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Ren J, Wang XQ, Nakao T, Libby P, Shi GP. Differential Roles of Interleukin-6 in Severe Acute Respiratory Syndrome-Coronavirus-2 Infection and Cardiometabolic Diseases. Cardiol Discov 2023; 3:166-182. [PMID: 38152628 PMCID: PMC10750760 DOI: 10.1097/cd9.0000000000000096] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection can lead to a cytokine storm, unleashed in part by pyroptosis of virus-infected macrophages and monocytes. Interleukin-6 (IL-6) has emerged as a key participant in this ominous complication of COVID-19. IL-6 antagonists have improved outcomes in patients with COVID-19 in some, but not all, studies. IL-6 signaling involves at least 3 distinct pathways, including classic-signaling, trans-signaling, and trans-presentation depending on the localization of IL-6 receptor and its binding partner glycoprotein gp130. IL-6 has become a therapeutic target in COVID-19, cardiovascular diseases, and other inflammatory conditions. However, the efficacy of inhibition of IL-6 signaling in metabolic diseases, such as obesity and diabetes, may depend in part on cell type-dependent actions of IL-6 in controlling lipid metabolism, glucose uptake, and insulin sensitivity owing to complexities that remain to be elucidated. The present review sought to summarize and discuss the current understanding of how and whether targeting IL-6 signaling ameliorates outcomes following SARS-CoV-2 infection and associated clinical complications, focusing predominantly on metabolic and cardiovascular diseases.
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Affiliation(s)
- Jingjing Ren
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115
| | - Xiao-Qi Wang
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115
| | - Tetsushi Nakao
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115
| | - Peter Libby
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115
| | - Guo-Ping Shi
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115
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Jimbo M, Saito S, Uematsu T, Hanaki H, Otori K, Shibuya K, Ando W. Risk analysis of COVID-19 hospitalization and critical care by race and region in the United States: a cohort study. BMC Public Health 2023; 23:1489. [PMID: 37542210 PMCID: PMC10401821 DOI: 10.1186/s12889-023-16401-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND This study aimed to identify the current risk factors for coronavirus disease 2019 severity and examine its association with medication use. METHODS We used data from a large United States electronic health record database to conduct an anonymized cohort study of 171,491 patients with coronavirus disease 2019. The study was conducted from January 1, 2020, to August 27, 2021. Data on age, race, sex, history of diseases, and history of medication prescriptions were analyzed using the Cox proportional hazards model analysis to calculate hazard ratios for hospitalization and severe risk. RESULTS Factors that increased the risk of hospitalization and critical care were age ≥ 65 years, male sex, type 2 diabetes, hypertension, interstitial pneumonia, and cardiovascular disease. In particular, age ≥ 65 years significantly increased the risk of hospitalization (hazard ratio, 2.81 [95% confidence interval, 2.58-3.07]; P < 0.001) and critical care (hazard ratio, 3.45 [2.88-4.14]; P < 0.001). In contrast, patients with hyperlipidemia had a reduced risk. However, patients with hyperlipidemia who were not taking statins had a significantly increased risk of hospitalization (hazard ratio, 1.24 [1.16-1.34]; P < 0.001). Sodium-glucose cotransporter-2 inhibitors, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, glucocorticoids, and statins significantly reduced the risk of hospitalization and critical care. The risk of hospitalization and critical care increased in patients of all ethnicities with type 2 diabetes. The factors that significantly increased the risk of hospitalization in all regions were older age, hypertension, chronic obstructive pulmonary disease, and cardiovascular disease. CONCLUSION This study identified factors that increase or reduce the risk of severe coronavirus disease. The provision of appropriate drug treatment and modification of lifestyle-related risk factors may reduce coronavirus disease severity.
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Affiliation(s)
- Mitsuki Jimbo
- Department of Clinical Pharmacy, Center for Clinical Pharmacy and Sciences, Kitasato University School of Pharmacy, Minato-Ku, Tokyo, Japan
| | - Sakae Saito
- Department of Pharmacy, Kitasato University Medical Center, Kitamoto City, Saitama, Japan
| | - Takayuki Uematsu
- Biomedical Laboratory, Division of Biomedical Research, Kitasato University Medical Center, Kitamoto City, Saitama, Japan
| | - Hideaki Hanaki
- Infection Control Research Center, Ōmura Satoshi Memorial Institute, Kitasato University, Minato-Ku, Tokyo, Japan
| | - Katsuya Otori
- Laboratory of Pharmacy Practice and Science 1, Division of Clinical Pharmacy, Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Sagamihara, Japan
| | - Kiyoshi Shibuya
- Department of Clinical Pharmacy, Center for Clinical Pharmacy and Sciences, Kitasato University School of Pharmacy, Minato-Ku, Tokyo, Japan
- Department of Pharmacy, Kitasato University Medical Center, Kitamoto City, Saitama, Japan
| | - Wataru Ando
- Department of Clinical Pharmacy, Center for Clinical Pharmacy and Sciences, Kitasato University School of Pharmacy, Minato-Ku, Tokyo, Japan.
- Department of Pharmacy, Kitasato University Medical Center, Kitamoto City, Saitama, Japan.
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Hamaway S, Nwokoma U, Goldberg M, Salifu MO, Saha S, Boursiquot R. Impact of diabetes on COVID-19 patient health outcomes in a vulnerable racial minority community. PLoS One 2023; 18:e0286252. [PMID: 37478111 PMCID: PMC10361494 DOI: 10.1371/journal.pone.0286252] [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: 10/14/2022] [Accepted: 05/11/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Diabetes is a growing health concern in the United States and especially New York City. New York City subsequently became an epicenter for the coronavirus pandemic in the Spring of 2020. Previous studies suggest that diabetes is a risk factor for adverse outcomes in COVID-19. OBJECTIVE To investigate the association between diabetes and COVID-19 outcomes as well as assess other covariates that may impact health outcomes. DESIGN Retrospective cohort study of COVID-19 hospitalized patients from March to May, 2020. PARTICIPANTS In total, 1805 patients were tested for COVID-19 and 778 tested positive for COVID-19. Patients were categorized into 2 groups: diabetes (measured by an Hba1c >6.5 or had a history of diabetes) and those without diabetes. RESULTS After controlling for other comorbidities, diabetes was associated with increased risk of mortality (aRR = 1.28, 95% CI 1.03-1.57, p = 0.0231) and discharge to tertiary care centers (aRR = 1.69, 95% CI 1.04-2.77, p = 0.036). compared to non-diabetes. Age and coronary artery disease (CAD) increased the risk of mortality among diabetic patients compared to patients with diabetes alone without CAD or advanced age. The diabetes cohort had more patients with resolving acute respiratory failure (62.2%), acute kidney injury secondary to COVID-19 (49.0%) and sepsis secondary to COVID-19 (30.1%). CONCLUSION This investigation found that COVID-19 patients with diabetes had increased mortality, multiple complications at discharge, and increased rates of admission to a tertiary care center than those without diabetes suggesting a more severe and complicated disease course that required additional services at time of discharge.
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Affiliation(s)
- Stefan Hamaway
- Department of Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, United States of America
- SUNY Downstate College of Medicine, Brooklyn, NY, United States of America
| | - Uchechukwu Nwokoma
- Department of Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, United States of America
- Office of Diversity Education and Research, SUNY Downstate College of Medicine, Brooklyn, NY, United States of America
| | - Michael Goldberg
- Department of Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, United States of America
- SUNY Downstate College of Medicine, Brooklyn, NY, United States of America
| | - Moro O Salifu
- Department of Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - Subhash Saha
- Department of Neurology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - Roosevelt Boursiquot
- Department of Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, United States of America
- Division of Hospital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Internal Medicine, Northwell Staten Island University Hospital, Staten Island, NY, United States of America
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Waddell T, Namburete AIL, Duckworth P, Eichert N, Thomaides-Brears H, Cuthbertson DJ, Despres JP, Brady M. Bayesian networks and imaging-derived phenotypes highlight the role of fat deposition in COVID-19 hospitalisation risk. Front Bioinform 2023; 3:1163430. [PMID: 37293292 PMCID: PMC10244647 DOI: 10.3389/fbinf.2023.1163430] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Objective: Obesity is a significant risk factor for adverse outcomes following coronavirus infection (COVID-19). However, BMI fails to capture differences in the body fat distribution, the critical driver of metabolic health. Conventional statistical methodologies lack functionality to investigate the causality between fat distribution and disease outcomes. Methods: We applied Bayesian network (BN) modelling to explore the mechanistic link between body fat deposition and hospitalisation risk in 459 participants with COVID-19 (395 non-hospitalised and 64 hospitalised). MRI-derived measures of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and liver fat were included. Conditional probability queries were performed to estimate the probability of hospitalisation after fixing the value of specific network variables. Results: The probability of hospitalisation was 18% higher in people living with obesity than those with normal weight, with elevated VAT being the primary determinant of obesity-related risk. Across all BMI categories, elevated VAT and liver fat (>10%) were associated with a 39% mean increase in the probability of hospitalisation. Among those with normal weight, reducing liver fat content from >10% to <5% reduced hospitalisation risk by 29%. Conclusion: Body fat distribution is a critical determinant of COVID-19 hospitalisation risk. BN modelling and probabilistic inferences assist our understanding of the mechanistic associations between imaging-derived phenotypes and COVID-19 hospitalisation risk.
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Affiliation(s)
- T. Waddell
- Department of Engineering Science, The University of Oxford, Oxford, United Kingdom
- Perspectum Ltd., Oxford, United Kingdom
| | - A. I. L. Namburete
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - P. Duckworth
- Oxford Robotics Institute, The University of Oxford, Oxford, United Kingdom
| | | | | | - D. J. Cuthbertson
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - J. P. Despres
- Scientific director of VITAM – Research Center for Sustainable Health, Laval University, Quebec, QC, Canada
| | - M. Brady
- Perspectum Ltd., Oxford, United Kingdom
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Lundberg DJ, Wrigley-Field E, Cho A, Raquib R, Nsoesie EO, Paglino E, Chen R, Kiang MV, Riley AR, Chen YH, Charpignon ML, Hempstead K, Preston SH, Elo IT, Glymour MM, Stokes AC. COVID-19 Mortality by Race and Ethnicity in US Metropolitan and Nonmetropolitan Areas, March 2020 to February 2022. JAMA Netw Open 2023; 6:e2311098. [PMID: 37129894 PMCID: PMC10155069 DOI: 10.1001/jamanetworkopen.2023.11098] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/10/2023] [Indexed: 05/03/2023] Open
Abstract
Importance Prior research has established that Hispanic and non-Hispanic Black residents in the US experienced substantially higher COVID-19 mortality rates in 2020 than non-Hispanic White residents owing to structural racism. In 2021, these disparities decreased. Objective To assess to what extent national decreases in racial and ethnic disparities in COVID-19 mortality between the initial pandemic wave and subsequent Omicron wave reflect reductions in mortality vs other factors, such as the pandemic's changing geography. Design, Setting, and Participants This cross-sectional study was conducted using data from the US Centers for Disease Control and Prevention for COVID-19 deaths from March 1, 2020, through February 28, 2022, among adults aged 25 years and older residing in the US. Deaths were examined by race and ethnicity across metropolitan and nonmetropolitan areas, and the national decrease in racial and ethnic disparities between initial and Omicron waves was decomposed. Data were analyzed from June 2021 through March 2023. Exposures Metropolitan vs nonmetropolitan areas and race and ethnicity. Main Outcomes and Measures Age-standardized death rates. Results There were death certificates for 977 018 US adults aged 25 years and older (mean [SD] age, 73.6 [14.6] years; 435 943 female [44.6%]; 156 948 Hispanic [16.1%], 140 513 non-Hispanic Black [14.4%], and 629 578 non-Hispanic White [64.4%]) that included a mention of COVID-19. The proportion of COVID-19 deaths among adults residing in nonmetropolitan areas increased from 5944 of 110 526 deaths (5.4%) during the initial wave to a peak of 40 360 of 172 515 deaths (23.4%) during the Delta wave; the proportion was 45 183 of 210 554 deaths (21.5%) during the Omicron wave. The national disparity in age-standardized COVID-19 death rates per 100 000 person-years for non-Hispanic Black compared with non-Hispanic White adults decreased from 339 to 45 deaths from the initial to Omicron wave, or by 293 deaths. After standardizing for age and racial and ethnic differences by metropolitan vs nonmetropolitan residence, increases in death rates among non-Hispanic White adults explained 120 deaths/100 000 person-years of the decrease (40.7%); 58 deaths/100 000 person-years in the decrease (19.6%) were explained by shifts in mortality to nonmetropolitan areas, where a disproportionate share of non-Hispanic White adults reside. The remaining 116 deaths/100 000 person-years in the decrease (39.6%) were explained by decreases in death rates in non-Hispanic Black adults. Conclusions and Relevance This study found that most of the national decrease in racial and ethnic disparities in COVID-19 mortality between the initial and Omicron waves was explained by increased mortality among non-Hispanic White adults and changes in the geographic spread of the pandemic. These findings suggest that despite media reports of a decline in disparities, there is a continued need to prioritize racial health equity in the pandemic response.
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Affiliation(s)
- Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
| | - Elizabeth Wrigley-Field
- Department of Sociology, University of Minnesota, Minneapolis
- Minnesota Population Center, University of Minnesota, Minneapolis
| | - Ahyoung Cho
- Center for Antiracist Research, Boston University, Boston, Massachusetts
- Department of Political Science, Boston University, Boston, Massachusetts
| | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Elaine O. Nsoesie
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Center for Antiracist Research, Boston University, Boston, Massachusetts
| | - Eugenio Paglino
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - Ruijia Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Alicia R. Riley
- Department of Sociology, University of California, Santa Cruz
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Marie-Laure Charpignon
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge
| | | | - Samuel H. Preston
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - Irma T. Elo
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
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6
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Pedrosa AR, Martins DC, Rizzo M, Silva-Nunes J. Metformin in SARS-CoV-2 infection: A hidden path - from altered inflammation to reduced mortality. A review from the literature. J Diabetes Complications 2023; 37:108391. [PMID: 36621213 PMCID: PMC9807268 DOI: 10.1016/j.jdiacomp.2022.108391] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
SARS-CoV-2 infection has been a major threat to human health and a huge challenge to Medicine. In only two years, COVID-19 affected >350 million people, causing >5.6 million deaths. Chronic inflammatory states, such as diabetes or obesity, are known risk factors for COVID-19 poorest outcomes, with higher risk for disease severity and greater mortality. Metformin remains on the first line of the management of hyperglycemia in type 2 diabetes. Through its anti-inflammatory and immunomodulatory mechanisms, metformin appears as an opportunity to control the dysregulated cytokine storm secondary to SARS-CoV-2 infection. Recent studies point towards a potential protective role of metformin in the course of COVID-19, showing that current or previous treatment with metformin associates with better outcomes.
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Affiliation(s)
- Ana Realista Pedrosa
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Department of Internal Medicine, Hospital do Espírito Santo de Évora, Évora, Portugal
| | - Diana Cruz Martins
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - José Silva-Nunes
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; NOVA Medical School/Faculdade de Ciências Medicas, New University of Lisbon, Lisbon, Portugal; Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Lisbon, Portugal.
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7
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Singh A, Singh N, Singh S, Srivastava RP, Singh L, Verma PC, Devkota HP, Rahman LU, Kumar Rajak B, Singh A, Saxena G. The industrially important genus Kaempferia: An ethnopharmacological review. Front Pharmacol 2023; 14:1099523. [PMID: 36923360 PMCID: PMC10008896 DOI: 10.3389/fphar.2023.1099523] [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: 11/15/2022] [Accepted: 02/03/2023] [Indexed: 03/01/2023] Open
Abstract
Kaempferia, a genus of the family Zingiberaceae, is widely distributed with more than 50 species which are mostly found throughout Southeast Asia. These plants have important ethnobotanical significance as many species are used in Ayurvedic and other traditional medicine preparations. This genus has received a lot of scholarly attention recently as a result of the numerous health advantages it possesses. In this review, we have compiled the scientific information regarding the relevance, distribution, industrial applications, phytochemistry, ethnopharmacology, tissue culture and conservation initiative of the Kaempferia genus along with the commercial realities and limitations of the research as well as missing industrial linkages followed by an exploration of some of the likely future promising clinical potential. The current review provides a richer and deeper understanding of Kaempferia, which can be applied in areas like phytopharmacology, molecular research, and industrial biology. The knowledge from this study can be further implemented for the establishment of new conservation strategies.
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Affiliation(s)
- Arpit Singh
- Department of Botany, University of Lucknow, Lucknow, Uttar Pradesh, India
| | - Nitesh Singh
- Department of Plant-Pathology, Faculty of Agriculture and Science, SGT University, Gurgaon, India
| | - Sanchita Singh
- Department of Botany, University of Lucknow, Lucknow, Uttar Pradesh, India.,CSIR-National Botanical Research Institute (NBRI), Lucknow, Uttar Pradesh, India
| | | | - Lav Singh
- 4 PG Department of Botany, R.D and D.J. College, Munger University, Munger, India.,Central Academy for State Forest Services, Burnihat, Assam, India
| | - Praveen C Verma
- CSIR-National Botanical Research Institute (NBRI), Lucknow, Uttar Pradesh, India
| | - Hari P Devkota
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan.,Pharmacy Program, Gandaki University, Pokhara, Nepal
| | - Laiq Ur Rahman
- CSIR-Central Institute of Medicinal and Aromatic Plants (CIMAP), Lucknow, Uttar Pradesh, India
| | - Bikash Kumar Rajak
- Department of Bioinformatics, Central University of South Bihar, Gaya, India
| | - Amrita Singh
- Department of Botany, Sri Venkateswara College, University of Delhi, Delhi, India
| | - Gauri Saxena
- Department of Botany, University of Lucknow, Lucknow, Uttar Pradesh, India
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Mokrysheva NG, Shestakova MV, Vikulova OK, Elfimova AR, Isakov MA, Gins NA, Deviatkin AA, Dedov II. Analysis of risk factors for COVID-19-related fatal outcome in 337991 patients with type 1 and type 2 diabetes mellitus in 2020–2022 years: Russian nationwide retrospective study. Diabetes mellitus 2022. [DOI: 10.14341/dm12954] [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] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND: The coronavirus pandemic has had an extremely negative impact on the patients with diabetes mellitus (DM both in terms of a more severe course of COVID -19 and an increased risk of death.AIM: Analysis of risk factors for death due to COVID -19 in patients with DM type 1 and type 2 (DM1 and DM2).MATERIALS AND METHODS: Retrospective analysis of the database of the national diabetes register (NDR), which included DM patients with COVID-19 and reported virus infection outcome (recovery/or death) in 15 712 DM1 and 322 279 DM2 patients during a 2-year follow-up period (01/02/2020 to 03/04/2022) (discharge date)).RESULTS: Case fatality rate in patients with DM, who underwent COVID -19 was 17.1% (DM1–8.8%; DM2–17.5%). As a result of multivariate regression analysis of seven significant factors in DM1 and thirteen in DM2 (evaluated by univariate anlisys), a number of the most important predictors of risk for fatal outcome were identified: in DM1 these were age ≥65 years (OR =4.01, 95% CI: 1.42–11.36), presence of arterial hypertension (AH) (OR =2.72, 95% CI: 1.03 -7.16) and diabetic foot syndrome (DFS) (OR = 7.22, 95% CI: 1.98–26.29); for T2DM: age ≥ 65 years (OR =2.53, 95% CI: 1.96–3.27), male (OR =1.51, 95% CI: 1.23–1.84), duration DM ≥10 years (OR =2.01, 95% CI: 1.61–2.51), BMI ≥ 30 kg/m2 (OR =1.26, 95% CI: 1.02–1.55), ASCVD/CKD (OR =1.49, 95% CI: 1.01–2.04), history of diabetic coma (OR =12.97, 95% CI: 1.89–88.99) and presence of disability ( OR =1.40, 95% CI: 1.14–1.73). In T2DM, the type of antidiabetic therapy (ADT) prior to COVID -19 (last visit before the development of infection) had a significant impact: Insulin therapy (OR = 1.64, 95% CI: 1.30–2.07), sulfonylureas (SU) (OR =1.51, 95% CI: 1.23–1.84)); dipeptidyl peptidase-4 inhibitor (iDPP-4) therapy (OR =0.57, 95% CI: 0.39–0.83) and sodium-glucose cotransporter-2 inhibitor (iSGLT2) therapy (OR =0.64, 95% CI: 0.46–0.88). Vaccination was the most important protective factor in both types of DM: DM1 OR =0.19, 95% CI: 0.06–0.59; SD2 OR =0.20, 95% CI: 0.16–0.26.CONCLUSION: The common risk factor for fatal outcome in both DM1 and DM2 was age ≥65 years; in DM1 — history of hypertension and DFS, in DM2 — male sex, diabetes duration ≥10 years, BMI ≥30 kg/m2, history of ASCVD/CKD and diabetic coma, disability. In T2DM, significant differences in risk were observed depending on the type of ADT: insulin and SU therapy were factors that increased the risk of death, whereas therapy with iDPP-4 and iSGLT2 reduced the risk of death. Vaccination reduced the risk of death in DM1 and DM2 by 5.2 and 5-fold, respectively.
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9
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Maki M, Takada R, Taniguchi A, Nomura N, Kuramoto S, Chiko Y, Okada T, Saito S, Tamura K. Immune checkpoint inhibitor therapy and elevated levels of C-reactive protein associated with COVID-19 aggravation in patients with lung cancer. J Pharm Health Care Sci 2022; 8:27. [PMID: 36316726 PMCID: PMC9624015 DOI: 10.1186/s40780-022-00259-6] [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: 04/27/2022] [Accepted: 10/03/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND COVID-19 has become a significant health threat and a primary healthcare concern among the most vulnerable patients with cancer. Patients with COVID-19 who have lung cancer are at great risk and need careful monitoring if they are affected. This study aimed to investigate the clinical characteristics of COVID-19-positive patients with lung cancer and the risks associated with anticancer medication. METHODS This study was a single-center, retrospective cohort study. Patients with lung cancer who presented with COVID-19 during hospitalization were divided into two groups: those who presented with respiratory failure and those who did not. The patient's background, clinical laboratory values, and anticancer drugs used for therapy were investigated to identify risk factors for respiratory failure. RESULTS Thirty-one patients were included in the study; 18 (58.1%) were in the respiratory failure group and 13 (41.9%) were in the group without respiratory failure. In the respiratory failure group, there was a significant difference in using immune checkpoint inhibitor (ICI) use within 90 days (p = 0.025) and the level of C-reactive protein (CRP) level (p = 0.017). The analysis of the operating characteristic of the receiver revealed a cutoff value of 2.75 mg/dL for CRP (area under the curve = 0.744, sensitivity 0.611, specificity 0.923). CONCLUSIONS A history of ICI within 90 days and elevated CRP (≥ 2.75 mg/dL) levels are potential factors leading to respiratory failure in COVID-19-affected patients undergoing chemotherapy for lung cancer.
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Affiliation(s)
- Masatoshi Maki
- Department of Hospital Pharmacy, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama, Hiroshima 720-8520 Japan
| | - Ryo Takada
- Department of Hospital Pharmacy, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama, Hiroshima 720-8520 Japan
| | - Akihiko Taniguchi
- grid.416698.4Department of Respiratory Medicine, National Hospital Organization Fukuyama Medical Center, Fukuyama, Hiroshima, Japan
| | - Naoyuki Nomura
- Department of Hospital Pharmacy, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama, Hiroshima 720-8520 Japan
| | - Seiichiro Kuramoto
- Department of Hospital Pharmacy, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama, Hiroshima 720-8520 Japan
| | - Yuki Chiko
- grid.416698.4Department of Respiratory Medicine, National Hospital Organization Fukuyama Medical Center, Fukuyama, Hiroshima, Japan
| | - Toshiaki Okada
- grid.416698.4Department of Respiratory Medicine, National Hospital Organization Fukuyama Medical Center, Fukuyama, Hiroshima, Japan
| | - Seiji Saito
- grid.416698.4Department of Infection Control, National Hospital Organization Fukuyama Medical Center, Fukuyama, Hiroshima, Japan
| | - Koji Tamura
- Department of Hospital Pharmacy, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama, Hiroshima 720-8520 Japan
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10
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Lee KS, Russ BP, Wong TY, Horspool AM, Winters MT, Barbier M, Bevere JR, Martinez I, Damron FH, Cyphert HA. Obesity and metabolic dysfunction drive sex-associated differential disease profiles in hACE2-mice challenged with SARS-CoV-2. iScience 2022; 25:105038. [PMID: 36068847 PMCID: PMC9436780 DOI: 10.1016/j.isci.2022.105038] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/25/2022] [Accepted: 08/25/2022] [Indexed: 12/05/2022] Open
Abstract
Severe outcomes from SARS-CoV-2 infection are highly associated with preexisting comorbid conditions like hypertension, diabetes, and obesity. We utilized the diet-induced obesity (DIO) model of metabolic dysfunction in K18-hACE2 transgenic mice to model obesity as a COVID-19 comorbidity. Female DIO, but not male DIO mice challenged with SARS-CoV-2 were observed to have shortened time to morbidity compared to controls. Increased susceptibility to SARS-CoV-2 in female DIO was associated with increased viral RNA burden and interferon production compared to males. Transcriptomic analysis of the lungs from all mouse cohorts revealed sex- and DIO-associated differential gene expression profiles. Male DIO mice after challenge had decreased expression of antibody-related genes compared to controls, suggesting antibody producing cell localization in the lung. Collectively, this study establishes a preclinical comorbidity model of COVID-19 in mice where we observed sex- and diet-specific responses that begin explaining the effects of obesity and metabolic disease on COVID-19 pathology. Transcriptomic analysis of infected lungs revealed unique sex-dependent differences Obese female mice have high viral RNA burden and interferon production in the lung Male mice have altered antibody and T cell response gene profiles after viral challenge Metabolic dysfunction comorbidity can be studied in the hACE2 mouse model of COVID-19
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Affiliation(s)
- Katherine S. Lee
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA
- Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Brynnan P. Russ
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA
- Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Ting Y. Wong
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA
- Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Alexander M. Horspool
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA
- Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Michael T. Winters
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA
| | - Mariette Barbier
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA
- Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Justin R. Bevere
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA
- Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Ivan Martinez
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA
- West Virginia University Cancer Institute, School of Medicine, Morgantown, WV, USA
| | - F. Heath Damron
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA
- Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Holly A. Cyphert
- Department of Biological Sciences, Marshall University, Huntington, WV, USA
- Corresponding author
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11
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Fukushima T, Chubachi S, Namkoong H, Otake S, Nakagawara K, Tanaka H, Lee H, Morita A, Watase M, Kusumoto T, Masaki K, Kamata H, Ishii M, Hasegawa N, Harada N, Ueda T, Ueda S, Ishiguro T, Arimura K, Saito F, Yoshiyama T, Nakano Y, Mutoh Y, Suzuki Y, Murakami K, Okada Y, Koike R, Kitagawa Y, Kimura A, Imoto S, Miyano S, Ogawa S, Kanai T, Fukunaga K. U-shaped association between abnormal serum uric acid levels and COVID-19 severity: reports from the Japan COVID-19 Task Force. Int J Infect Dis 2022; 122:747-754. [PMID: 35811077 PMCID: PMC9262647 DOI: 10.1016/j.ijid.2022.07.014] [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: 01/20/2022] [Revised: 05/28/2022] [Accepted: 07/04/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES This study aimed to identify the relationship between abnormal serum uric acid levels or a history of hyperuricemia and COVID-19 severity in the Japanese population. METHODS We included 1523 patients enrolled in the Japan COVID-19 Task Force cohort between February 2020 and May 2021. We compared the clinical characteristics, including co-morbidities, laboratory findings, and outcomes, particularly invasive mechanical ventilation (IMV), among patients with and without abnormal uric acid levels or a history of hyperuricemia. RESULTS Patients with high serum uric acid levels were older and had higher body weight and body mass index than those without. In addition, the multiple logistic regression analysis revealed a significant association between high serum uric acid levels or a history of hyperuricemia and an increased risk of IMV (odds ratio [OR] = 1.77; P = 0.03/OR = 1.56; P = 0.04). Moreover, patients with low uric acid levels on admission were also associated significantly with the requirement of IMV (OR = 5.09; P <0.0001). CONCLUSION Abnormal serum uric acid levels or a history of hyperuricemia were significantly associated with COVID-19 severity in the Japanese cohort.
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Affiliation(s)
- Takahiro Fukushima
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan,Corresponding author: Shotaro Chubachi, Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine. 35 Shinanomachi, Tokyo 160-8582, Japan, Telephone: 03-5363-3793; Fax: 03-3353-2502
| | - Ho Namkoong
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shiro Otake
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kensuke Nakagawara
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiromu Tanaka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Ho Lee
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Atsuho Morita
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mayuko Watase
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Tatsuya Kusumoto
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Katsunori Masaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Tetsuya Ueda
- Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Soichiro Ueda
- JCHO (Japan Community Health Care Organization) Saitama Medical Center, Internal Medicine, Saitama, Japan
| | - Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Japan
| | - Ken Arimura
- Department of Respiratory Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Fukuki Saito
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, Moriguchi, Japan
| | - Takashi Yoshiyama
- Department of Respiratory Medicine, Fukujuji hospital, Kiyose, Japan
| | - Yasushi Nakano
- Department of Internal Medicine, Kawasaki Municipal Ida Hospital, Kawasaki, Japan
| | - Yoshikazu Mutoh
- Department of Infectious Diseases, Tosei General Hospital, Seto, Japan
| | - Yusuke Suzuki
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Koji Murakami
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan,Department of Genome Informatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan,Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Ryuji Koike
- Medical Innovation Promotion Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akinori Kimura
- Institute of Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seiya Imoto
- Division of Health Medical Intelligence, Human Genome Center, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
| | - Satoru Miyano
- M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan,Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institute, Stockholm, Sweden
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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12
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Lundberg DJ, Cho A, Raquib R, Nsoesie EO, Wrigley-Field E, Stokes AC. Geographic and Temporal Patterns in Covid-19 Mortality by Race and Ethnicity in the United States from March 2020 to February 2022. medRxiv 2022:2022.07.20.22277872. [PMID: 35898347 PMCID: PMC9327633 DOI: 10.1101/2022.07.20.22277872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Prior research has established that American Indian, Alaska Native, Black, Hispanic, and Pacific Islander populations in the United States have experienced substantially higher mortality rates from Covid-19 compared to non-Hispanic white residents during the first year of the pandemic. What remains less clear is how mortality rates have changed for each of these racial/ethnic groups during 2021, given the increasing prevalence of vaccination. In particular, it is unknown how these changes in mortality have varied geographically. In this study, we used provisional data from the National Center for Health Statistics (NCHS) to produce age-standardized estimates of Covid-19 mortality by race/ethnicity in the United States from March 2020 to February 2022 in each metro-nonmetro category, Census region, and Census division. We calculated changes in mortality rates between the first and second years of the pandemic and examined mortality changes by month. We found that when Covid-19 first affected a geographic area, non-Hispanic Black and Hispanic populations experienced extremely high levels of Covid-19 mortality and racial/ethnic inequity that were not repeated at any other time during the pandemic. Between the first and second year of the pandemic, racial/ethnic inequities in Covid-19 mortality decreased-but were not eliminated-for Hispanic, non-Hispanic Black, and non-Hispanic AIAN residents. These inequities decreased due to reductions in mortality for these populations alongside increases in non-Hispanic white mortality. Though racial/ethnic inequities in Covid-19 mortality decreased, substantial inequities still existed in most geographic areas during the pandemic's second year: Non-Hispanic Black, non-Hispanic AIAN, and Hispanic residents reported higher Covid-19 death rates in rural areas than in urban areas, indicating that these communities are facing serious public health challenges. At the same time, the non-Hispanic white mortality rate worsened in rural areas during the second year of the pandemic, suggesting there may be unique factors driving mortality in this population. Finally, vaccination rates were associated with reductions in Covid-19 mortality for Hispanic, non-Hispanic Black, and non-Hispanic white residents, and increased vaccination may have contributed to the decreases in racial/ethnic inequities in Covid-19 mortality observed during the second year of the pandemic. Despite reductions in mortality, Covid-19 mortality remained elevated in nonmetro areas and increased for some racial/ethnic groups, highlighting the need for increased vaccination delivery and equitable public health measures especially in rural communities. Taken together, these findings highlight the continued need to prioritize health equity in the pandemic response and to modify the structures and policies through which systemic racism operates and has generated racial health inequities.
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Affiliation(s)
| | - Ahyoung Cho
- Center for Antiracist Research, Boston University
- Department of Political Science, Boston University
| | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health
| | - Elaine O. Nsoesie
- Department of Global Health, Boston University School of Public Health
- Center for Antiracist Research, Boston University
| | | | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health
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13
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Amari Y, Morimoto S, Teranishi T, Ohata M, Takeshita A, Hirano H, Kobayashi H. Case report of a Japanese patient with chronic renal failure who developed
SARS‐CoV
‐2 in a hospital cluster during treatment for acute respiratory failure: An autopsy report. Clin Case Rep 2022; 10:e6024. [PMID: 35846939 PMCID: PMC9272203 DOI: 10.1002/ccr3.6024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Yoshifumi Amari
- Department of Nephrology Moriguchi Keijinkai Hospital Osaka Japan
| | - Satoshi Morimoto
- Department of Endocrinology and Hypertension Tokyo Women's Medical University Tokyo Japan
| | - Takashi Teranishi
- Department of General Medicine Moriguchi Keijinkai Hospital Osaka Japan
| | - Mai Ohata
- Department of Pathology and Laboratory Medicine Moriguchi Keijinkai Hospital Osaka Japan
| | - Atsushi Takeshita
- Department of Pathology and Laboratory Medicine Moriguchi Keijinkai Hospital Osaka Japan
| | - Hiroshi Hirano
- Department of Pathology and Laboratory Medicine Nozaki Tokushukai Hospital Osaka Japan
| | - Hitoshi Kobayashi
- Department of General Medicine Moriguchi Keijinkai Hospital Osaka Japan
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14
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Yoroidaka A, Kurita S, Kita T. HbA1c measurement may save COVID-19 inpatients from overlooked diabetes. J Diabetes Investig 2022; 13:1925-1933. [PMID: 35704430 PMCID: PMC9350257 DOI: 10.1111/jdi.13869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/22/2022] [Revised: 05/19/2022] [Accepted: 06/08/2022] [Indexed: 01/08/2023] Open
Abstract
Aims/Introduction To investigate overlooked diabetes in patients with coronavirus disease 2019 (COVID‐19). Materials and Methods In total, 462 COVID‐19 inpatients were included in this retrospective study. The presence of diabetes before COVID‐19 admission, and the HbA1c and blood glucose levels at admission were examined. Results Of the 462 patients, 116 had diabetes. Seventy‐six patients had been diagnosed with diabetes before COVID‐19 admission, and 40 patients were diagnosed for the first time. Of the patients with diabetes 72% required insulin. Patients with diabetes were significantly (P < 0.05) older, more likely to be male, heavier, and showed a lower eGFR. Patients with overlooked diabetes showed a lower HbA1c (average 7.1% vs 7.5%), a lower casual blood glucose (average 157 vs 179 mg/dL), and they used less insulin per day during hospitalization (average 16.0 units vs 34.5 units) than patients with previously diagnosed diabetes. Patients with overlooked diabetes tended to have more severe COVID‐19 than those with pre‐diagnosed diabetes. Multivariable logistic regression analyses showed that the increased odds ratios (ORs) of aggravation in all patients with COVID‐19 were associated with age [OR 1.04], BMI [OR 1.05], and diabetes [OR 2.15]. The risk factors for aggravation in patients with COVID‐19 and diabetes were age [OR 1.05] and HbA1c [OR 1.45]. Conclusions Diabetes is a predictor of COVID‐19 aggravation. Furthermore, in COVID‐19 patients with diabetes, high HbA1c levels are a risk factor for severe COVID‐19. A total of 8.7% of COVID‐19 inpatients were diagnosed with diabetes after HbA1c was measured on admission. Therefore, it is important to measure HbA1c in COVID‐19 patients.
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Affiliation(s)
- Ayaka Yoroidaka
- Department of Endocrinology and Metabolism, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Seiichiro Kurita
- Department of Endocrinology and Metabolism, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Toshiyuki Kita
- Department of Pulmonology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
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15
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Singh R, Rathore SS, Khan H, Karale S, Chawla Y, Iqbal K, Bhurwal A, Tekin A, Jain N, Mehra I, Anand S, Reddy S, Sharma N, Sidhu GS, Panagopoulos A, Pattan V, Kashyap R, Bansal V. Association of Obesity With COVID-19 Severity and Mortality: An Updated Systemic Review, Meta-Analysis, and Meta-Regression. Front Endocrinol (Lausanne) 2022; 13:780872. [PMID: 35721716 PMCID: PMC9205425 DOI: 10.3389/fendo.2022.780872] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
Background Obesity affects the course of critical illnesses. We aimed to estimate the association of obesity with the severity and mortality in coronavirus disease 2019 (COVID-19) patients. Data Sources A systematic search was conducted from the inception of the COVID-19 pandemic through to 13 October 2021, on databases including Medline (PubMed), Embase, Science Web, and Cochrane Central Controlled Trials Registry. Preprint servers such as BioRxiv, MedRxiv, ChemRxiv, and SSRN were also scanned. Study Selection and Data Extraction Full-length articles focusing on the association of obesity and outcome in COVID-19 patients were included. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used for study selection and data extraction. Our Population of interest were COVID-19 positive patients, obesity is our Intervention/Exposure point, Comparators are Non-obese vs obese patients The chief outcome of the study was the severity of the confirmed COVID-19 positive hospitalized patients in terms of admission to the intensive care unit (ICU) or the requirement of invasive mechanical ventilation/intubation with obesity. All-cause mortality in COVID-19 positive hospitalized patients with obesity was the secondary outcome of the study. Results In total, 3,140,413 patients from 167 studies were included in the study. Obesity was associated with an increased risk of severe disease (RR=1.52, 95% CI 1.41-1.63, p<0.001, I2 = 97%). Similarly, high mortality was observed in obese patients (RR=1.09, 95% CI 1.02-1.16, p=0.006, I2 = 97%). In multivariate meta-regression on severity, the covariate of the female gender, pulmonary disease, diabetes, older age, cardiovascular diseases, and hypertension was found to be significant and explained R2 = 40% of the between-study heterogeneity for severity. The aforementioned covariates were found to be significant for mortality as well, and these covariates collectively explained R2 = 50% of the between-study variability for mortality. Conclusions Our findings suggest that obesity is significantly associated with increased severity and higher mortality among COVID-19 patients. Therefore, the inclusion of obesity or its surrogate body mass index in prognostic scores and improvement of guidelines for patient care management is recommended.
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Affiliation(s)
- Romil Singh
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Sawai Singh Rathore
- Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur, India
| | - Hira Khan
- Department of Neurology, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Smruti Karale
- Department of Internal Medicine, Government Medical College-Kolhapur, Kolhapur, India
| | - Yogesh Chawla
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
| | - Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Abhishek Bhurwal
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States
| | - Aysun Tekin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States
| | - Nirpeksh Jain
- Department of Emergency Medicine, Marshfield Clinic, Marshfield, WI, United States
| | - Ishita Mehra
- Department of Internal Medicine, North Alabama Medical Center, Florence, AL, United States
| | - Sohini Anand
- Department of Internal Medicine, Patliputra Medical College and Hospital, Dhanbad, India
| | - Sanjana Reddy
- Department of Internal Medicine, Gandhi Medical College, Secunderabad, India
| | - Nikhil Sharma
- Department of Nephrology, Mayo Clinic, Rochester, MI, United States
| | - Guneet Singh Sidhu
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MI, United States
| | | | - Vishwanath Pattan
- Department of Medicine, Division of Endocrinology and Metabolism, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States
| | - Vikas Bansal
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MI, United States
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16
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de Miguel-Yanes JM, Jimenez-Garcia R, de Miguel-Diez J, Hernández-Barrera V, Carabantes-Alarcon D, Zamorano-Leon JJ, Omaña-Palanco R, Lopez-de-Andres A. Impact of Type 2 Diabetes Mellitus on the Incidence and Outcomes of COVID-19 Needing Hospital Admission According to Sex: Retrospective Cohort Study Using Hospital Discharge Data in Spain, Year 2020. J Clin Med 2022; 11. [PMID: 35566794 DOI: 10.3390/jcm11092654] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/01/2022] [Accepted: 05/08/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: To analyze incidence and in-hospital mortality (IHM) of COVID-19 needing hospital admission in Spain (2020) in patients with T2DM. (2) Methods: We conducted a retrospective cohort study. Using the Spanish Register of Specialized Care-Basic Minimum Database we estimated age-adjusted incidence rates (IR). (3) Results: We included 203,488 patients (56.77% men), of whom 45,620 (22.41%) had T2DM. Age-adjusted IRs/1000 for men with and without T2DM was 12.90 and 5.87, respectively (IRR 2.20; 95% CI 2.18−2.22; p < 0.001), and for women with and without T2DM was 9.23 and 4.27, respectively (IRR 2.16; 95% CI 2.13−2.19; p < 0.001). Crude IHM was 23.86% in people with T2DM, and 15.94% in non-T2DM people (p < 0.001). After matching, intensive-care admission (7.37% vs. 6.15%; p < 0.001) and IHM (23.37% vs. 20.41%; p < 0.001) remained higher in women with T2DM. After matching, IHM among T2DM men was 1.5% higher than among non-T2DM men (24.27% vs. 22.72%; p < 0.001). Men with T2DM had a 34% higher IHM than women with T2DM. Prevalent T2DM increased IHM among women (1.09; 95% 1.03−1.16) and men (1.05; 95% 1.01−1.10). (4) Conclusions: Incidence rates of COVID-19 needing hospital admission were higher in men vs. women, and for people with T2DM vs. non-T2DM. Men had higher IHM beside T2DM status. Prevalent T2DM was associated with higher IHM for both sexes.
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17
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Hashiguchi A, San Thawtar M, Duangsodsri T, Kusano M, Watanabe KN. Biofunctional properties and plant physiology of Kaempferia spp.: Status and trends. J Funct Foods 2022. [DOI: 10.1016/j.jff.2022.105029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Langan MT, Smith DA, Verma G, Khegai O, Saju S, Rashid S, Ranti D, Markowitz M, Belani P, Jette N, Mathew B, Goldstein J, Kirsch CFE, Morris LS, Becker JH, Delman BN, Balchandani P. Semi-automated Segmentation and Quantification of Perivascular Spaces at 7 Tesla in COVID-19. Front Neurol 2022; 13:846957. [PMID: 35432151 PMCID: PMC9010775 DOI: 10.3389/fneur.2022.846957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/10/2022] [Indexed: 01/12/2023] Open
Abstract
While COVID-19 is primarily considered a respiratory disease, it has been shown to affect the central nervous system. Mounting evidence shows that COVID-19 is associated with neurological complications as well as effects thought to be related to neuroinflammatory processes. Due to the novelty of COVID-19, there is a need to better understand the possible long-term effects it may have on patients, particularly linkage to neuroinflammatory processes. Perivascular spaces (PVS) are small fluid-filled spaces in the brain that appear on MRI scans near blood vessels and are believed to play a role in modulation of the immune response, leukocyte trafficking, and glymphatic drainage. Some studies have suggested that increased number or presence of PVS could be considered a marker of increased blood-brain barrier permeability or dysfunction and may be involved in or precede cascades leading to neuroinflammatory processes. Due to their size, PVS are better detected on MRI at ultrahigh magnetic field strengths such as 7 Tesla, with improved sensitivity and resolution to quantify both concentration and size. As such, the objective of this prospective study was to leverage a semi-automated detection tool to identify and quantify differences in perivascular spaces between a group of 10 COVID-19 patients and a similar subset of controls to determine whether PVS might be biomarkers of COVID-19-mediated neuroinflammation. Results demonstrate a detectable difference in neuroinflammatory measures in the patient group compared to controls. PVS count and white matter volume were significantly different in the patient group compared to controls, yet there was no significant association between PVS count and symptom measures. Our findings suggest that the PVS count may be a viable marker for neuroinflammation in COVID-19, and other diseases which may be linked to neuroinflammatory processes.
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Affiliation(s)
- Mackenzie T. Langan
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Biomedical Engineering and Imaging Institute at Mount Sinai School of Medicine, New York, NY, United States
- *Correspondence: Mackenzie T. Langan
| | - Derek A. Smith
- Biomedical Engineering and Imaging Institute at Mount Sinai School of Medicine, New York, NY, United States
| | - Gaurav Verma
- Biomedical Engineering and Imaging Institute at Mount Sinai School of Medicine, New York, NY, United States
| | - Oleksandr Khegai
- Biomedical Engineering and Imaging Institute at Mount Sinai School of Medicine, New York, NY, United States
| | - Sera Saju
- Biomedical Engineering and Imaging Institute at Mount Sinai School of Medicine, New York, NY, United States
| | - Shams Rashid
- Biomedical Engineering and Imaging Institute at Mount Sinai School of Medicine, New York, NY, United States
| | - Daniel Ranti
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Biomedical Engineering and Imaging Institute at Mount Sinai School of Medicine, New York, NY, United States
| | - Matthew Markowitz
- The Graduate Center, City University of New York, New York, NY, United States
| | - Puneet Belani
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Brian Mathew
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jonathan Goldstein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Claudia F. E. Kirsch
- Biomedical Engineering and Imaging Institute at Mount Sinai School of Medicine, New York, NY, United States
- Department of Radiology, Zucker Hofstra School of Medicine at Northwell Health, Uniondale, NY, United States
| | - Laurel S. Morris
- Biomedical Engineering and Imaging Institute at Mount Sinai School of Medicine, New York, NY, United States
- Department of Psychiatry at the Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jacqueline H. Becker
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bradley N. Delman
- Biomedical Engineering and Imaging Institute at Mount Sinai School of Medicine, New York, NY, United States
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Priti Balchandani
- Biomedical Engineering and Imaging Institute at Mount Sinai School of Medicine, New York, NY, United States
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Deckmyn O, Poynard T, Bedossa P, Paradis V, Peta V, Pais R, Ratziu V, Thabut D, Brzustowski A, Gautier JF, Cacoub P, Valla D. Clinical Interest of Serum Alpha-2 Macroglobulin, Apolipoprotein A1, and Haptoglobin in Patients with Non-Alcoholic Fatty Liver Disease, with and without Type 2 Diabetes, before or during COVID-19. Biomedicines 2022; 10. [PMID: 35327501 DOI: 10.3390/biomedicines10030699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/06/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
In patients with non-alcoholic fatty liver disease (NAFLD) with or without type 2 diabetes mellitus (T2DM), alpha-2 macroglobulin (A2M), apolipoprotein A1 (ApoA1), and haptoglobin are associated with the risk of liver fibrosis, inflammation (NASH), and COVID-19. We assessed if these associations were worsened by T2DM after adjustment by age, sex, obesity, and COVID-19. Three datasets were used: the “Control Population”, which enabled standardization of protein serum levels according to age and sex (N = 27,382); the “NAFLD-Biopsy” cohort for associations with liver features (N = 926); and the USA “NAFLD-Serum” cohort for protein kinetics before and during COVID-19 (N = 421,021). The impact of T2DM was assessed by comparing regression curves adjusted by age, sex, and obesity for the liver features in “NAFLD-Biopsy”, and before and during COVID-19 pandemic peaks in “NAFLD-Serum”. Patients with NAFLD without T2DM, compared with the values of controls, had increased A2M, decreased ApoA1, and increased haptoglobin serum levels. In patients with both NAFLD and T2DM, these significant mean differences were magnified, and even more during the COVID-19 pandemic in comparison with the year 2019 (all p < 0.001), with a maximum ApoA1 decrease of 0.21 g/L in women, and a maximum haptoglobin increase of 0.17 g/L in men. In conclusion, T2DM is associated with abnormal levels of A2M, ApoA1, and haptoglobin independently of NAFLD, age, sex, obesity, and COVID-19.
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Bailey CJ, Gwilt M. Diabetes, Metformin and the Clinical Course of Covid-19: Outcomes, Mechanisms and Suggestions on the Therapeutic Use of Metformin. Front Pharmacol 2022; 13:784459. [PMID: 35370738 PMCID: PMC8964397 DOI: 10.3389/fphar.2022.784459] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 09/27/2021] [Accepted: 02/21/2022] [Indexed: 12/18/2022] Open
Abstract
Objectives: Pre-existing or new diabetes confers an adverse prognosis in people with Covid-19. We reviewed the clinical literature on clinical outcomes in metformin-treated subjects presenting with Covid-19. Methods: Structured PubMed search: metformin AND [covid (ti) OR covid-19 (ti) OR covid19 (ti) OR coronavirus (ti) OR SARS-Cov2 (ti)], supplemented with another PubMed search: "diabetes AND [covid OR covid-19 OR covid19 OR coronavirus (i) OR SARS-Cov2 (ti)]" (limited to "Clinical Study", "Clinical Trial", "Controlled Clinical Trial", "Meta-Analysis", "Observational Study", "Randomized Controlled Trial", "Systematic Review"). Results: The effects of metformin on the clinical course of Covid-19 were evaluated in retrospective analyses: most noted improved clinical outcomes amongst type 2 diabetes patients treated with metformin at the time of hospitalisation with Covid-19 infection. These outcomes include reduced admission into intensive care and reduced mortality in subgroups with versus without metformin treatment. Conclusion: The pleiotropic actions of metformin associated with lower background cardiovascular risk may mediate some of these effects, for example reductions of insulin resistance, systemic inflammation and hypercoagulability. Modulation by metformin of the cell-surface ACE2 protein (a key binding target for SARS-CoV 2 spike protein) via the AMP kinase pathway may be involved. While pre-existing metformin treatment offers potentially beneficial effects and can be continued when Covid-19 infection is not severe, reports of increased acidosis and lactic acidosis in patients with more severe Covid-19 disease remind that metformin should be withdrawn in patients with hypoxaemia or acute renal disease. Prospective study of the clinical and metabolic effects of metformin in Covid-19 is warranted.
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Shestakova MV, Vikulova OK, Elfimova AR, Deviatkin AA, Dedov II, Mokrysheva NG. Risk factors for COVID-19 case fatality rate in people with type 1 and type 2 diabetes mellitus: A nationwide retrospective cohort study of 235,248 patients in the Russian Federation. Front Endocrinol (Lausanne) 2022; 13:909874. [PMID: 36017317 PMCID: PMC9396282 DOI: 10.3389/fendo.2022.909874] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/28/2022] [Indexed: 11/22/2022] Open
Abstract
THE AIM To study the association of demographic, clinical, and laboratory factors and the use of glucose-lowering drugs and anti-coronavirus disease (COVID-19) vaccination with the COVID-19-related case fatality rate (CFR) in diabetes mellitus (DM) patients. METHODS This study is a nationwide observational cohort study based on the data from the National Diabetes Register (NDR) that is the database containing online clinical information about the population with DM. The outcomes (death or recovery) for COVID-19 were registered in 235,248 patients with DM [type 1 diabetes mellitus (T1DM), n = 11,058; type 2 diabetes mellitus (T2DM), n = 224,190] from March 20, 2020, until November 25, 2021. The unadjusted odds ratio (OR) and 95% confidence interval (CI) were used to estimate the risk factors for CFR. Then the ranging of significant factors was performed and the most vulnerable groups of factors for the lethal outcome were chosen. RESULTS The CFR due to COVID-19 was 8.1% in T1DM and 15.3% in T2DM. Increased CFR was associated with the male population [OR = 1.25 (95% CI: 1.09-1.44) in T1DM and 1.18 (95% CI: 1.15-1.21) in T2DM], age ≥65 years [OR = 4.44 (95% CI: 3.75-5.24) in T1DM and 3.18 (95% CI: 3.09-3.26) in T2DM], DM duration ≥10 years [OR = 2.46 (95% CI: 2.06-2.95) in T1DM and 2.11 (95% CI: 2.06-2.16) in T2DM], body mass index (BMI) ≥30 kg/m2 [OR = 1.95 (95% CI: 1.52-2.50)] in T1DM, HbA1c ≥7% [OR = 1.35 (95% CI: 1.29-1.43)] in T2DM. The atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD) were associated with higher CFR in T1DM but not in T2DM. The pre-COVID-19 glucose-lowering therapy in T2DM was differently associated with CFR (OR): 0.61 (95% CI: 0.59-0.62) for metformin, 0.59 (95% CI: 0.57-0.61) for dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors), 0.46 (95% CI: 0.44-0.49) for sodium-glucose co-transporter-2 (SGLT2) inhibitors, 0.38 (95% CI: 0.29-0.51) for glucagon-like peptide-1 receptor agonists (arGLP-1), 1.34 (95% CI: 1.31-1.37) for sulfonylurea (SU), and 1.47 (95% CI: 1.43-1.51) for insulin. Anti-COVID-19 vaccination was associated with a lower fatality risk in both DM types: OR = 0.07 (95% CI: 0.03-0.20) in T1DM and OR = 0.19 (95% CI: 0.17-0.22) in T2DM. CONCLUSIONS The results of our study suggest that increased COVID-19-related fatality risk in both T1DM and T2DM patients associated with the male population, older age, longer DM duration, and absence of anti-COVID-19 vaccination. In T2DM, pre-COVID-19 glucose-lowering therapy with metformin, DPP-4 inhibitors, SGLT2 inhibitors, and arGLP-1 had a positive effect on the risk of death. The most vulnerable combination of risk factors for lethal outcome in both DM types was vaccine absence + age ≥65 years + DM duration ≥10 years.
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22
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Enocsson H, Idoff C, Gustafsson A, Govender M, Hopkins F, Larsson M, Nilsdotter-Augustinsson Å, Sjöwall J. Soluble Urokinase Plasminogen Activator Receptor (suPAR) Independently Predicts Severity and Length of Hospitalisation in Patients With COVID-19. Front Med (Lausanne) 2021; 8:791716. [PMID: 34926532 PMCID: PMC8674575 DOI: 10.3389/fmed.2021.791716] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 10/08/2021] [Accepted: 11/12/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Efficient healthcare based on prognostic variables in hospitalised patients with COVID-19 could reduce the risk of complications and death. Recently, soluble urokinase Plasminogen Activator Receptor (suPAR) was shown to predict respiratory failure, kidney injury, and clinical outcome in patients with SARS-CoV-2 infection. The aim of this study was to investigate the value of suPAR as a prognostic tool, in comparison with other variables, regarding disease severity and length of hospital stay in patients with COVID-19. Patients and Methods: Individuals hospitalised with COVID-19 (40 males, 20 females; median age 57.5 years) with a median symptom duration of 10 days and matched, healthy controls (n = 30) were included. Admission levels of suPAR were measured in serum by enzyme-linked immunosorbent assay. Blood cell counts, C-reactive protein (CRP) levels, lactate dehydrogenase (LDH), plasma creatinine and estimated glomerular filtration rates were analysed and oxygen demand, level of care and length of hospitalisation recorded. Results: Patients had significantly higher suPAR levels compared to controls (P < 0.001). Levels were higher in severely/critically (median 6.6 ng/mL) compared with moderately ill patients (median 5.0 ng/mL; P = 0.002). In addition, suPAR levels correlated with length of hospitalisation (rho = 0.35; P = 0.006). Besides suPAR, LDH, CRP, neutrophil count, neutrophil-to-monocyte and neutrophil-to-lymphocyte ratio, body mass index and chronic renal failure were discriminators of COVID-19 severity and/or predictors of length of hospitalisation. Conclusion: Admission levels of suPAR were higher in patients who developed severe/critical COVID-19 and associated with length of hospital stay. In addition, we showed that suPAR functioned as an independent predictor of COVID-19 disease severity.
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Affiliation(s)
- Helena Enocsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Cornelia Idoff
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Annette Gustafsson
- Department of Infectious Diseases, The Vrinnevi Hospital, Norrköping, Sweden
| | - Melissa Govender
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Francis Hopkins
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marie Larsson
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Åsa Nilsdotter-Augustinsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johanna Sjöwall
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,Department of Infectious Diseases, The Vrinnevi Hospital, Norrköping, Sweden,*Correspondence: Johanna Sjöwall
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