each group's demographic and clinical parameters, along with CRP, interleukin (IL)-6, IL-8 levels, and mortality rate, were studied in three-time points. The results showed that there was no statistically significant difference between our study groups in terms of age and sex. (P > 0.05). Besides, in patients, receiving lovastatin the CRP, IL-6, IL-8 levels were significantly decreased from T1 to T3 than to the control group. Our results also showed that the use of lovastatin in COVID-19 patients significantly reduced the length of hospitalization in the ICU compared with the control group. In addition, our results showed that the mortality rate in patients receiving lovastatin was lower when compared to the control group; however, this difference was not statistically significant. Since the cytokine storm is a significant factor in the pathology of SARS-CoV-2, our findings highlighted the potential use of lovastatin to mitigate the inflammatory response induced by SARS-CoV-2 infection.
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Affiliation(s)
- Sajad Karampoor
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Khashayar Hesamizadeh
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Middle East Liver Diseases (MELD) Center, Tehran, Iran
| | - Zinat Shams
- Department of Biological Science, Kharazmi University, Tehran, Iran
| | - Arefeh Ghafari Novin
- Department of Medical Genetics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Farahmand
- Department of Medical Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Zahednasab
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Rasoul Mirzaei
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farhad Zamani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Hajibaba
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Behnaz Bouzari
- Department of Pathology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Laali
- Department of Infectious Disease, School of Medicine, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Tabibzadeh
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Hossein Keyvani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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21
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Obremska M, Pazgan-Simon M, Budrewicz K, Bilaszewski L, Wizowska J, Jagielski D, Jankowska-Polanska B, Nadolny K, Madowicz J, Zuwala-Jagiello J, Zysko D, Banasiak W, Simon K. Simple demographic characteristics and laboratory findings on admission may predict in-hospital mortality in patients with SARS-CoV-2 infection: development and validation of the covid-19 score. BMC Infect Dis 2021; 21:945. [PMID: 34521357 PMCID: PMC8438286 DOI: 10.1186/s12879-021-06645-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/26/2021] [Indexed: 12/24/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitutes a major health burden worldwide due to high mortality rates and hospital bed shortages. SARS-CoV-2 infection is associated with several laboratory abnormalities. We aimed to develop and validate a risk score based on simple demographic and laboratory data that could be used on admission in patients with SARS-CoV-2 infection to predict in-hospital mortality. Methods Three cohorts of patients from different hospitals were studied consecutively (developing, validation, and prospective cohorts). The following demographic and laboratory data were obtained from medical records: sex, age, hemoglobin, mean corpuscular volume (MCV), platelets, leukocytes, sodium, potassium, creatinine, and C-reactive protein (CRP). For each variable, classification and regression tree analysis were used to establish the cut-off point(s) associated with in-hospital mortality outcome based on data from developing cohort and before they were used for analysis in the validation and prospective cohort. The covid-19 score was calculated as a sum of cut-off points associated with mortality outcome. Results The developing, validation, and prospective cohorts included 129, 239, and 497 patients, respectively (median age, 71, 67, and 70 years, respectively). The following cut of points associated with in-hospital mortality: age > 56 years, male sex, hemoglobin < 10.55 g/dL, MCV > 92.9 fL, leukocyte count > 9.635 or < 2.64 103/µL, platelet count, < 81.49 or > 315.5 103/µL, CRP > 51.14 mg/dL, creatinine > 1.115 mg/dL, sodium < 134.7 or > 145.4 mEq/L, and potassium < 3.65 or > 6.255 mEq/L. The AUC of the covid-19 score for predicting in-hospital mortality was 0.89 (0.84–0.95), 0.850 (0.75–0.88), and 0.773 (0.731–0.816) in the developing, validation, and prospective cohorts, respectively (P < 0.001The mortality of the prospective cohort stratified on the basis of the covid-19 score was as follows: 0–2 points,4.2%; 3 points, 15%; 4 points, 29%; 5 points, 38.2%; 6 and more points, 60%. Conclusion The covid-19 score based on simple demographic and laboratory parameters may become an easy-to-use, widely accessible, and objective tool for predicting mortality in hospitalized patients with SARS-CoV-2 infection.
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Affiliation(s)
- Marta Obremska
- Department of Preclinical Research, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Pazgan-Simon
- Ist Department of Infectious Diseases Regional Specialistic Hospital, Wroclaw, Poland
| | - Katarzyna Budrewicz
- Department of Emergency Medicine, Wroclaw Medical University, ul. Borowska 213, 50-556, Wroclaw, Poland.
| | - Lukasz Bilaszewski
- Department of Emergency Medicine, Wroclaw Medical University, ul. Borowska 213, 50-556, Wroclaw, Poland
| | - Joanna Wizowska
- Department of Emergency Medicine, Wroclaw Medical University, ul. Borowska 213, 50-556, Wroclaw, Poland
| | | | | | - Klaudiusz Nadolny
- Department of Emergency Medical Service, Higher School of Strategic Planning in Dabrowa Gornicza, Dabrowa Gornicza, Poland.,Faculty of Medicine, Katowice School of Technology, Katowice, Poland
| | - Jarosław Madowicz
- Provincial Specialist Hospital, Tychy, Poland.,Department of Health Sciences, Higher School of Strategic Planning in Dabrowa Gornicza, Dabrowa Gornicza, Poland
| | | | - Dorota Zysko
- Department of Emergency Medicine, Wroclaw Medical University, ul. Borowska 213, 50-556, Wroclaw, Poland
| | | | - Krzysztof Simon
- Ist Department of Infectious Diseases Regional Specialistic Hospital, Wroclaw, Poland.,Department of Infectious Diseases and Hepatology, Wroclaw Medical University, Wroclaw, Poland
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22
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Elevated C-reactive protein in early COVID-19 predicts worse survival among hospitalized geriatric patients. PLoS One 2021; 16:e0256931. [PMID: 34506514 PMCID: PMC8432790 DOI: 10.1371/journal.pone.0256931] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/18/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The objective of this cohort study was to determine whether elevated CRP in early COVID-19 was associated with 14-day mortality in geriatric patients. METHODS Plasma CRP levels at hospital admission and 14-day all-cause mortality were assessed in geriatric inpatients hospitalized for COVID-19. Potential confounders were age, sex, functional abilities, history of malignancies, hypertension, cardiomyopathy, albuminemia, number of acute health issues, use of antibiotics and respiratory treatments. RESULTS Ninety-five participants (mean±SD 88.0±5.5years; 49.5%women; mean CRP, 76.7±77.5mg/L; mean albuminemia, 32.9±6.0g/L) were included. Sixteen participants who did not survive at day 14 exhibited higher CRP level at baseline than the others (120.3±71.2 versus 67.9±76.1 mg/L, P = 0.002). There was no difference in albuminemia (P = 0.329). Plasma CRP level was directly associated with 14-day mortality (fully adjusted HR = 1.11, P = 0.025). The cut-off for CRP associated with 14-day mortality was set at 35mg/L (sensitivity = 0.88; specificity = 0.56). Those with CRP<35mg/L had longer survival time than the others (log-rank P<0.001). CONCLUSIONS Elevated CRP levels were associated with poorer 14-day survival in hospitalized geriatric COVID-19 patients.
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23
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Banoei MM, Dinparastisaleh R, Zadeh AV, Mirsaeidi M. Machine-learning-based COVID-19 mortality prediction model and identification of patients at low and high risk of dying. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:328. [PMID: 34496940 PMCID: PMC8424411 DOI: 10.1186/s13054-021-03749-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/27/2021] [Indexed: 01/08/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-Cov2 virus has become the greatest health and controversial issue for worldwide nations. It is associated with different clinical manifestations and a high mortality rate. Predicting mortality and identifying outcome predictors are crucial for COVID patients who are critically ill. Multivariate and machine learning methods may be used for developing prediction models and reduce the complexity of clinical phenotypes. Methods Multivariate predictive analysis was applied to 108 out of 250 clinical features, comorbidities, and blood markers captured at the admission time from a hospitalized cohort of patients (N = 250) with COVID-19. Inspired modification of partial least square (SIMPLS)-based model was developed to predict hospital mortality. Prediction accuracy was randomly assigned to training and validation sets. Predictive partition analysis was performed to obtain cutting value for either continuous or categorical variables. Latent class analysis (LCA) was carried to cluster the patients with COVID-19 to identify low- and high-risk patients. Principal component analysis and LCA were used to find a subgroup of survivors that tends to die. Results SIMPLS-based model was able to predict hospital mortality in patients with COVID-19 with moderate predictive power (Q2 = 0.24) and high accuracy (AUC > 0.85) through separating non-survivors from survivors developed using training and validation sets. This model was obtained by the 18 clinical and comorbidities predictors and 3 blood biochemical markers. Coronary artery disease, diabetes, Altered Mental Status, age > 65, and dementia were the topmost differentiating mortality predictors. CRP, prothrombin, and lactate were the most differentiating biochemical markers in the mortality prediction model. Clustering analysis identified high- and low-risk patients among COVID-19 survivors. Conclusions An accurate COVID-19 mortality prediction model among hospitalized patients based on the clinical features and comorbidities may play a beneficial role in the clinical setting to better management of patients with COVID-19. The current study revealed the application of machine-learning-based approaches to predict hospital mortality in patients with COVID-19 and identification of most important predictors from clinical, comorbidities and blood biochemical variables as well as recognizing high- and low-risk COVID-19 survivors.
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Affiliation(s)
- Mohammad M Banoei
- Department of Critical Care Medicine, University of Calgary, Alberta, Canada.,Department of Biological Science, University of Calgary, Alberta, Canada
| | - Roshan Dinparastisaleh
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Ali Vaeli Zadeh
- Division of Pulmonary and Critical Care, Miami VA Medical Center, Miami, FL, USA
| | - Mehdi Mirsaeidi
- Division of Pulmonary and Critical Care, Department of Medicine, University of Miami, Miami, FL, USA.
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24
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Tzoulis P, Waung JA, Bagkeris E, Hussein Z, Biddanda A, Cousins J, Dewsnip A, Falayi K, McCaughran W, Mullins C, Naeem A, Nwokolo M, Quah H, Bitat S, Deyab E, Ponnampalam S, Bouloux PM, Montgomery H, Baldeweg SE. Dysnatremia is a Predictor for Morbidity and Mortality in Hospitalized Patients with COVID-19. J Clin Endocrinol Metab 2021; 106:1637-1648. [PMID: 33624101 PMCID: PMC7928894 DOI: 10.1210/clinem/dgab107] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Dysnatremia is an independent predictor of mortality in patients with bacterial pneumonia. There is paucity of data about the incidence and prognostic impact of abnormal sodium concentration in patients with coronavirus disease 2019 (COVID-19). OBJECTIVE This work aimed to examine the association of serum sodium during hospitalization with key clinical outcomes, including mortality, need for advanced respiratory support and acute kidney injury (AKI), and to explore the role of serum sodium as a marker of inflammatory response in COVID-19. METHODS This retrospective longitudinal cohort study, including all adult patients who presented with COVID-19 to 2 hospitals in London over an 8-week period, evaluated the association of dysnatremia (serum sodium < 135 or > 145 mmol/L, hyponatremia, and hypernatremia, respectively) at several time points with inpatient mortality, need for advanced ventilatory support, and AKI. RESULTS The study included 488 patients (median age, 68 years). At presentation, 24.6% of patients were hyponatremic, mainly due to hypovolemia, and 5.3% hypernatremic. Hypernatremia 2 days after admission and exposure to hypernatremia at any time point during hospitalization were associated with a 2.34-fold (95% CI, 1.08-5.05; P = .0014) and 3.05-fold (95% CI, 1.69-5.49; P < .0001) increased risk of death, respectively, compared to normonatremia. Hyponatremia at admission was linked with a 2.18-fold increase in the likelihood of needing ventilatory support (95% CI, 1.34-3.45, P = .0011). Hyponatremia was not a risk factor for in-hospital mortality, except for the subgroup of patients with hypovolemic hyponatremia. Sodium values were not associated with the risk for AKI and length of hospital stay. CONCLUSION Abnormal sodium levels during hospitalization are risk factors for poor prognosis, with hypernatremia and hyponatremia being associated with a greater risk of death and respiratory failure, respectively. Serum sodium values could be used for risk stratification in patients with COVID-19.
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Affiliation(s)
- Ploutarchos Tzoulis
- Department of Metabolism & Experimental Therapeutics, Division of Medicine, University College London, London, UK
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
- Correspondence: Ploutarchos Tzoulis, MD, PhD, MSc (Hons), MRCP, Department of Metabolism & Experimental Therapeutics, Division of Medicine, University College London, Gower St, WC1E 6BT, London, UK.
| | - Julian A Waung
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Emmanouil Bagkeris
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Ziad Hussein
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Medicine, University College London, London, UK
| | - Aiyappa Biddanda
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - John Cousins
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Alice Dewsnip
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Kanoyin Falayi
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Will McCaughran
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Chloe Mullins
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Ammara Naeem
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Muna Nwokolo
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Helen Quah
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Syed Bitat
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
| | - Eithar Deyab
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
| | - Swarupini Ponnampalam
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
| | - Pierre-Marc Bouloux
- Centre for Neuroendocrinology, Royal Free Campus, University College London, London, UK
| | - Hugh Montgomery
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
- UCL Institute for Human Health and Performance, University College London, London, UK
| | - Stephanie E Baldeweg
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Medicine, University College London, London, UK
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25
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Marwah M, Marwah S, Blann A, Morrissey H, Ball P, Wandroo FA. Analysis of laboratory blood parameter results for patients diagnosed with COVID-19, from all ethnic group populations: A single centre study. Int J Lab Hematol 2021; 43:1243-1251. [PMID: 33939271 PMCID: PMC8239882 DOI: 10.1111/ijlh.13538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/26/2021] [Indexed: 01/08/2023]
Abstract
Introduction Although factors such as age, sex, diabetes, obesity and changes in certain laboratory investigations are important prognostic factors in COVID‐19 infection, these may not apply to all ethnic/racial groups. We hypothesized differences in routine biochemistry and haematology indices in Caucasian and a combined group of Black, Asian and Minority Ethnic (BAME) patients who tested positive for COVID‐19 who died, compared to survivors. Methods We tested our hypothesis in 445 patients (229 Caucasian, 216 BAME) admitted to secondary care with proven COVID‐19 infection, in whom standard routine laboratory indices were collected on admission. Results After 28 weeks, 190 (42.7%) had died within 28 days of COVID diagnosis (97 Caucasians [42.4%], 93 BAMEs [43.1%], P = .923). A general linear model analysis found the ethnicity interaction with mortality to be significant for fibrinogen, ferritin and HbA1c (after controlling for age). In a multivariate analysis, a neutrophil/lymphocyte ratio > 7.4 and a urea/albumin ratio > 0.28 increased the odds of death for both the Caucasian and the BAME group. Additional factors increasing the odds ratio in the BAME group included age >60 years and being diabetic. Conclusion Neutrophil/lymphocyte ratio and urea/albumin ratio are simple metrics that predict death to aid clinicians in determining the prognosis of COVID‐19 and help provide early intensive intervention to reduce mortality. In the BAME groups, intensive monitoring even at younger age and those with diabetes may also help reduce COVID‐19 associated mortality.
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Affiliation(s)
| | - Sukhjinder Marwah
- Department of Haematology, Sandwell and West Birmingham Hospitals, NHS Trust, West Bromwich, UK
| | | | | | | | - Farooq A Wandroo
- Department of Haematology, Sandwell and West Birmingham Hospitals, NHS Trust, West Bromwich, UK
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26
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Predictors of Mortality in Critically Ill COVID-19 Patients Demanding High Oxygen Flow: A Thin Line between Inflammation, Cytokine Storm, and Coagulopathy. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6648199. [PMID: 33968298 PMCID: PMC8081622 DOI: 10.1155/2021/6648199] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 03/06/2021] [Indexed: 12/13/2022]
Abstract
Introduction Mortality among critically ill COVID-19 patients remains relatively high despite different potential therapeutic modalities being introduced recently. The treatment of critically ill patients is a challenging task, without identified credible predictors of mortality. Methods We performed an analysis of 160 consecutive patients with confirmed COVID-19 infection admitted to the Respiratory Intensive Care Unit between June 23, 2020, and October 2, 2020, in University Hospital Center Bezanijska kosa, Belgrade, Serbia. Patients on invasive, noninvasive ventilation and high flow oxygen therapy with moderate to severe ARDS, according to the Berlin definition of ARDS, were selected for the study. Demographic data, past medical history, laboratory values, and CT severity score were analyzed to identify predictors of mortality. Univariate and multivariate logistic regression models were used to assess potential predictors of mortality in critically ill COVID-19 patients. Results The mean patient age was 65.6 years (range, 29–92 years), predominantly men, 68.8%. 107 (66.9%) patients were on invasive mechanical ventilation, 31 (19.3%) on noninvasive, and 22 (13.8%) on high flow oxygen therapy machine. The median total number of ICU days was 10 (25th to 75th percentile: 6–18), while the median total number of hospital stay was 18 (25th to 75th percentile: 12–28). The mortality rate was 60% (96/160). Univariate logistic regression analysis confirmed the significance of age, CRP, and lymphocytes at admission to hospital, serum albumin, D-dimer, and IL-6 at admission to ICU, and CT score. Serum albumin, D-dimer, and IL-6 at admission to ICU were independently associated with mortality in the final multivariate analysis. Conclusion In the present study of 160 consecutive critically ill COVID-19 patients with moderate to severe ARDS, IL-6, serum albumin, and D-dimer at admission to ICU, accompanied by chest CT severity score, were marked as independent predictors of mortality.
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Karakoyun I, Colak A, Turken M, Altin Z, Arslan FD, Iyilikci V, Yilmaz N, Kose S. Diagnostic utility of C-reactive protein to albumin ratio as an early warning sign in hospitalized severe COVID-19 patients. Int Immunopharmacol 2020; 91:107285. [PMID: 33348293 PMCID: PMC7833970 DOI: 10.1016/j.intimp.2020.107285] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 01/08/2023]
Abstract
C-reactive protein-to-albumin ratio (CAR) has been used as an indicator of prognosis in various diseases. Here, we intended to assess the CAR’s diagnostic power in early differentiation of hospitalized severe COVID-19 cases. In this retrospectively designed study, we evaluated 197 patients in total. They were divided into two groups based on their severity of COVID-19 as non-severe (n = 113) and severe (n = 84). The comparison of groups’ demographic data, comorbidities, clinical symptoms, and laboratory test results were done. Laboratory data of the patients within the first 24 h after admission to the hospital were evaluated. The calculation of receiver operating characteristic (ROC) curve was used to determine the diagnostic power of CAR in differentiating severity of COVID-19. Independent risk factors predictive of COVID-19 severity were determined by using logistic regression analysis. Although lymphocyte count levels were lower, severe COVID-19 patients had higher mean age, higher levels of neutrophil count, CRP, aspartate aminotransferase (AST), ferritin, and prothrombin time (P < 0.05). Compared with non-severe patients (median, 0.23 [IQR = 0.07–1.56]), patients with severe COVID-19 had higher CAR levels (median, 1.66 [IQR = 0.50–3.35]; P < 0.001). Age (OR = 1.046, P = 0.003), CAR (OR = 1.264, P = 0.037), and AST (OR = 1.029, P = 0.037) were independent risk factors for severe COVID-19 based on the multivariate logistic regression analysis. ROC curve analysis assigned 0.9 as the cut-off value for CAR for differentiation of severe COVID-19 (area under the curve = 0.718, 69.1% sensitivity, 70.8% specificity, P < 0.001). CAR is a useful marker in early differentiation of severity in patients hospitalized due to COVID-19 that have longer hospital stay and higher mortality.
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Affiliation(s)
- Inanc Karakoyun
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Biochemistry, Izmir, Turkey.
| | - Ayfer Colak
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Biochemistry, Izmir, Turkey
| | - Melda Turken
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Zeynep Altin
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Internal Medicine, Izmir, Turkey
| | - Fatma Demet Arslan
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Biochemistry, Izmir, Turkey
| | - Veli Iyilikci
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Biochemistry, Izmir, Turkey
| | - Nisel Yilmaz
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Microbiology, Izmir, Turkey
| | - Sukran Kose
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
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28
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Akin H, Kurt R, Tufan F, Swi A, Ozaras R, Tahan V, Hammoud G. Newly Reported Studies on the Increase in Gastrointestinal Symptom Prevalence withCOVID-19 Infection: A Comprehensive Systematic Review and Meta-Analysis. Diseases 2020; 8:E41. [PMID: 33182651 PMCID: PMC7709133 DOI: 10.3390/diseases8040041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIM Although constitutional and respiratory symptoms such as cough and fever are the most common symptoms in patients infected with COVID-19, gastrointestinal (GI) tract involvement has been observed by endoscopic biopsies. Multiple GI symptoms, including diarrhea, nausea or vomiting and abdominal pain, have also been reported. This review aims to present the currently available data regarding the GI symptoms of COVID-19 patients, and to compare the frequency of GI symptoms in early stage (Eastern) mostly Chinese data to the current stage (Western) non-Chinese data. METHODS We performed a systematic literature search to identify both published studies by using PubMed, Google Scholar, and CNKI (Chinese medical search engine), and yet unpublished studies through medRxiv and bioRxiv. We also reviewed the cross references of the detected articles. We conducted a Medical Subject Headings (MeSH) search up until 20 September 2020. We pooled the prevalence of symptoms of diarrhea, anorexia, nausea, vomiting, and abdominal pain by using the Freeman-Tukey's transforming random effect model. RESULTS A total of 118 studies were included in the systematic review and 44 of them were included in the meta-analysis. There was a significant heterogeneity between the studies; therefore, the random effects model was used. The pooled prevalence estimate of any GI symptoms reported was found to be 0.21 (95%CI, 0.16-0.27). Anorexia was the most commonly reported GI symptom at 18% (95%CI, 0.10-0.27) followed by diarrhea at 15% (95%CI, 0.12-0.19). Diarrhea, abdominal pain, nausea/vomiting, and respiratory symptoms were more common in non-Chinese studies. The prevalence of abdominal pain was lower in the "inpatient-only" studies when compared with studies that included outpatients only and those including both inpatients and outpatients. CONCLUSIONS In this comprehensive systematic review and meta-analysis study, we observed higher rates of diarrhea, nausea/vomiting, and abdominal pain in COVID-19 infected patients among non-Chinese studies compared to Chinese studies. We also observed a higher prevalence of GI symptoms in Chinese studies than was reported previously. Non-respiratory symptoms, including GI tract symptoms, should be more thoroughly and carefully evaluated and reported in future studies.
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Affiliation(s)
- Hakan Akin
- Birinci International Hospital, Istanbul 34525, Turkey;
| | - Ramazan Kurt
- Sondurak Medical Center, Istanbul 34764, Turkey;
| | - Fatih Tufan
- Independent Investigator, Istanbul 34107, Turkey;
| | - Ahmed Swi
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, USA; (A.S.); (G.H.)
| | - Resat Ozaras
- Medilife International Hospital, Istanbul 34523, Turkey;
| | - Veysel Tahan
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, USA; (A.S.); (G.H.)
| | - Ghassan Hammoud
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, USA; (A.S.); (G.H.)
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Emmanuel A. Transformation: fighting the past or building the new? Clin Med (Lond) 2020; 20:445. [DOI: 10.7861/clinmed.ed.20.5.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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