1
|
Fernández-Villabrille S, Martín-Carro B, Martín-Vírgala J, Alonso-Montes C, Palomo-Antequera C, García-Castro R, López-Ongil S, Dusso AS, Fernández-Martín JL, Naves-Díaz M, Cannata-Andía JB, Carrillo-López N, Panizo S. MicroRNA-145 and microRNA-486 are potential serum biomarkers for vascular calcification. Nephrol Dial Transplant 2023:7017856. [PMID: 36722155 DOI: 10.1093/ndt/gfad027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION MicroRNAs (miRs) regulate vascular calcification (VC), their quantification may contribute to suspect the presence of VC. MATERIAL AND METHODS The study was performed in 4 phases. 1) miRs sequencing of rat calcified and non-calcified aortas. 2) miRs with the highest rate of change, plus miR-145 (the most abundant miR in vascular smooth muscle cells (VSMCs), were validated in aortas and serum from rats with and without VC. 3) The selected miRs were analyzed in epigastric arteries from kidney donors and recipients, and serum samples from general population. 4) VSMCs were exposed to different phosphorus concentrations and miR-145 and miR-486 were overexpressed to investigate their role in VC. RESULTS miR-145, miR-122-5p, miR-486 and miR-598-3p decreased in the rat calcified aortas, but only miR-145 and miR-486, were detected in serum. In human epigastric arteries, miR-145 and miR-486 were lower in kidney transplant recipients compared to donors. Both miRs inversely correlated with arterial calcium content and with VC (Kauppila index). In the general population, the severe VC was associated with the lowest serum levels of both miRs. The ROC curve showed that serum miR-145 was a good biomarker of VC. In VSMCs exposed to high phosphorus, calcium content, osteogenic markers (Runx2 and Osterix) increased, and the contractile marker (α-actin), miR-145 and miR-486 decreased. Overexpression of miR-145, and in lesser extent miR-486, prevented the increase in calcium content induced by high phosphorus, the osteogenic differentiation, and the loss of the contractile phenotype. CONCLUSION miR-145 and miR-486 regulate the osteogenic differentiation of VSMCs, their quantification in serum could serve as markers of VC.
Collapse
Affiliation(s)
- Sara Fernández-Villabrille
- Bone and Mineral Research Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Beatriz Martín-Carro
- Bone and Mineral Research Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), RICORS2040 (Kidney Disease), Spain
| | - Julia Martín-Vírgala
- Bone and Mineral Research Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), RICORS2040 (Kidney Disease), Spain
| | - Cristina Alonso-Montes
- Bone and Mineral Research Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), RICORS2040 (Kidney Disease), Spain
| | - Carmen Palomo-Antequera
- Bone and Mineral Research Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Department of Internal Medicine, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain.,Departament of Medicine, Universidad de Oviedo, Oviedo, Spain
| | - Raúl García-Castro
- Department of Nephrology, Hospital Juaneda Miramar, Red Asistencial Juaneda, Palma de Mallorca, Spain
| | - Susana López-Ongil
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), RICORS2040 (Kidney Disease), Spain.,Unidad de investigación de la Fundación Biomédica del Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid
| | - Adriana S Dusso
- Bone and Mineral Research Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO, USA
| | - José Luis Fernández-Martín
- Bone and Mineral Research Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), RICORS2040 (Kidney Disease), Spain
| | - Manuel Naves-Díaz
- Bone and Mineral Research Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), RICORS2040 (Kidney Disease), Spain
| | - Jorge B Cannata-Andía
- Bone and Mineral Research Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), RICORS2040 (Kidney Disease), Spain.,Departament of Medicine, Universidad de Oviedo, Oviedo, Spain
| | - Natalia Carrillo-López
- Bone and Mineral Research Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), RICORS2040 (Kidney Disease), Spain
| | - Sara Panizo
- Bone and Mineral Research Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), RICORS2040 (Kidney Disease), Spain
| |
Collapse
|
2
|
Bernardo Á, Caro A, Martínez-Carballeira D, Corte JR, Vázquez S, Palomo-Antequera C, Andreu A, Fernández-Pardo Á, Oto J, Gutiérrez L, Soto I, Medina P. Applicability of the Thrombin Generation Test to Evaluate the Hemostatic Status of Hemophilia A Patients in Daily Clinical Practice. J Clin Med 2022; 11:jcm11123345. [PMID: 35743412 PMCID: PMC9224793 DOI: 10.3390/jcm11123345] [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: 05/13/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 02/01/2023] Open
Abstract
Hemophilia A (HA) is a rare bleeding disorder caused by factor VIII (FVIII) deficiency due to various genetic mutations in the F8 gene. The disease severity inversely correlates with the plasma levels of functional FVIII. The treatment of HA patients is based on FVIII replacement therapy, either following a prophylactic or on-demand regime, depending on the severity of the disease at diagnosis and the patient’s clinical manifestations. The hemorrhagic manifestations are widely variable amongst HA patients, who may require monitoring and treatment re-adjustment to minimize bleeding symptoms. Notably, laboratory monitoring of the FVIII activity is difficult due to a lack of sensitivity to various FVIII-related molecules, including non-factor replacement therapies. Hence, patient management is determined mainly based on clinical manifestations and patient–clinician history. Our goal was to validate the ST Genesia® automated thrombin generation analyzer to quantify the relative hemostatic status in HA patients. We recruited a cohort of HA patients from the Principality of Asturias (Spain), following treatment and at a stable non-bleeding phase. The entire cohort (57 patients) had been comprehensively studied at diagnosis, including FVIII and VWF activity assays and F8 genetic screening, and then clinically monitored until the Thrombin Generation Test (TGT) was performed. All patients were recruited prior to treatment administration, at the maximum time-window following the previous dose. Interestingly, the severe/moderate patients had a similar TGT compared to the mild patients, reflecting the non-bleeding phase of our patient cohort, regardless of the initial diagnosis (i.e., the severity of the disease), treatment regime, and FVIII activity measured at the time of the TGT. Thus, TGT parameters, especially the peak height (Peak), may reflect the actual hemostatic status of a patient more accurately compared to FVIII activity assays, which may be compromised by non-factor replacement therapies. Furthermore, our data supports the utilization of combined TGT variables, together with the severity of patient symptoms, along with the F8 mutation type to augment the prognostic capacity of TGT. The results from this observational study suggest that TGT parameters measured with ST Genesia® may represent a suitable tool to monitor the hemostatic status of patients requiring a closer follow-up and a tailored therapeutic adjustment, including other hemophilia subtypes or bleeding disorders.
Collapse
Affiliation(s)
- Ángel Bernardo
- Department of Hematology, Central University Hospital of Asturias (HUCA), 33011 Oviedo, Spain; (A.C.); (D.M.-C.); (J.R.C.); (S.V.); (I.S.)
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Correspondence:
| | - Alberto Caro
- Department of Hematology, Central University Hospital of Asturias (HUCA), 33011 Oviedo, Spain; (A.C.); (D.M.-C.); (J.R.C.); (S.V.); (I.S.)
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - Daniel Martínez-Carballeira
- Department of Hematology, Central University Hospital of Asturias (HUCA), 33011 Oviedo, Spain; (A.C.); (D.M.-C.); (J.R.C.); (S.V.); (I.S.)
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - José Ramón Corte
- Department of Hematology, Central University Hospital of Asturias (HUCA), 33011 Oviedo, Spain; (A.C.); (D.M.-C.); (J.R.C.); (S.V.); (I.S.)
| | - Sonia Vázquez
- Department of Hematology, Central University Hospital of Asturias (HUCA), 33011 Oviedo, Spain; (A.C.); (D.M.-C.); (J.R.C.); (S.V.); (I.S.)
| | - Carmen Palomo-Antequera
- Department of Internal Medicine, Central University Hospital of Asturias (HUCA), 33011 Oviedo, Spain;
- Bone Metabolism, Vascular Metabolism and Chronic Inflammatory Diseases Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Alfredo Andreu
- Department of Pharmacology, University of Navarra, 31008 Pamplona, Spain;
| | - Álvaro Fernández-Pardo
- Hemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe (IIS La Fe), 46026 Valencia, Spain; (Á.F.-P.); (J.O.); (P.M.)
| | - Julia Oto
- Hemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe (IIS La Fe), 46026 Valencia, Spain; (Á.F.-P.); (J.O.); (P.M.)
| | - Laura Gutiérrez
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Department of Medicine, University of Oviedo, 33006 Oviedo, Spain
| | - Inmaculada Soto
- Department of Hematology, Central University Hospital of Asturias (HUCA), 33011 Oviedo, Spain; (A.C.); (D.M.-C.); (J.R.C.); (S.V.); (I.S.)
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - Pilar Medina
- Hemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe (IIS La Fe), 46026 Valencia, Spain; (Á.F.-P.); (J.O.); (P.M.)
| |
Collapse
|
3
|
Cannata-Andía JB, Díaz-Sottolano A, Fernández P, Palomo-Antequera C, Herrero-Puente P, Mouzo R, Carrillo-López N, Panizo S, Ibañez GH, Cusumano CA, Ballarino C, Sánchez-Polo V, Pefaur-Penna J, Maderuelo-Riesco I, Calviño-Varela J, Gómez MD, Gómez-Alonso C, Cunningham J, Naves-Díaz M, Douthat W, Fernández-Martín JL. A single-oral bolus of 100,000 IU of cholecalciferol at hospital admission did not improve outcomes in the COVID-19 disease: the COVID-VIT-D-a randomised multicentre international clinical trial. BMC Med 2022; 20:83. [PMID: 35177066 PMCID: PMC8853840 DOI: 10.1186/s12916-022-02290-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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: 08/30/2021] [Accepted: 02/09/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Vitamin D status has been implicated in COVID-19 disease. The objective of the COVID-VIT-D trial was to investigate if an oral bolus of cholecalciferol (100,000 IU) administered at hospital admission influences the outcomes of moderate-severe COVID-19 disease. In the same cohort, the association between baseline serum calcidiol levels with the same outcomes was also analysed. METHODS The COVID-VIT-D is a multicentre, international, randomised, open label, clinical trial conducted throughout 1 year. Patients older than 18 years with moderate-severe COVID-19 disease requiring hospitalisation were included. At admission, patients were randomised 1:1 to receive a single oral bolus of cholecalciferol (n=274) or nothing (n=269). Patients were followed from admission to discharge or death. Length of hospitalisation, admission to intensive care unit (ICU) and mortality were assessed. RESULTS In the randomised trial, comorbidities, biomarkers, symptoms and drugs used did not differ between groups. Median serum calcidiol in the cholecalciferol and control groups were 17.0 vs. 16.1 ng/mL at admission and 29.0 vs. 16.4 ng/mL at discharge, respectively. The median length of hospitalisation (10.0 [95%CI 9.0-10.5] vs. 9.5 [95%CI 9.0-10.5] days), admission to ICU (17.2% [95%CI 13.0-22.3] vs. 16.4% [95%CI 12.3-21.4]) and death rate (8.0% [95%CI 5.2-12.1] vs. 5.6% [95%CI 3.3-9.2]) did not differ between the cholecalciferol and control group. In the cohort analyses, the highest serum calcidiol category at admission (>25ng/mL) was associated with lower percentage of pulmonary involvement and better outcomes. CONCLUSIONS The randomised clinical trial showed the administration of an oral bolus of 100,000 IU of cholecalciferol at hospital admission did not improve the outcomes of the COVID-19 disease. A cohort analysis showed that serum calcidiol at hospital admission was associated with outcomes. TRIAL REGISTRATION COVID-VIT-D trial was authorised by the Spanish Agency for Medicines and Health products (AEMPS) and registered in European Union Drug Regulating Authorities Clinical Trials (EudraCT 2020-002274-28) and in ClinicalTrials.gov ( NCT04552951 ).
Collapse
Affiliation(s)
- Jorge B Cannata-Andía
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain. .,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain. .,Universidad de Oviedo, Oviedo, Spain. .,Retic REDinREN-ISCIII, Madrid, Spain.
| | - Augusto Díaz-Sottolano
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Centro de Salud Roces Montevil, Gijón, Spain
| | - Pehuén Fernández
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina.,Hospital Raúl Ángel Ferreyra, Córdoba, Argentina.,Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Carmen Palomo-Antequera
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Universidad de Oviedo, Oviedo, Spain
| | - Pablo Herrero-Puente
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Universidad de Oviedo, Oviedo, Spain
| | | | - Natalia Carrillo-López
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Retic REDinREN-ISCIII, Madrid, Spain
| | - Sara Panizo
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Retic REDinREN-ISCIII, Madrid, Spain
| | | | | | - Carolina Ballarino
- Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich, Buenos Aires, Argentina
| | - Vicente Sánchez-Polo
- Hospital General de Enfermedades del Instituto Guatemalteco de Seguridad Social (IGSS), Ciudad de Guatemala, Guatemala
| | | | | | | | | | - Carlos Gómez-Alonso
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Universidad de Oviedo, Oviedo, Spain.,Retic REDinREN-ISCIII, Madrid, Spain
| | - John Cunningham
- Centre for Nephrology, Royal Free Hospital and University College London, London, UK
| | - Manuel Naves-Díaz
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain. .,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain. .,Retic REDinREN-ISCIII, Madrid, Spain.
| | - Walter Douthat
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina.,Hospital Raúl Ángel Ferreyra, Córdoba, Argentina.,Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - José L Fernández-Martín
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Retic REDinREN-ISCIII, Madrid, Spain
| | | |
Collapse
|
4
|
Martínez-Arias L, Panizo S, Alonso-Montes C, Martín-Vírgala J, Martín-Carro B, Fernández-Villabrille S, García Gil-Albert C, Palomo-Antequera C, Fernández-Martín JL, Ruiz-Torres MP, Dusso AS, Carrillo-López N, Cannata-Andía JB, Naves-Díaz M. Effects of calcitriol and paricalcitol on renal fibrosis in CKD. Nephrol Dial Transplant 2021; 36:793-803. [PMID: 33416889 DOI: 10.1093/ndt/gfaa373] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 07/31/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In chronic kidney disease, the activation of the renin-angiotensin-aldosterone system (RAAS) and renal inflammation stimulates renal fibrosis and the progression to end-stage renal disease. The low levels of vitamin D receptor (VDR) and its activators (VDRAs) contribute to worsen secondary hyperparathyroidism and renal fibrosis. METHODS The 7/8 nephrectomy model of experimental chronic renal failure (CRF) was used to examine the anti-fibrotic effects of treatment with two VDRAs, paricalcitol and calcitriol, at equivalent doses (3/1 dose ratio) during 4 weeks. RESULTS CRF increased the activation of the RAAS, renal inflammation and interstitial fibrosis. Paricalcitol treatment reduced renal collagen I and renal interstitial fibrosis by decreasing the activation of the RAAS through renal changes in renin, angiotensin receptor 1 (ATR1) and ATR2 mRNAs levels and renal inflammation by decreasing renal inflammatory leucocytes (CD45), a desintegrin and metaloproteinase mRNA, transforming growth factor beta mRNA and protein, and maintaining E-cadherin mRNA levels. Calcitriol showed similar trends without significant changes in most of these biomarkers. CONCLUSIONS Paricalcitol effectively attenuated the renal interstitial fibrosis induced by CRF through a combination of inhibitory actions on the RAAS, inflammation and epithelial/mesenchymal transition.
Collapse
Affiliation(s)
- Laura Martínez-Arias
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Retic REDinREN-ISCIII, Oviedo, Spain
| | - Sara Panizo
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Retic REDinREN-ISCIII, Oviedo, Spain
| | - Cristina Alonso-Montes
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Retic REDinREN-ISCIII, Oviedo, Spain
| | - Julia Martín-Vírgala
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Retic REDinREN-ISCIII, Oviedo, Spain
| | - Beatriz Martín-Carro
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Retic REDinREN-ISCIII, Oviedo, Spain
| | - Sara Fernández-Villabrille
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Retic REDinREN-ISCIII, Oviedo, Spain
| | | | | | - José Luis Fernández-Martín
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Retic REDinREN-ISCIII, Oviedo, Spain
| | - María Piedad Ruiz-Torres
- Department of System Biology, Universidad de Alcalá, Retic REDinREN-ISCIII, Alcalá de Henares, Spain
| | - Adriana S Dusso
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Retic REDinREN-ISCIII, Oviedo, Spain
| | - Natalia Carrillo-López
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Retic REDinREN-ISCIII, Oviedo, Spain
| | - Jorge B Cannata-Andía
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Retic REDinREN-ISCIII, Oviedo, Spain.,Departament of Medicine, Universidad de Oviedo, Oviedo, Spain
| | - Manuel Naves-Díaz
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Retic REDinREN-ISCIII, Oviedo, Spain
| |
Collapse
|
5
|
Martínez-Botía P, Bernardo Á, Acebes-Huerta A, Caro A, Leoz B, Martínez-Carballeira D, Palomo-Antequera C, Soto I, Gutiérrez L. Clinical Management of Hypertension, Inflammation and Thrombosis in Hospitalized COVID-19 Patients: Impact on Survival and Concerns. J Clin Med 2021; 10:jcm10051073. [PMID: 33806709 PMCID: PMC7961450 DOI: 10.3390/jcm10051073] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/13/2021] [Accepted: 02/24/2021] [Indexed: 02/06/2023] Open
Abstract
The most severe clinical manifestations of the Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are due to an unbalanced immune response and a pro-thrombotic hemostatic disturbance, with arterial hypertension or diabetes as acknowledged risk factors. While waiting for a specific treatment, the clinical management of hospitalized patients is still a matter of debate, and the effectiveness of treatments to manage clinical manifestations and comorbidities has been questioned. In this study, we aim to assess the impact of the clinical management of arterial hypertension, inflammation and thrombosis on the survival of COVID-19 patients. The Spanish cohorts included in this observational retrospective study are from HM Hospitales (2035 patients) and from Hospital Universitario Central de Asturias (72 patients). Kaplan Meier survival curves, Cox regression and propensity score matching analyses were employed, considering demographic variables, comorbidities and treatment arms (when opportune) as covariates. The management of arterial hypertension with angiotensin-converting enzyme 2 (ACE2) inhibitors or angiotensin receptor blockers is not detrimental, as was initially reported, and neither was the use of non-steroidal anti-inflammatory drugs (NSAIDs). On the contrary, our analysis shows that the use on itself of corticosteroids is not beneficial. Importantly, the management of COVID-19 patients with low molecular weight heparin (LMWH) as an anticoagulant significantly improves the survival of hospitalized patients. These results delineate the current treatment options under debate, supporting the effectiveness of thrombosis prophylaxis on COVID-19 patients as a first-line treatment without the need for compromising the treatment of comorbidities, while suggesting cautiousness when administering corticosteroids.
Collapse
Affiliation(s)
- Patricia Martínez-Botía
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (P.M.-B.); (Á.B.); (A.A.-H.); (A.C.); (D.M.-C.)
| | - Ángel Bernardo
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (P.M.-B.); (Á.B.); (A.A.-H.); (A.C.); (D.M.-C.)
- Clinical Diagnosis Laboratory, Department of Hematology, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
| | - Andrea Acebes-Huerta
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (P.M.-B.); (Á.B.); (A.A.-H.); (A.C.); (D.M.-C.)
| | - Alberto Caro
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (P.M.-B.); (Á.B.); (A.A.-H.); (A.C.); (D.M.-C.)
- Department of Hematology, Hemostasis Section, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
| | - Blanca Leoz
- Department of Intensive Medicine, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain;
- Translational Microbiology Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Daniel Martínez-Carballeira
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (P.M.-B.); (Á.B.); (A.A.-H.); (A.C.); (D.M.-C.)
- Department of Hematology, Hemostasis Section, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
| | - Carmen Palomo-Antequera
- Department of Internal Medicine, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain;
- Bone Metabolism, Vascular Metabolism and Chronic Inflammatory Diseases Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Inmaculada Soto
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (P.M.-B.); (Á.B.); (A.A.-H.); (A.C.); (D.M.-C.)
- Department of Hematology, Hemostasis Section, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
- Correspondence: (I.S.); (L.G.)
| | - Laura Gutiérrez
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (P.M.-B.); (Á.B.); (A.A.-H.); (A.C.); (D.M.-C.)
- Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain
- Correspondence: (I.S.); (L.G.)
| |
Collapse
|
6
|
Rodríguez-García M, Gómez-Alonso C, Rodríguez-Rebollar A, Palomo-Antequera C, Martín-Vírgala J, Martín-Carro B, Fernández-Villabrille S, Rodríguez-Carrio J, Cannata-Andía JB, Naves-Díaz M. Efecto de la fragilidad y la sarcopenia sobre el riesgo de caídas y de fracturas osteoporóticas en población no seleccionada. Rev Osteoporos Metab Miner 2020. [DOI: 10.4321/s1889-836x2020000300002] [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: 11/11/2022] Open
|