1
|
Louka M, Tatsi EB, Vassiliu S, Theoharis G, Straka K, Filippatos F, Dourdouna MM, Siahanidou T, Syriopoulou V, Michos A. The Soluble Urokinase Plasminogen Activator Receptor as a Severity Biomarker in Children With Acute COVID-19 or Multisystem Inflammatory Syndrome. Pediatr Infect Dis J 2024; 43:477-482. [PMID: 38251905 DOI: 10.1097/inf.0000000000004244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Elevated soluble urokinase plasminogen activator receptor (suPAR) has been associated with a poor prognosis in serious infections. The aim of this study was to evaluate the clinical value of suPAR in children with acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome (MIS-C). METHODS Serum suPAR was measured using the suPARnostic AUTO Flex enzyme-linked immunosorbent assay in hospitalized children with COVID-19, MIS-C, bacterial pneumonia, and healthy controls. RESULTS A total of 211 children with a mean (±SD) age of 6.9 ± 4.96 years were tested; with COVID-19: 59 (28%), MIS-C: 36 (17%), pneumonia: 78 (37%) and healthy controls: 38 (18%). In the acute phase, the levels of suPAR (mean ± SD) were: MIS-C: 8.11 ± 2.80 ng/mL, COVID-19: 4.91 ± 1.90 ng/mL, pneumonia: 4.25 ± 1.44 ng/mL and controls: 2.09 ± 0.47 ng/mL ( P < 0.001). Children with acute COVID-19 and a severe or moderate clinical presentation had higher values than those with mild symptoms: 5.79 ± 1.58 versus 5.40 ± 1.94 versus 3.19 ± 0.73 ng/mL, respectively ( P < 0.001). In the MIS-C group, children hospitalized in the intensive care unit and in need of mechanical ventilation had higher suPAR than those who were not admitted to an intensive care unit: 9.32 ± 3.06 versus 7.13 ± 2.19 ng/mL, respectively ( P = 0.023). In children with COVID-19 or MIS-C, a correlation was detected between suPAR values and length of hospitalization ( rs = 0.418, P < 0.001). CONCLUSIONS The findings suggest that suPAR may be a valuable biomarker of disease severity in children with COVID-19 or MIS-C. This could facilitate the identification of children in need of intensive anti-inflammatory treatment, as it has been shown in adults with severe COVID-19.
Collapse
Affiliation(s)
- Magdalini Louka
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
| | - Elizabeth Barbara Tatsi
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
- University Research Institute of Maternal and Child Health and Precision Medicine, Athens, Greece
| | - Sofia Vassiliu
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
| | - George Theoharis
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
| | - Kalliopi Straka
- Pediatric Intensive Care Unit, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Filippos Filippatos
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
| | - Maria Myrto Dourdouna
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
| | - Tania Siahanidou
- Neonatal Unit, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Vasiliki Syriopoulou
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
| | - Athanasios Michos
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
| |
Collapse
|
2
|
Veronese N, Di Gennaro F, Frallonardo L, Ciriminna S, Papagni R, Carruba L, Agnello D, De Iaco G, De Gennaro N, Di Franco G, Naro L, Brindicci G, Rizzo A, Bavaro DF, Garlisi MC, Santoro CR, Signorile F, Balena F, Mansueto P, Milano E, Giannitrapani L, Fiordelisi D, Mariani MF, Procopio A, Lattanzio R, Licata A, Vernuccio L, Amodeo S, Guido G, Segala FV, Barbagallo M, Saracino A. Real life experience on the use of Remdesivir in patients admitted to COVID-19 in two referral Italian hospital: a propensity score matched analysis. Sci Rep 2024; 14:9303. [PMID: 38654033 DOI: 10.1038/s41598-024-59957-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
Remdesivir (RDV) was the first Food and Drug Administration (FDA)-approved medication for COVID-19, with discordant data on efficacy in reducing mortality risk and disease progression. In the context of a dynamic and rapidly changing pandemic landscape, the utilization of real-world evidence is of utmost importance. The objective of this study is to evaluate the impact of RDV on patients who have been admitted to two university referral hospitals in Italy due to COVID-19. All patients older than 18 years and hospitalized at two different universities (Bari and Palermo) were enrolled in this study. To minimize the effect of potential confounders, we used propensity score matching with one case (Remdesivir) and one control that never experienced this kind of intervention during hospitalization. Mortality was the primary outcome of our investigation, and it was recorded using death certificates and/or medical records. Severe COVID-19 was defined as admission to the intensive care unit or a qSOFAscore ≥ 2 or CURB65scores ≥ 3. After using propensity score matching, 365 patients taking Remdesivir and 365 controls were included. No significant differences emerged between the two groups in terms of mean age and percentage of females, while patients taking Remdesivir were less frequently active smokers (p < 0.0001). Moreover, the patients taking Remdesivir were less frequently vaccinated against COVID-19. All the other clinical, radiological, and pharmacological parameters were balanced between the two groups. The use of Remdesivir in our cohort was associated with a significantly lower risk of mortality during the follow-up period (HR 0.56; 95% CI 0.37-0.86; p = 0.007). Moreover, RDV was associated with a significantly lower incidence of non-invasive ventilation (OR 0.27; 95% CI 0.20-0.36). Furthermore, in the 365 patients taking Remdesivir, we observed two cases of mild renal failure requiring a reduction in the dosage of Remdesivir and two cases in which the physicians decided to interrupt Remdesivir for bradycardia and for QT elongation. Our study suggests that the use of Remdesivir in hospitalized COVID-19 patients is a safe therapy associated with improved clinical outcomes, including halving of mortality and with a reduction of around 75% of the risk of invasive ventilation. In a constantly changing COVID-19 scenario, ongoing research is necessary to tailor treatment decisions based on the latest scientific evidence and optimize patient outcomes.
Collapse
Affiliation(s)
- Nicola Veronese
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Francesco Di Gennaro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Luisa Frallonardo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy.
| | - Stefano Ciriminna
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Roberta Papagni
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Luca Carruba
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Diletta Agnello
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Giuseppina De Iaco
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Nicolò De Gennaro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Giuseppina Di Franco
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Liliana Naro
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Gaetano Brindicci
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Angelo Rizzo
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Davide Fiore Bavaro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Maria Chiara Garlisi
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Carmen Rita Santoro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Fabio Signorile
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Flavia Balena
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Pasquale Mansueto
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Eugenio Milano
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Lydia Giannitrapani
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Deborah Fiordelisi
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Michele Fabiano Mariani
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Andrea Procopio
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Rossana Lattanzio
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Anna Licata
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Laura Vernuccio
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Simona Amodeo
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Giacomo Guido
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Francesco Vladimiro Segala
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Mario Barbagallo
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| |
Collapse
|
3
|
Kang DH, Kim GHJ, Park SB, Lee SI, Koh JS, Brown MS, Abtin F, McNitt-Gray MF, Goldin JG, Lee JS. Quantitative Computed Tomography Lung COVID Scores with Laboratory Markers: Utilization to Predict Rapid Progression and Monitor Longitudinal Changes in Patients with Coronavirus 2019 (COVID-19) Pneumonia. Biomedicines 2024; 12:120. [PMID: 38255225 PMCID: PMC10813449 DOI: 10.3390/biomedicines12010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19), is an ongoing issue in certain populations, presenting rapidly worsening pneumonia and persistent symptoms. This study aimed to test the predictability of rapid progression using radiographic scores and laboratory markers and present longitudinal changes. This retrospective study included 218 COVID-19 pneumonia patients admitted at the Chungnam National University Hospital. Rapid progression was defined as respiratory failure requiring mechanical ventilation within one week of hospitalization. Quantitative COVID (QCOVID) scores were derived from high-resolution computed tomography (CT) analyses: (1) ground glass opacity (QGGO), (2) mixed diseases (QMD), and (3) consolidation (QCON), and the sum, quantitative total lung diseases (QTLD). Laboratory data, including inflammatory markers, were obtained from electronic medical records. Rapid progression was observed in 9.6% of patients. All QCOVID scores predicted rapid progression, with QMD showing the best predictability (AUC = 0.813). In multivariate analyses, the QMD score and interleukin(IL)-6 level were important predictors for rapid progression (AUC = 0.864). With >2 months follow-up CT, remained lung lesions were observed in 21 subjects, even after several weeks of negative reverse transcription polymerase chain reaction test. AI-driven quantitative CT scores in conjugation with laboratory markers can be useful in predicting the rapid progression and monitoring of COVID-19.
Collapse
Affiliation(s)
- Da Hyun Kang
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea; (D.H.K.); (S.-I.L.); (J.S.K.)
| | - Grace Hyun J. Kim
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA;
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.S.B.); (F.A.); (M.F.M.-G.)
| | - Sa-Beom Park
- Center of Biohealth Convergence and Open Sharing System, Hongik University, Seoul 04401, Republic of Korea;
| | - Song-I Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea; (D.H.K.); (S.-I.L.); (J.S.K.)
| | - Jeong Suk Koh
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea; (D.H.K.); (S.-I.L.); (J.S.K.)
| | - Matthew S. Brown
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.S.B.); (F.A.); (M.F.M.-G.)
| | - Fereidoun Abtin
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.S.B.); (F.A.); (M.F.M.-G.)
| | - Michael F. McNitt-Gray
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.S.B.); (F.A.); (M.F.M.-G.)
| | - Jonathan G. Goldin
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.S.B.); (F.A.); (M.F.M.-G.)
| | - Jeong Seok Lee
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Republic of Korea
| |
Collapse
|
4
|
Veronese N, Segala FV, Carruba L, La Carrubba A, Pollicino F, Di Franco G, Guido G, Cormio M, Lugli A, De Santis L, Guerra V, Pepe M, Tritto R, Ciccone MM, Bavaro DF, Brindicci G, Mansueto P, Giannitrapani L, Di Gennaro F, Barbagallo M, Saracino A. Anemia as a risk factor for disease progression in patients admitted for COVID-19: data from a large, multicenter cohort study. Sci Rep 2023; 13:9035. [PMID: 37270578 DOI: 10.1038/s41598-023-36208-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/31/2023] [Indexed: 06/05/2023] Open
Abstract
In respiratory infections, anemia is both a consequence of acute inflammation and a predictor of poor clinical outcomes. There are few studies investigating the role of anemia in COVID-19, suggesting a potential role in predicting disease severity. In this study, we aimed to assess the association between the presence of anemia at admission and incidence of severe disease and death in patients hospitalized for COVID-19. Data from all adult patients admitted for COVID-19 in University Hospital "P. Giaccone" Palermo, and University Hospital of Bari, Italy, were retrospectively collected from 1st of September 2020 to 31 August 2022. The association between anemia (defined as Hb < 13 g/dl and < 12 g/dl in males and females, respectively), in-hospital mortality and severe COVID-19 was tested using a Cox's regression analysis. Severe COVID-19 forms were defined as admission to intensive or sub-intensive care unit or a qSOFAscore ≥ 2 or CURB65scores ≥ 3. p values were calculated using the Student's t test for continuous variables and the Mantel-Haenszel Chi-square test for categorical ones. The association between anemia and the mortality was made using a Cox's regression analysis, adjusted, in two models, for the potential confounders and using a propensity score. Among the 1562 patients included in the analysis, prevalence of anemia was 45.1% (95% CI 43-48%). Patients with anemia were significantly older (p < 0.0001), reported more co-morbidities, and presented higher baseline levels of procalcitonin, CRP, ferritin and IL-6. Overall, the crude incidence of mortality was about four times higher in patients with anemia compared to those without. After adjusting for 17 potential confounders, the presence of anemia significantly increased the risk of death (HR = 2.68; 95% CI: 1.59-4.52) and of risk of severe COVID-19 (OR = 2.31; 95% CI: 1.65-3.24). The propensity score analysis substantially confirmed these analyses. Our study provides evidence that, in patients hospitalized for COVID-19, anemia is both associated with a more pronounced baseline pro-inflammatory profile and higher incidence of in-hospital mortality and severe disease.
Collapse
Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Francesco Vladimiro Segala
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Luca Carruba
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Anna La Carrubba
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Francesco Pollicino
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Giusi Di Franco
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Giacomo Guido
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy.
| | - Mariangela Cormio
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Alessia Lugli
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Laura De Santis
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Vittorio Guerra
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Martino Pepe
- Section of Cardiovascular Diseases, Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Italy
| | - Rocco Tritto
- Section of Cardiovascular Diseases, Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Italy
| | - Marco Matteo Ciccone
- Section of Cardiovascular Diseases, Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Italy
| | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Gaetano Brindicci
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Pasquale Mansueto
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Lydia Giannitrapani
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Via Ugo La Malfa 153, 90146, Palermo, Italy
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| |
Collapse
|
5
|
Wang N, Liu L, He W, Shang N, Li J, Qin Z, Du X. Circulating mid-regional proadrenomedullin is a predictor of mortality in patients with COVID-19: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:305. [PMID: 37158819 PMCID: PMC10165584 DOI: 10.1186/s12879-023-08275-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/24/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Although there is increasing understanding of the changes in the laboratory parameters of Coronavirus disease 2019 (COVID-19), the correlation between circulating Mid-regional Proadrenomedullin (MR-proADM) and mortality of patients with COVID-19 is not fully understood. In this study, we conducted a systematic review and meta-analysis to evaluate the prognostic value of MR-proADM in patients with COVID-19. METHODS The PubMed, Embase, Web of Science, Cochrane Library, Wanfang, SinoMed and Chinese National Knowledge Infrastructure (CNKI) databases were searched from 1 January 2020 to 20 March 2022 for relevant literature. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess quality bias, STATA was employed to pool the effect size by a random effects model, and potential publication bias and sensitivity analyses were performed. RESULTS 14 studies comprising 1822 patients with COVID-19 met the inclusion criteria, there were 1145 (62.8%) males and 677 (31.2%) females, and the mean age was 63.8 ± 16.1 years. The concentration of MR-proADM was compared between the survivors and non-survivors in 9 studies and the difference was significant (P < 0.01), I2 = 46%. The combined sensitivity was 0.86 [0.73-0.92], and the combined specificity was 0.78 [0.68-0.86]. We drew the summary receiver operating characteristic (SROC) curve and calculated the area under curve (AUC) = 0.90 [0.87-0.92]. An increase of 1 nmol/L of MR-proADM was independently associated with a more than threefold increase in mortality (odds ratio (OR) 3.03, 95% confidence interval (CI) 2.26-4.06, I2 = 0.0%, P = 0.633). The predictive value of MR-proADM for mortality was better than many other biomarkers. CONCLUSION MR-proADM had a very good predictive value for the poor prognosis of COVID-19 patients. Increased levels of MR-proADM were independently associated with mortality in COVID-19 patients and may allow a better risk stratification.
Collapse
Affiliation(s)
- Na Wang
- Emergency department of China Rehabilitation Research Center, Capital Medical University, no.10 Jiaomen north Street, Fengtai District, Beijing, 100068, China
| | - Lushan Liu
- Emergency department of China Rehabilitation Research Center, Capital Medical University, no.10 Jiaomen north Street, Fengtai District, Beijing, 100068, China
| | - Wei He
- Emergency department of China Rehabilitation Research Center, Capital Medical University, no.10 Jiaomen north Street, Fengtai District, Beijing, 100068, China
| | - Na Shang
- Emergency department of China Rehabilitation Research Center, Capital Medical University, no.10 Jiaomen north Street, Fengtai District, Beijing, 100068, China
| | - Junyu Li
- Emergency department of China Rehabilitation Research Center, Capital Medical University, no.10 Jiaomen north Street, Fengtai District, Beijing, 100068, China
| | - Zhou Qin
- Emergency department of China Rehabilitation Research Center, Capital Medical University, no.10 Jiaomen north Street, Fengtai District, Beijing, 100068, China
| | - Xiaoxia Du
- Department of neurorehabilitation of China Rehabilitation Research Center, Capital Medical University, no.10 Jiaomen north Street, Fengtai District, Beijing, 100068, China.
| |
Collapse
|
6
|
Meletis G, Tychala A, Ntritsos G, Verrou E, Savvidou F, Dermitzakis I, Chatzidimitriou A, Gkeka I, Fyntanidou B, Gkarmiri S, Tzallas AT, Protonotariou E, Makedou K, Tsalikakis DG, Skoura L. Variant-Related Differences in Laboratory Biomarkers among Patients Affected with Alpha, Delta and Omicron: A Retrospective Whole Viral Genome Sequencing and Hospital-Setting Cohort Study. Biomedicines 2023; 11:biomedicines11041143. [PMID: 37189760 DOI: 10.3390/biomedicines11041143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
During the COVID-19 pandemic, different SARS-CoV-2 variants of concern (VOC) with specific characteristics have emerged and spread worldwide. At the same time, clinicians routinely evaluate the results of certain blood tests upon patient admission as well as during hospitalization to assess disease severity and the overall patient status. In the present study, we searched for significant cell blood count and biomarker differences among patients affected with the Alpha, Delta and Omicron VOCs at admission. Data from 330 patients were retrieved regarding age, gender, VOC, cell blood count results (WBC, Neut%, Lymph%, Ig%, PLT), common biomarkers (D-dimers, urea, creatinine, SGOT, SGPT, CRP, IL-6, suPAR), ICU admission and death. Statistical analyses were performed using ANOVA, the Kruskal-Wallis test, two-way ANOVA, Chi-square, T-test, the Mann-Whitney test and logistic regression was performed where appropriate using SPSS v.28 and STATA 14. Age and VOC were significantly associated with hospitalization, whereas significant differences among VOC groups were found for WBC, PLT, Neut%, IL-6, creatinine, CRP, D-dimers and suPAR. Our analyses showed that throughout the current pandemic, not only the SARS-CoV-2 VOCs but also the laboratory parameters that are used to evaluate the patient's status at admission are subject to changes.
Collapse
Affiliation(s)
- Georgios Meletis
- Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Areti Tychala
- Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Georgios Ntritsos
- Department of Informatics and Telecommunications, School of Informatics and Telecommunications, University of Ioannina, 47100 Arta, Greece
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Eleni Verrou
- School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Filio Savvidou
- School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Iasonas Dermitzakis
- School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Anastasia Chatzidimitriou
- Institute of Applied Bioscience, Centre for Research and Technology Hellas, 6th km Charilaou-Thermi Rd., Thermi, 57001 Thessaloniki, Greece
| | - Ioanna Gkeka
- Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Barbara Fyntanidou
- Department of Emergency Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Sofia Gkarmiri
- Department of Emergency Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Alexandros T Tzallas
- Department of Informatics and Telecommunications, School of Informatics and Telecommunications, University of Ioannina, 47100 Arta, Greece
| | - Efthymia Protonotariou
- Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Kali Makedou
- Laboratory of Biochemistry, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Dimitrios G Tsalikakis
- Department of Electrical and Computer Engineering, University of Western Macedonia, 50131 Kozani, Greece
| | - Lemonia Skoura
- Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| |
Collapse
|
7
|
Zanelli S, Bakakos A, Sotiropoulou Z, Papaioannou AI, Koukaki E, Potamianou E, Kyriakoudi A, Kaniaris E, Bakakos P, Giamarellos-Bourboulis EJ, Koutsoukou A, Rovina N. Modified SCOPE (mSCOPE) Score as a Tool to Predict Mortality in COVID-19 Critically Ill Patients. J Pers Med 2023; 13:jpm13040628. [PMID: 37109014 PMCID: PMC10146219 DOI: 10.3390/jpm13040628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Introduction: Efficient clinical scores predicting the outcome of severe COVID-19 pneumonia may play a pivotal role in patients’ management. The aim of this study was to assess the modified Severe COvid Prediction Estimate score (mSCOPE) index as a predictor of mortality in patients admitted to the ICU due to severe COVID-19 pneumonia. Materials and methods: In this retrospective observational study, 268 critically ill COVID-19 patients were included. Demographic and laboratory characteristics, comorbidities, disease severity, and outcome were retrieved from the electronical medical files. The mSCOPE was also calculated. Results: An amount of 70 (26.1%) of patients died in the ICU. These patients had higher mSCOPE score compared to patients who survived (p < 0.001). mSCOPE correlated to disease severity (p < 0.001) and to the number and severity of comorbidities (p < 0.001). Furthermore, mSCOPE significantly correlated with days on mechanical ventilation (p < 0.001) and days of ICU stay (p = 0.003). mSCOPE was found to be an independent predictor of mortality (HR:1.219, 95% CI: 1.010–1.471, p = 0.039), with a value ≥ 6 predicting poor outcome with a sensitivity (95%CI) 88.6%, specificity 29.7%, a positive predictive value of 31.5%, and a negative predictive value of 87.7%. Conclusion: mSCOPE score could be proved useful in patients’ risk stratification, guiding clinical interventions in patients with severe COVID-19.
Collapse
Affiliation(s)
- Stavroula Zanelli
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Agamemnon Bakakos
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Zoi Sotiropoulou
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Andriana I. Papaioannou
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Evangelia Koukaki
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Efstathia Potamianou
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Anna Kyriakoudi
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Evangelos Kaniaris
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Petros Bakakos
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Evangelos J. Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, “Attikon” Hospital, 12462 Athens, Greece
| | - Antonia Koutsoukou
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Nikoletta Rovina
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| |
Collapse
|
8
|
Buttia C, Llanaj E, Raeisi-Dehkordi H, Kastrati L, Amiri M, Meçani R, Taneri PE, Ochoa SAG, Raguindin PF, Wehrli F, Khatami F, Espínola OP, Rojas LZ, de Mortanges AP, Macharia-Nimietz EF, Alijla F, Minder B, Leichtle AB, Lüthi N, Ehrhard S, Que YA, Fernandes LK, Hautz W, Muka T. Prognostic models in COVID-19 infection that predict severity: a systematic review. Eur J Epidemiol 2023; 38:355-372. [PMID: 36840867 PMCID: PMC9958330 DOI: 10.1007/s10654-023-00973-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 01/28/2023] [Indexed: 02/26/2023]
Abstract
Current evidence on COVID-19 prognostic models is inconsistent and clinical applicability remains controversial. We performed a systematic review to summarize and critically appraise the available studies that have developed, assessed and/or validated prognostic models of COVID-19 predicting health outcomes. We searched six bibliographic databases to identify published articles that investigated univariable and multivariable prognostic models predicting adverse outcomes in adult COVID-19 patients, including intensive care unit (ICU) admission, intubation, high-flow nasal therapy (HFNT), extracorporeal membrane oxygenation (ECMO) and mortality. We identified and assessed 314 eligible articles from more than 40 countries, with 152 of these studies presenting mortality, 66 progression to severe or critical illness, 35 mortality and ICU admission combined, 17 ICU admission only, while the remaining 44 studies reported prediction models for mechanical ventilation (MV) or a combination of multiple outcomes. The sample size of included studies varied from 11 to 7,704,171 participants, with a mean age ranging from 18 to 93 years. There were 353 prognostic models investigated, with area under the curve (AUC) ranging from 0.44 to 0.99. A great proportion of studies (61.5%, 193 out of 314) performed internal or external validation or replication. In 312 (99.4%) studies, prognostic models were reported to be at high risk of bias due to uncertainties and challenges surrounding methodological rigor, sampling, handling of missing data, failure to deal with overfitting and heterogeneous definitions of COVID-19 and severity outcomes. While several clinical prognostic models for COVID-19 have been described in the literature, they are limited in generalizability and/or applicability due to deficiencies in addressing fundamental statistical and methodological concerns. Future large, multi-centric and well-designed prognostic prospective studies are needed to clarify remaining uncertainties.
Collapse
Affiliation(s)
- Chepkoech Buttia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
- Epistudia, Bern, Switzerland
| | - Erand Llanaj
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
- ELKH-DE Public Health Research Group of the Hungarian Academy of Sciences, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Epistudia, Bern, Switzerland
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Hamidreza Raeisi-Dehkordi
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lum Kastrati
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mojgan Amiri
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Renald Meçani
- Department of Pediatrics, “Mother Teresa” University Hospital Center, Tirana, University of Medicine, Tirana, Albania
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Petek Eylul Taneri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- HRB-Trials Methodology Research Network College of Medicine, Nursing and Health Sciences University of Galway, Galway, Ireland
| | | | - Peter Francis Raguindin
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences, University of Lucerne, Lucerne, Switzerland
| | - Faina Wehrli
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Farnaz Khatami
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Octavio Pano Espínola
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Preventive Medicine and Public Health, University of Navarre, Pamplona, Spain
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Lyda Z. Rojas
- Research Group and Development of Nursing Knowledge (GIDCEN-FCV), Research Center, Cardiovascular Foundation of Colombia, Floridablanca, Santander, Colombia
| | | | | | - Fadi Alijla
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Beatrice Minder
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Alexander B. Leichtle
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, and Center for Artificial Intelligence in Medicine (CAIM), University of Bern, Bern, Switzerland
| | - Nora Lüthi
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Simone Ehrhard
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurenz Kopp Fernandes
- Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wolf Hautz
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Epistudia, Bern, Switzerland
| |
Collapse
|
9
|
Aomar-Millán IF, de Victoria-Carazo JM, Fernández Reyes D, Torres-Parejo Ú, Pérez Fernández L, Martínez-Diz S, Ceballos Torres A, López Gómez J, Bizzarri F, Raya Álvarez E, Salvatierra J. Characteristics and clinical outcome in 312 patients with moderate to severe pneumonia due to SARS-COV-2 and hyperinflammation treated with anakinra and corticosteroids: A retrospective cohort study. PLoS One 2023; 18:e0283529. [PMID: 36961847 PMCID: PMC10038301 DOI: 10.1371/journal.pone.0283529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/12/2023] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVE To assess the clinical outcome (death and/or Intensive Care Unit (ICU) admission) based on the time from hospital admission to the administration of anakinra and the possible usefulness of a "simplified" SCOPE score to stratify the risk of worse prognosis in our cohort of patients with moderate/severe SARS-CoV-2 pneumonia, both vaccinated and unvaccinated, that received anakinra and corticosteroids. In addition, the clinical, analytical, and imaging characteristics of patients at admission are described. METHODS Retrospective cohort study of 312 patients admitted to Hospital Clínico San Cecilio in Granada for moderate/severe pneumonia caused by SARS-CoV-2 that received anakinra and corticosteroids between March 2020 and January 2022. Clinical and analytical data were collected as well as the patient outcome at 30 and 60 days after admission. Three treatment groups were established according to the time from hospital admission to administration of anakinra: early (1st-2nd day), intermediate (3rd-5th day), and late (after the 5th day). RESULTS The median age was 67.4 years (IQR 22-97 years) and 204 (65.4%) were male. The most common comorbidity was hypertension (58%). The median time from the start of symptoms to anakinra administration was 6 days (IQR 5-10) and the SaFi (SaO2/FiO2) was 228 (IQR 71-471). The cure rate was higher in the early-onset anakinra group versus the late-onset group (73% vs 56.6%). The latter had a higher percentage of deaths (27.4%) and a greater number of patients remained hospitalized for a month (16%). On admission, the patients had elevated C-reactive protein (CRP), ferritin, and D-dimer values and decreased total lymphocytes. Analytical improvement was observed at both 72 hours and one month after treatment. 42 (13.5%) required ICU admission, and 23 (7.3%) orotracheal intubation. At 60 days, 221 (70.8%) were discharged, 87 (27.8%) had died and 4 (1.4%) remained hospitalized. The mean dose of anakinra was 1000 mg (100-2600 mg) with differences found between the dose administered and the clinical outcome. There were no differences in the primary outcome based on vaccination. A simplified SCOPE score at the start of anakinra administration was lower in patients with better clinical evolution. CONCLUSIONS Early treatment with anakinra and corticosteroids was associated with a better outcome regardless of vaccination status. A simplified SCOPE was found to be a good prognostic tool.
Collapse
Affiliation(s)
- Ismael Francisco Aomar-Millán
- Department of Internal Medicine, Hospital Universitario Clínico San Cecilio, Granada, Spain
- Biosanitary Research Institute of Granada, ibsGRANADA, Granada, Spain
| | | | - Daniel Fernández Reyes
- Department of Internal Medicine, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Úrsula Torres-Parejo
- Department of Statistics, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | - Silvia Martínez-Diz
- Department of Preventive Medicine, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Angel Ceballos Torres
- Department of Internal Medicine, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Jairo López Gómez
- Department of Internal Medicine, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Francesco Bizzarri
- Department of Rheumatology, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Enrique Raya Álvarez
- Biosanitary Research Institute of Granada, ibsGRANADA, Granada, Spain
- Department of Rheumatology, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Juan Salvatierra
- Biosanitary Research Institute of Granada, ibsGRANADA, Granada, Spain
- Department of Rheumatology, Hospital Universitario Clínico San Cecilio, Granada, Spain
| |
Collapse
|
10
|
Akinosoglou K, Kotsaki A, Gounaridi IM, Christaki E, Metallidis S, Adamis G, Fragkou A, Fantoni M, Rapti A, Kalomenidis I, Chrysos G, Boni G, Kainis I, Alexiou Z, Castelli F, Serino FS, Bakakos P, Nicastri E, Tzavara V, Safarika A, Ioannou S, Dagna L, Dimakou K, Tzatzagou G, Chini M, Bassetti M, Kotsis V, Angheben A, Tsoukalas G, Selmi C, Spiropoulou OM, Samarkos M, Doumas M, Damoraki G, Masgala A, Papanikolaou I, Argyraki A, Negri M, Leventogiannis K, Sympardi S, Gatselis NK, Petrakis V, Netea MG, Panagopoulos P, Sakka V, Milionis H, Dalekos GN, Giamarellos-Bourboulis EJ. Efficacy and safety of early soluble urokinase plasminogen receptor plasma-guided anakinra treatment of COVID-19 pneumonia: A subgroup analysis of the SAVE-MORE randomised trial. EClinicalMedicine 2023; 56:101785. [PMID: 36590789 PMCID: PMC9791950 DOI: 10.1016/j.eclinm.2022.101785] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The SAVE-MORE trial demonstrated that anakinra treatment in COVID-19 pneumonia with plasma soluble urokinase plasminogen activator (suPAR) levels of 6 ng/mL or more was associated with 0.36 odds for a worse outcome compared to placebo when expressed by the WHO-Clinical Progression Scale (CPS) at day 28. Herein, we report the results of subgroup analyses and long-term outcomes. METHODS This prospective, double-blind, randomised clinical trial, recruited patients with a confirmed SARS-CoV-2 infection, in need of hospitalisation, lower respiratory tract infection and plasma suPAR ≥6 ng/mL from 37 academic and community hospitals in Greece and Italy. Patients were 1:2 randomised to subcutaneous treatment with placebo or anakinra (100 mg) once daily for 10 days. Pre-defined subgroups of Charlson's comorbidity index (CCI), sex, age, level of suPAR, and time from symptom onset were analysed for the primary endpoint (overall comparison of distribution of frequencies of the scores from the WHO-CPS between treatments on day 28), by multivariable ordinal regression analysis in the intention to treat (ITT) population. This trial is registered with the EU Clinical Trials Register (2020-005828-11) and ClinicalTrials.gov (NCT04680949). FINDINGS Patients were enrolled between 23 December 2020 and 31 March 2021; 189 patients in the placebo arm and 405 patients in the anakinra arm were the ITT population. Multivariable analysis showed that anakinra treatment was accompanied by significantly lower odds for worse outcome compared to placebo at day 28 for all studied subgroups (CCI ≥ 2, OR: 0.34, 95% confidence intervals [CI] 0.22-0.50; CCI < 2, OR: 0.38, 95% CI 0.21-0.68; suPAR > 9 ng/mL, OR: 0.35, 95% CI 0.19-0.66; suPAR 6-9 ng/mL, OR: 0.35, 95% CI 0.24-0.52; patients ≥65 years, OR: 0.41, 95% CI 0.25-0.66; and patients <65 years, OR: 0.29, 95% CI 0.19-0.45). The benefit was uniform, irrespective of the time from start of symptoms until the start of the study drug. At days 60 and 90, anakinra treatment had odds of 0.40 (95% CI 0.28-0.57) and 0.46 (95% CI 0.32-0.67) respectively, for a worse outcome compared to placebo. The costs of general ward stay, ICU stay, and drugs were lower with anakinra treatment. INTERPRETATION Anakinra represents an important therapeutic tool in the management of COVID-19 that may be administered in all subgroups of patients; benefits are maintained until day 90. FUNDING Hellenic Institute for the Study of Sepsis; Swedish Orphan Biovitrum AB.
Collapse
Affiliation(s)
| | - Antigone Kotsaki
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Ioanna-Maria Gounaridi
- Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eirini Christaki
- First Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Simeon Metallidis
- First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Adamis
- First Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | | | - Massimo Fantoni
- Dipartimento Scienze di Laboratorio e Infettivologiche - Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Aggeliki Rapti
- Second Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Ioannis Kalomenidis
- First Department of Critical Care and Pulmonary Medicine, Medical School, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Chrysos
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Gloria Boni
- Hospital Pharmacy, IRCCS Hospital Sacro Cuore, Negrar di Valpolicella, Verona, Italy
- IRCSS Sacro Cuore Hospital, Negrar di Valpolicella, Verona, Italy
| | - Ilias Kainis
- Tenth Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases of Athens, Athens, Greece
| | - Zoi Alexiou
- Second Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Francesco Castelli
- Spedali Civili, Brescia ASST Spedali Civili Hospital, University of Brescia, Italy
| | | | - Petros Bakakos
- First Department of Chest Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Emanuele Nicastri
- Department of Internal Medicine, Spallanzani Institute of Rome, Rome, Italy
| | - Vassiliki Tzavara
- First Department of Internal Medicine, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Asimina Safarika
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Sofia Ioannou
- Department of Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Katerina Dimakou
- Fifth Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Glykeria Tzatzagou
- First Department of Internal Medicine, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Chini
- Third Department of Internal Medicine and Infectious Diseases Unit, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Matteo Bassetti
- Infectious Diseases Clinic, Ospedale Policlinico San Martino IRCCS and Department of Health Sciences, University of Genova, Genoa, Italy
| | - Vasileios Kotsis
- Third Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andrea Angheben
- Department of Infectious – Tropical Diseases and Microbiology, IRCSS Sacro Cuore Hospital, Negrar di Valpolicella, Verona, Italy
| | - George Tsoukalas
- Fourth Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20072, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - Olga-Maria Spiropoulou
- First Department of Internal Medicine, Asklipieio General Hospital of Voula, Athens, Greece
| | - Michael Samarkos
- First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Doumas
- Second Department of Propedeutic Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Damoraki
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Masgala
- Second Department of Internal Medicine, Konstantopouleio General Hospital, Athens, Greece
| | - Ilias Papanikolaou
- Department of Pulmonary Medicine, General Hospital of Kerkyra, Kerkyra, Greece
| | - Aikaterini Argyraki
- Department of Internal Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Marcantonio Negri
- Dipartimento Scienze Mediche e Chirurgiche - Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Konstantinos Leventogiannis
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Styliani Sympardi
- First Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Nikolaos K. Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Disases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa 41110, Greece
| | - Vasileios Petrakis
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Mihai G. Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen 6500, Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Periklis Panagopoulos
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Vissaria Sakka
- Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- First Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - George N. Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Disases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa 41110, Greece
| | - Evangelos J. Giamarellos-Bourboulis
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
- Corresponding author. 4th Department of Internal Medicine, ATTIKON University Hospital, 1 Rimini Street, Athens 12462, Greece.
| |
Collapse
|
11
|
Samaras C, Kyriazopoulou E, Poulakou G, Reiner E, Kosmidou M, Karanika I, Petrakis V, Adamis G, Gatselis NK, Fragkou A, Rapti A, Taddei E, Kalomenidis I, Chrysos G, Bertoli G, Kainis I, Alexiou Z, Castelli F, Saverio Serino F, Bakakos P, Nicastri E, Tzavara V, Kostis E, Dagna L, Koukidou S, Tzatzagou G, Chini M, Bassetti M, Trakatelli C, Tsoukalas G, Selmi C, Samarkos M, Pyrpasopoulou A, Masgala A, Antonakis E, Argyraki A, Akinosoglou K, Sympardi S, Panagopoulos P, Milionis H, Metallidis S, Syrigos KN, Angel A, Dalekos GN, Netea MG, Giamarellos-Bourboulis EJ. Interferon gamma-induced protein 10 (IP-10) for the early prognosis of the risk for severe respiratory failure and death in COVID-19 pneumonia. Cytokine 2023; 162:156111. [PMID: 36529030 PMCID: PMC9747699 DOI: 10.1016/j.cyto.2022.156111] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/18/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Elevated concentrations of soluble urokinase plasminogen activator receptor (suPAR) predict progression to severe respiratory failure (SRF) or death among patients with COVID-19 pneumonia and guide early anakinra treatment. As suPAR testing may not be routinely available in every health-care setting, alternative biomarkers are needed. We investigated the performance of C-reactive protein (CRP), interferon gamma-induced protein-10 (IP-10) and TNF-related apoptosis-inducing ligand (TRAIL) for predicting SRF or death in COVID-19. METHODS Two cohorts were studied; one discovery cohort with 534 patients from the SAVE-MORE clinical trial; and one validation cohort with 364 patients from the SAVE trial including also 145 comparators. CRP, IP-10 and TRAIL were measured by the MeMed Key® platform in order to select the biomarker with the best prognostic performance for the early prediction of progression into SRF or death. RESULTS IP-10 had the best prognostic performance: baseline concentrations 2000 pg/ml or higher predicted equally well to suPAR (sensitivity 85.0 %; negative predictive value 96.6 %). Odds ratio for poor outcome among anakinra-treated participants of the SAVE-MORE trial was 0.35 compared to placebo when IP-10 was 2,000 pg/ml or more. IP-10 could divide different strata of severity for SRF/death by day 14 in the validation cohort. Anakinra treatment decreased this risk irrespective the IP-10 concentrations. CONCLUSIONS IP-10 concentrations of 2,000 pg/ml or higher are a valid alternative to suPAR for the early prediction of progression into SRF or death the first 14 days from hospital admission for COVID-19 and they may guide anakinra treatment. TRIAL REGISTRATION CLINICALTRIALS gov, NCT04680949 and NCT04357366.
Collapse
Affiliation(s)
- Charilaos Samaras
- 1(st) Department of Internal Medicine, Asklepieio General Hospital of Voula, Greece
| | - Evdoxia Kyriazopoulou
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece; Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Garyfallia Poulakou
- 3(rd) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Maria Kosmidou
- 1st Department of Internal Medicine, University of Ioannina, Medical School, Ioannina, Greece
| | - Ioanna Karanika
- 1st Department of Internal Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Vasileios Petrakis
- 2(nd) Department of Internal Medicine, Democritus University of Thrace, Medical School, 681 00, Alexandroupolis, Greece
| | - George Adamis
- 1(st) Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Nikolaos K Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Disases (ERN RARE-LIVER), General University Hospital of Larissa, 41110 Larissa, Greece
| | | | - Aggeliki Rapti
- 2(nd) Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Eleonora Taddei
- Dipartimento Scienze di Laboratorio e Infettivologiche - Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Roma, Italy
| | - Ioannis Kalomenidis
- 1(st) Department of Critical Care and Pulmonary Medicine, Medical School, National and Kapodistrian University of Athens, Evangelismos General Hospital, Athens, Greece
| | - George Chrysos
- 2(nd) Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Giulia Bertoli
- Department of Infectious - Tropical Diseases and Microbiology, IRCSS Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Ilias Kainis
- 10(th) Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases of Athens, Greece
| | - Zoi Alexiou
- 2(nd) Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Francesco Castelli
- Spedali Civili, Brescia ASST Spedali Civili Hospital, University of Brescia, Italy
| | | | - Petros Bakakos
- 1(st) Department of Chest Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emanuele Nicastri
- Department of Internal Medicine, Spallanzani Institute of Rome, Italy
| | - Vassiliki Tzavara
- 1(st) Department of Internal Medicine, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Evangelos Kostis
- Department of Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Sofia Koukidou
- 5(th) Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Glykeria Tzatzagou
- 1(st) Department of Internal Medicine, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Chini
- 3rd Dpt of Internal Medicine and Infectious Diseases Unit, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Matteo Bassetti
- Infectious Diseases Clinic, Ospedale Policlinico San Martino IRCCS and Department of Health Sciences, University of Genova, Genova, Italy
| | - Christina Trakatelli
- 3(rd) Department of Internal Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - George Tsoukalas
- 4(th) Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele and IRCCS Humanitas Research Hospital, via Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Michael Samarkos
- 1(st) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Athina Pyrpasopoulou
- 2(nd) Department of Propedeutic Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Aikaterini Masgala
- 2(nd) Department of Internal Medicine, Konstantopouleio General Hospital, Athens, Greece
| | | | - Aikaterini Argyraki
- Department of Internal Medicine, Sotiria General Hospital of Chest Diseases, Greece
| | | | - Styliani Sympardi
- 1(st) Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Periklis Panagopoulos
- 2(nd) Department of Internal Medicine, Democritus University of Thrace, Medical School, 681 00, Alexandroupolis, Greece
| | - Haralampos Milionis
- 1st Department of Internal Medicine, University of Ioannina, Medical School, Ioannina, Greece
| | - Simeon Metallidis
- 1st Department of Internal Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Konstantinos N Syrigos
- 3(rd) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Disases (ERN RARE-LIVER), General University Hospital of Larissa, 41110 Larissa, Greece
| | - Mihai G Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, the Netherlands; Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Germany
| | - Evangelos J Giamarellos-Bourboulis
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece; Hellenic Institute for the Study of Sepsis, Athens, Greece.
| |
Collapse
|
12
|
Vélez-Páez JL, Pelosi P, Battaglini D, Best I. Biological Markers to Predict Outcome in Mechanically Ventilated Patients with Severe COVID-19 Living at High Altitude. J Clin Med 2023; 12:jcm12020644. [PMID: 36675573 PMCID: PMC9860769 DOI: 10.3390/jcm12020644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/24/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There is not much evidence on the prognostic utility of different biological markers in patients with severe COVID-19 living at high altitude. The objective of this study was to determine the predictive value of inflammatory and hematological markers for the risk of mortality at 28 days in patients with severe COVID-19 under invasive mechanical ventilation, living at high altitude and in a low-resource setting. METHODS We performed a retrospective observational study including patients with severe COVID-19, under mechanical ventilation and admitted to the intensive care unit (ICU) located at 2850 m above sea level, between 1 April 2020 and 1 August 2021. Inflammatory (interleukin-6 (IL-6), ferritin, D-dimer, lactate dehydrogenase (LDH)) and hematologic (mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), MPV/platelet ratio) markers were evaluated at 24 h and in subsequent controls, and when available at 48 h and 72 h after admission to the ICU. The primary outcome was the association of inflammatory and hematological markers with the risk of mortality at 28 days. RESULTS We analyzed 223 patients (median age (1st quartile [Q1]-3rd quartile [Q3]) 51 (26-75) years and 70.4% male). Patients with severe COVID-19 and with IL-6 values at 24 h ≥ 11, NLR values at 24 h ≥ 22, and NLR values at 72 h ≥ 14 were 8.3, 3.8, and 3.8 times more likely to die at 28 days, respectively. The SOFA and APACHE-II scores were not able to independently predict mortality. CONCLUSIONS In mechanically ventilated patients with severe COVID-19 and living at high altitude, low-cost and immediately available blood markers such as IL-6 and NLR may predict the severity of the disease in low-resource settings.
Collapse
Affiliation(s)
- Jorge Luis Vélez-Páez
- Facultad de Ciencias Médicas, Universidad Central de Ecuador, Quito 170129, Ecuador
- Laboratorio de Inmunología, Facultad de Ciencias y Filosofía, Departamento de Ciencias Celulares y Moleculares, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
- Unidad de Terapia Intensiva, Hospital Pablo Arturo Suárez, Centro de Investigación Clínica, Quito 170129, Ecuador
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy
- Anesthesiology and Critical Care, San Martino Policlinico Hospital, 16132 Genoa, Italy
| | - Denise Battaglini
- Anesthesiology and Critical Care, San Martino Policlinico Hospital, 16132 Genoa, Italy
- Correspondence:
| | - Ivan Best
- Carrera de Medicina Humana, Facultad de Ciencias de la Salud, Universidad San Ignacio de Loyola, Lima 15024, Peru
| |
Collapse
|
13
|
Khani E, Shahrabi M, Rezaei H, Pourkarim F, Afsharirad H, Solduzian M. Current evidence on the use of anakinra in COVID-19. Int Immunopharmacol 2022; 111:109075. [PMID: 35905562 PMCID: PMC9296834 DOI: 10.1016/j.intimp.2022.109075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 02/07/2023]
Abstract
Despite the progressing knowledge in COVID-19 management, remdesivir is the only agent that got approval to inhibit viral replication. However, there are limited data about effective immunomodulatory agents to prevent cytokine release in COVID-19. Cytokine release syndrome in COVID-19 resembles secondary hemophagocytic lymphohistiocytosis, in which interleukin-1 (IL-1) plays a key role. Anakinra is the first recombinant IL-1 receptor antagonist studied for off-label use in COVID-19 treatment. This study reviews the current clinical evidence on the role of interleukin-1 in COVID-19-related cytokine storm, therapeutic effects, significant clinical concerns, and pros and cons of anakinra administration in the management of COVID-19 patients. In this review, four items are shown to be important for achieving the optimal therapeutic effects of anakinra in COVID-19 patients. These items include duration of treatment ≥ 10 days, doses ≥ 100 mg, intravenous administration, and early initiation of therapy. Also, anakinra might be more beneficial in the early stages of the disease when higher levels of cytokines are yet to be observed, which could prevent progression to severe illness and mechanical ventilation. Further studies are required to address the SARS-CoV-2 induced cytokine release syndrome and the role of anakinra in identifying ideal treatment approaches for COVID-19 patients based on their clinical status.
Collapse
Affiliation(s)
- Elnaz Khani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Marzieh Shahrabi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Rezaei
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Pourkarim
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hoda Afsharirad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Solduzian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
| |
Collapse
|
14
|
Campagna D, Caci G, Trovato E, Carpinteri G, Spicuzza L. COVID-19 and emergency departments: need for a validated severity illness score. The history of emerging CovHos score. Intern Emerg Med 2022; 17:2065-2067. [PMID: 35962902 PMCID: PMC9375184 DOI: 10.1007/s11739-022-03069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Davide Campagna
- Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy.
- UOC MCAU, Emergency Department at University Hospital AOU Policlinico "G.Rodolico-San Marco" of Catania, via S. Sofia, 78-Ed.7, 95123, Catania, Italy.
| | - Grazia Caci
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Elisa Trovato
- UOC MCAU, Emergency Department at University Hospital AOU Policlinico "G.Rodolico-San Marco" of Catania, via S. Sofia, 78-Ed.7, 95123, Catania, Italy
| | - Giuseppe Carpinteri
- UOC MCAU, Emergency Department at University Hospital AOU Policlinico "G.Rodolico-San Marco" of Catania, via S. Sofia, 78-Ed.7, 95123, Catania, Italy
| | - Lucia Spicuzza
- Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy
| |
Collapse
|
15
|
Rădulescu A, Lupse M, Istrate A, Calin M, Topan A, Kormos NF, Macicasan RV, Briciu V. External Validation of Mortality Scores among High-Risk COVID-19 Patients: A Romanian Retrospective Study in the First Pandemic Year. J Clin Med 2022; 11:5630. [PMID: 36233498 PMCID: PMC9573119 DOI: 10.3390/jcm11195630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 01/08/2023] Open
Abstract
Background: We aimed to externally validate three prognostic scores for COVID-19: the 4C Mortality Score (4CM Score), the COVID-GRAM Critical Illness Risk Score (COVID-GRAM), and COVIDAnalytics. Methods: We evaluated the scores in a retrospective study on adult patients hospitalized with severe/critical COVID-19 (1 March 2020–1 March 2021), in the Teaching Hospital of Infectious Diseases, Cluj-Napoca, Romania. We assessed all the deceased patients matched with two survivors by age, gender, and at least two comorbidities. The areas under the receiver-operating characteristic curves (AUROCs) were computed for in-hospital mortality. Results: Among 780 severe/critical COVID-19 patients, 178 (22.8%) died. We included 474 patients according to the case definition (158 deceased/316 survivors). The median age was 75 years; diabetes mellitus, malignancies, chronic pulmonary diseases, and chronic kidney and moderate/severe liver diseases were associated with higher risks of death. According to the predefined 4CM Score, the mortality rates were 0% (low), 13% (intermediate), 27% (high), and 61% (very high). The AUROC for the 4CM Score was 0.72 (95% CI: 0.67–0.77) for in-hospital mortality, close to COVID-GRAM, with slightly greater discriminatory ability for COVIDAnalytics: 0.76 (95% CI: 0.71–0.80). Conclusion: All the prognostic scores showed close values compared to their validation cohorts, were fairly accurate in predicting mortality, and can be used to prioritize care and resources.
Collapse
|
16
|
Kotla NK, Dutta P, Parimi S, Das NK. The Role of Ferritin in Health and Disease: Recent Advances and Understandings. Metabolites 2022; 12:metabo12070609. [PMID: 35888733 PMCID: PMC9320524 DOI: 10.3390/metabo12070609] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Systemic iron homeostasis needs to be tightly controlled, as both deficiency and excess iron cause major global health concerns, such as iron deficiency anemia, hemochromatosis, etc. In mammals, sufficient dietary acquisition is critical for fulfilling the systemic iron requirement. New questions are emerging about whether and how cellular iron transport pathways integrate with the iron storage mechanism. Ferritin is the intracellular iron storage protein that stores surplus iron after all the cellular needs are fulfilled and releases it in the face of an acute demand. Currently, there is a surge in interest in ferritin research after the discovery of novel pathways like ferritinophagy and ferroptosis. This review emphasizes the most recent ferritin-related discoveries and their impact on systemic iron regulation.
Collapse
|
17
|
Gatselis NK, Lygoura V, Lyberopoulou A, Giannoulis G, Samakidou A, Vaiou A, Vatidis G, Antoniou K, Stefos A, Georgiadou S, Sagris D, Sveroni D, Stergioula D, Gabeta S, Ntaios G, Dalekos GN. Soluble IL-2R Levels at Baseline Predict the Development of Severe Respiratory Failure and Mortality in COVID-19 Patients. Viruses 2022; 14:787. [PMID: 35458517 PMCID: PMC9025750 DOI: 10.3390/v14040787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 12/03/2022] Open
Abstract
Risk stratification of coronavirus disease-19 (COVID-19) patients by simple markers is critical to guide treatment. We studied the predictive value of soluble interleukin-2 receptor (sIL-2R) for the early identification of patients at risk of developing severe clinical outcomes. sIL-2R levels were measured in 197 patients (60.9% males; median age 61 years; moderate disease, n = 65; severe, n = 132, intubated and/or died, n = 42). All patients received combined immunotherapies (anakinra ± corticosteroids ± intravenous immunoglobulin ± tocilizumab) according to our local treatment algorithm. The endpoint was the composite event of intubation due to severe respiratory failure (SRF) or mortality. Median (interquartile range) sIL-2R levels were significantly higher in patients with severe disease, compared with those with moderate disease (6 (6.2) vs. 5.2 (3.4) ng/mL, p = 0.017). sIL-2R was the strongest laboratory predictive factor for intubation/death (hazard ratio 1.749, 95%CI 1.041–2.939, p = 0.035) after adjustment for other known risk factors. Youden’s index revealed optimal sIL-2R cut-off for predicting intubation/death at 9 ng/mL (sensitivity: 67%; specificity: 86%; positive and negative predictive value: 57% and 91%, respectively). Delta sIL-2R between the day of event or discharge minus admission date was higher in patients that intubated/died than in those who did not experience an event (2.91 (10.42) vs. 0.44 (2.88) ng/mL; p = 0.08)). sIL-2R on admission and its dynamic changes during follow-up may reflect disease severity and predict the development of SRF and mortality.
Collapse
|