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Lorenzon A, Palandri L, Uguzzoni F, Cristofor CD, Lozza F, Poluzzi R, Rizzi C, Bertoli P, Zerzer F, Righi E. Effectiveness of the SARS-CoV-2 Vaccination in Preventing Severe Disease-Related Outcomes: A Population-Based Study in the Italian Province of Bolzano (South Tyrol). Int J Public Health 2024; 69:1606792. [PMID: 38550269 PMCID: PMC10976940 DOI: 10.3389/ijph.2024.1606792] [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] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
Objective: To investigate the effectiveness of SARS-CoV2 vaccination in preventing ordinary or intensive care unit (ICU) admissions and deaths among cases registered during a variant transitional pandemic phase in the geographically and culturally unique territory of the Province of Bolzano (South Tyrol), an Italian region with low vaccination coverage. Methods: We collected data from 93,643 patients registered as positive for SARS-CoV-2 by health authorities during the winter of 2021-22. The data were analyzed retrospectively using descriptive statistics and multiple logistic regression. Results: 925 patients were hospitalized (0.99%), 89 (0.10%) were in intensive care, and 194 (0.21%) died. Vaccinated patients had a significantly lower risk of being hospitalized: adjusted Odds Ratio (aOR): 0.39; 95% CI: 0.33-0.46, ICU admission: aOR: 0.16; 95% CI: 0.09-0.29 and death: aOR: 0.41; 95% CI: 0.29-0.58. Similar risk reductions were also observed in booster-vaccinated patients, independent of sex, age, and predominant variant. Furthermore, the median length of stay (LoS) in the ICU was significantly longer for unvaccinated individuals compared to vaccinated subjects (9 vs. 6 days; p < 0.003). Conclusion: Primary series vaccination and ongoing campaign booster doses were effective in preventing all severe disease-related outcomes and in reducing ICU Length of Stay, even during a transitional pandemic phase and in a unique territorial context.
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Affiliation(s)
- Antonio Lorenzon
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Epidemiological Surveillance Unit, South Tyrolean Health Care Agency, Bolzano, Italy
| | - Lucia Palandri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Uguzzoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Filippo Lozza
- Epidemiological Surveillance Unit, South Tyrolean Health Care Agency, Bolzano, Italy
| | - Riccardo Poluzzi
- Epidemiological Surveillance Unit, South Tyrolean Health Care Agency, Bolzano, Italy
| | - Cristiana Rizzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Pierpaolo Bertoli
- Epidemiological Surveillance Unit, South Tyrolean Health Care Agency, Bolzano, Italy
| | - Florian Zerzer
- Epidemiological Surveillance Unit, South Tyrolean Health Care Agency, Bolzano, Italy
| | - Elena Righi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Hasseli R, Hanses F, Stecher M, Specker C, Weise T, Borgmann S, Hasselberger M, Hertenstein B, Hower M, Hoyer BF, Koll C, Krause A, von Lilienfeld-Toal M, Lorenz HM, Merle U, Nunes de Miranda SM, Pletz MW, Regierer AC, Richter JG, Rieg S, Roemmele C, Ruethrich MM, Schmeiser T, Schulze-Koops H, Strangfeld A, Vehreschild MJ, Voit F, Voll RE, Vehreschild JJ, Müller-Ladner U, Pfeil A. The protective effect of tumor necrosis factor-alpha inhibitors in COVID-19 in patients with inflammatory rheumatic diseases compared to the general population-A comparison of two German registries. Front Med (Lausanne) 2024; 11:1332716. [PMID: 38510457 PMCID: PMC10953502 DOI: 10.3389/fmed.2024.1332716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/12/2024] [Indexed: 03/22/2024] Open
Abstract
Objectives To investigate, whether inflammatory rheumatic diseases (IRD) inpatients are at higher risk to develop a severe course of SARS-CoV-2 infections compared to the general population, data from the German COVID-19 registry for IRD patients and data from the Lean European Survey on SARS-CoV-2 (LEOSS) infected patients covering inpatients from the general population with SARS-CoV-2 infections were compared. Methods 4310 (LEOSS registry) and 1139 cases (IRD registry) were collected in general. Data were matched for age and gender. From both registries, 732 matched inpatients (LEOSS registry: n = 366 and IRD registry: n = 366) were included for analyses in total. Results Regarding the COVID-19 associated lethality, no significant difference between both registries was observed. Age > 65°years, chronic obstructive pulmonary disease, diabetes mellitus, rheumatoid arthritis, spondyloarthritis and the use of rituximab were associated with more severe courses of COVID-19. Female gender and the use of tumor necrosis factor-alpha inhibitors (TNF-I) were associated with a better outcome of COVID-19. Conclusion Inflammatory rheumatic diseases (IRD) patients have the same risk factors for severe COVID-19 regarding comorbidities compared to the general population without any immune-mediated disease or immunomodulation. The use of rituximab was associated with an increased risk for severe COVID-19. On the other hand, the use of TNF-I was associated with less severe COVID-19 compared to the general population, which might indicate a protective effect of TNF-I against severe COVID-19 disease.
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Affiliation(s)
- Rebecca Hasseli
- Section of Rheumatology and Clinical Immunology, Department of Internal Medicine D, University Hospital Münster, Münster, Germany
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Giessen, Germany
| | - Frank Hanses
- Emergency Department and Department for Infectious Diseases and Infection Control, University Hospital Regensburg, Regensburg, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
| | | | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany
| | | | | | - Martin Hower
- Department of Pneumology, Infectious Diseases, Internal Medicine and Intensive Care, Klinikum Dortmund GmbH, Dortmund, Germany
| | - Bimba F. Hoyer
- Department for Rheumatology and Clinical Immunology, University of Schleswig-Holstein, Kiel, Germany
| | - Carolin Koll
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin, Berlin, Germany
| | | | - Hanns-Martin Lorenz
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Gastroenterology and Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mathias W. Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Anne C. Regierer
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Jutta G. Richter
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, University of Freiburg, Freiburg, Germany
| | - Christoph Roemmele
- Department of Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Maria M. Ruethrich
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
| | | | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Maria J.G.T. Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Voit
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Reinhard E. Voll
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jörg Janne Vehreschild
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Giessen, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
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Cobo-Calvo Á, Gómez-Ballesteros R, Orviz A, Díaz Sánchez M, Boyero S, Aguado-Valcarcel M, Sepúlveda M, Rebollo P, López-Laiz P, Maurino J, Téllez Lara N. Therapeutic inertia in the management of neuromyelitis optica spectrum disorder. Front Neurol 2024; 15:1341473. [PMID: 38450077 PMCID: PMC10915282 DOI: 10.3389/fneur.2024.1341473] [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: 11/20/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction and objective Limited information is available on how neurologists make therapeutic decisions in neuromyelitis optica spectrum disorder (NMOSD), especially when new treatments with different mechanisms of action, administration, and safety profile are being approved. Decision-making can be complex under this uncertainty and may lead to therapeutic inertia (TI), which refers to lack of treatment initiation or intensification when therapeutic goals are not met. The study aim was to assess neurologists' TI in NMOSD. Methods An online, cross-sectional study was conducted in collaboration with the Spanish Society of Neurology. Neurologists answered a survey composed of demographic characteristics, professional background, and behavioral traits. TI was defined as the lack of initiation or intensification with high-efficacy treatments when there is evidence of disease activity and was assessed through five NMOSD aquaporin-4 positive (AQP4+) simulated case scenarios. A multivariate logistic regression analysis was used to determine the association between neurologists' characteristics and TI. Results A total of 78 neurologists were included (median interquartile range [IQR] age: 36.0 [29.0-46.0] years, 55.1% male, median [IQR] experience managing demyelinating conditions was 5.2 [3.0-11.1] years). The majority of participants were general neurologists (59.0%) attending a median (IQR) of 5.0 NMOSD patients (3.0-12.0) annually. Thirty participants (38.5%) were classified as having TI. Working in a low complexity hospital and giving high importance to patient's tolerability/safety when choosing a treatment were predictors of TI. Conclusion TI is a common phenomenon among neurologists managing NMOSD AQP4+. Identifying TI and implementing specific intervention strategies may be critical to improving therapeutic decisions and patient care.
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Affiliation(s)
- Álvaro Cobo-Calvo
- Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Aida Orviz
- Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - María Díaz Sánchez
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Sabas Boyero
- Department of Neurology, Hospital Universitario Cruces, Bilbao, Spain
| | | | - María Sepúlveda
- Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | | | - Nieves Téllez Lara
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Kahn R, Mossberg M, Berthold E, Schmidt T, Najibi SM, Månsson B, Król P. Capillary leak syndrome was associated with more severe multisystem inflammatory syndrome in children during the COVID-19 pandemic. Acta Paediatr 2024. [PMID: 38372417 DOI: 10.1111/apa.17162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/20/2024]
Abstract
AIM This population-based study investigated the occurrence of capillary leak syndrome (CLS) in children with multisystem inflammatory syndrome in children (MIS-C), associated with COVID-19. We also examined associations between CLS and MIS-C disease severity. METHODS All eligible individuals aged 0-18 years, who were diagnosed with MIS-C in Skåne, southern Sweden, from 1 April 2020 to 31 July 2021, were studied. They were all included in the Pediatric Rheumatology Quality Register and clinical and laboratory data were compared between patients with and without CLS. RESULTS We included 31 patients (61% male) with MIS-C in the study. The median age at diagnosis was 10.6 years (range 1.99-17.15) and 45% developed CLS. All six patients who required intensive care had CLS. Patients with CLS also had a higher incidence of reduced cardiac function, measured as low ejection fraction. The CLS group exhibited significantly higher C-reactive protein values (p < 0.001) and N-terminal pro-B-type natriuretic peptide levels (p < 0.001), as well as lower platelet counts (p = 0.03), during the first week of treatment. Individuals with CLS also received more intense immunosuppression. CONCLUSION CLS was a common complication of MIS-C in our study and these patients had a more severe disease course that required more intensive treatment.
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Affiliation(s)
- Robin Kahn
- Department of Pediatrics, Institute of Clinical Sciences Lund, Lund University, Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Maria Mossberg
- Department of Pediatrics, Institute of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Elisabet Berthold
- Department of Rheumatology, Institute of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Tobias Schmidt
- Department of Pediatrics, Institute of Clinical Sciences Lund, Lund University, Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Seyed Morteza Najibi
- Department of Rheumatology, Institute of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Bengt Månsson
- Department of Rheumatology, Institute of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Petra Król
- Department of Pediatrics, Institute of Clinical Sciences Lund, Lund University, Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
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Kojima N, Taylor CA, Tenforde MW, Ujamaa D, O’Halloran A, Patel K, Chai SJ, Daily Kirley P, Alden NB, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Reeg L, Tellez Nunez V, Lynfield R, Como-Sabetti K, Ropp SL, Shaw YP, Spina NL, Barney G, Bushey S, Popham K, Moran NE, Shiltz E, Sutton M, Abdullah N, Talbot HK, Schaffner W, Chatelain R, Price A, Garg S, Havers FP, Bozio CH. Clinical Outcomes of US Adults Hospitalized for COVID-19 and Influenza in the Respiratory Virus Hospitalization Surveillance Network, October 2021-September 2022. Open Forum Infect Dis 2024; 11:ofad702. [PMID: 38269052 PMCID: PMC10807992 DOI: 10.1093/ofid/ofad702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024] Open
Abstract
Severe outcomes were common among adults hospitalized for COVID-19 or influenza, while the percentage of COVID-19 hospitalizations involving critical care decreased from October 2021 to September 2022. During the Omicron BA.5 period, intensive care unit admission frequency was similar for COVID-19 and influenza, although patients with COVID-19 had a higher frequency of in-hospital death.
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Affiliation(s)
- Noah Kojima
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher A Taylor
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dawud Ujamaa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alissa O’Halloran
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kadam Patel
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shua J Chai
- California Emerging Infections Program, Oakland, California, USA
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pam Daily Kirley
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - James Meek
- Connecticut Emerging Infections Program, New Haven, Connecticut, USA
- Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Evan J Anderson
- School of Medicine, Emory University, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Kyle P Openo
- School of Medicine, Emory University, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Val Tellez Nunez
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Ruth Lynfield
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | | | - Susan L Ropp
- New Mexico Department of Health, Albuquerque, New Mexico, USA
| | - Yomei P Shaw
- New Mexico Department of Health, Albuquerque, New Mexico, USA
| | - Nancy L Spina
- New York State Department of Health, Albany, New York, USA
| | - Grant Barney
- New York State Department of Health, Albany, New York, USA
| | - Sophrena Bushey
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Kevin Popham
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | | | - Eli Shiltz
- Ohio Department of Health, Columbus, Ohio, USA
| | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Nasreen Abdullah
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ryan Chatelain
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Andrea Price
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fiona P Havers
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Catherine H Bozio
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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6
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Wang L, Liu T, Yue H, Zhang J, Sheng Q, Wu L, Wang X, Zhang M, Wang J, Wang J, Yu W. Clinical characteristics and high risk factors of patients with Omicron variant strain infection in Hebei, China. Front Cell Infect Microbiol 2023; 13:1294904. [PMID: 38145047 PMCID: PMC10744887 DOI: 10.3389/fcimb.2023.1294904] [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] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The Omicron variant has a weaker pathogenicity compared to the Delta variant but is highly transmissible and elderly critically ill patients account for the majority. This study has significant implications for guiding clinical personalized treatment and effectively utilizing healthcare resources. Methods The study focuses on 157 patients infected with the novel coronavirus Omicron variant, from December, 2022, to February, 2023. The objective is to analyze the baseline data, test results, imaging findings and identify risk factors associated with severe illness. Results Among the 157 included patients, there were 55 cases in the non-severe group (all were moderate cases) and 102 cases in the severe group (including severe and critical cases). Infection with the Omicron variant exhibits significant differences between non-severe and severe cases (baseline data, blood routine, coagulation, inflammatory markers, cardiac, liver, kidney functions, Chest CT, VTE score, etc.). A multifactorial logistic regression analysis showed that neutrophil percentage >75%, eosinophil percentage <0.4%, D-dimer >0.55 mg/L, PCT >0.25 ng/mL, LDH >250 U/L, albumin <40 g/L, A/G ratio <1.2, cholinesterase<5100 U/L, uric acid >357 mole/L and blood calcium<2.11 mmol/L were the most likely independent risk factors for severe novel coronavirus infection. Conclusion Advanced age, low oxygenation index, elevated neutrophil percentage, decreased eosinophil percentage, elevated PCT, elevated LDH, decreased albumin, decreased A/G ratio, elevated uric acid, decreased blood calcium, and elevated D-dimer are independent prognostic risk factors for non-severe patients progressing to severe illness. These factors should be closely monitored and actively treated to prevent or minimize the occurrence of severe illness.
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Affiliation(s)
- Lihong Wang
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ting Liu
- Department of Endoscopy Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongjuan Yue
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiaojiao Zhang
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qihong Sheng
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ling Wu
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoyu Wang
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mei Zhang
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jing Wang
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jia Wang
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Weifang Yu
- Department of Endoscopy Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
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7
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Xu Y, Xu K, Guo J, Fang M, Wang Z. Association between dynamic fluctuations in triiodothyronine levels and prognosis among critically ill patients within comprehensive intensive care units. Front Endocrinol (Lausanne) 2023; 14:1282547. [PMID: 38093954 PMCID: PMC10716294 DOI: 10.3389/fendo.2023.1282547] [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: 08/24/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Objective Decrease in free thyroid hormone T3 (FT3) can be used as an independent prognostic indicator for the risk of death in ICUs. However, FT3 as a predictive marker is hindered by its accuracy. The study introduces the concept of dynamic FT3 data as a means to bolster the value of FT3 as a prognostic tool. Therefore, the aim of this study is to investigate the prognostic value of dynamic FT3 evolution in a comprehensive ICU setting, analyze the consistency between dynamic FT3 changes and variations in disease severity, and explore the feasibility of FT3 as an objective indicator for real-time clinical treatment feedback. Methods Employing a single-center prospective observational study, FT3 measurements were taken on multiple days following enrollment, corresponding clinical data were collected. To investigated the pattern of dynamic changes of FT3,its prognostic significance in forecasting the risk of 28-day mortality, the alignment between dynamic FT3 changes and variations in the Sequential Organ Failure Assessment (SOFA) score. Results The survival group exhibited higher last FT3 levels compared to the lowest point (p<0.05), while the death group did not show statistically significant differences (p>0.05). The study also identifies the optimal correlation between FT3 and SOFA score at day 5 (optimal correlation coefficient -0.546).The ROC curve for FT3 at day 5 yielded an optimal AUC of 0.88, outperforming the SOFA score. The study categorizes FT3 curve patterns,Kaplan-Meier survival analysis of these patterns highlighted that the descending-type curve was significantly associated with increased risk of death (P<0.001). Additionally, the research explores the consistency between changes in FT3 and SOFA scores. While overall consistency rates were modest, subgroup analyses unveiled that greater disease severity led to higher consistency rates. Conclusions This study introduces the concept of dynamic FT3 changes to augment its prognostic utility in comprehensive ICU settings. The research identifies day 5 as the optimal time point for predictive efficacy, the descending FT3 curve as indicative of poor prognosis. While overall consistency with SOFA scores is modest, the correlation strengthens with greater disease severity.
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Affiliation(s)
- Yu Xu
- Department of Critical Care Medicine, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Kang Xu
- Department of Critical Care Medicine, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Jianying Guo
- Department of Critical Care Medicine, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Mingxing Fang
- Department of Critical Care Medicine, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Zhiyong Wang
- Department of Critical Care Medicine, Hebei Medical University Third Hospital, Shijiazhuang, China
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8
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Kojima N, Adams K, Self WH, Gaglani M, McNeal T, Ghamande S, Steingrub JS, Shapiro NI, Duggal A, Busse LW, Prekker ME, Peltan ID, Brown SM, Hager DN, Ali H, Gong MN, Mohamed A, Exline MC, Khan A, Wilson JG, Qadir N, Chang SY, Ginde AA, Withers CA, Mohr NM, Mallow C, Martin ET, Lauring AS, Johnson NJ, Casey JD, Stubblefield WB, Gibbs KW, Kwon JH, Baughman A, Chappell JD, Hart KW, Jones ID, Rhoads JP, Swan SA, Womack KN, Zhu Y, Surie D, McMorrow ML, Patel MM, Tenforde MW. Changing Severity and Epidemiology of Adults Hospitalized With Coronavirus Disease 2019 (COVID-19) in the United States After Introduction of COVID-19 Vaccines, March 2021-August 2022. Clin Infect Dis 2023; 77:547-557. [PMID: 37255285 PMCID: PMC10526883 DOI: 10.1093/cid/ciad276] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Understanding the changing epidemiology of adults hospitalized with coronavirus disease 2019 (COVID-19) informs research priorities and public health policies. METHODS Among adults (≥18 years) hospitalized with laboratory-confirmed, acute COVID-19 between 11 March 2021, and 31 August 2022 at 21 hospitals in 18 states, those hospitalized during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron-predominant period (BA.1, BA.2, BA.4/BA.5) were compared to those from earlier Alpha- and Delta-predominant periods. Demographic characteristics, biomarkers within 24 hours of admission, and outcomes, including oxygen support and death, were assessed. RESULTS Among 9825 patients, median (interquartile range [IQR]) age was 60 years (47-72), 47% were women, and 21% non-Hispanic Black. From the Alpha-predominant period (Mar-Jul 2021; N = 1312) to the Omicron BA.4/BA.5 sublineage-predominant period (Jun-Aug 2022; N = 1307): the percentage of patients who had ≥4 categories of underlying medical conditions increased from 11% to 21%; those vaccinated with at least a primary COVID-19 vaccine series increased from 7% to 67%; those ≥75 years old increased from 11% to 33%; those who did not receive any supplemental oxygen increased from 18% to 42%. Median (IQR) highest C-reactive protein and D-dimer concentration decreased from 42.0 mg/L (9.9-122.0) to 11.5 mg/L (2.7-42.8) and 3.1 mcg/mL (0.8-640.0) to 1.0 mcg/mL (0.5-2.2), respectively. In-hospital death peaked at 12% in the Delta-predominant period and declined to 4% during the BA.4/BA.5-predominant period. CONCLUSIONS Compared to adults hospitalized during early COVID-19 variant periods, those hospitalized during Omicron-variant COVID-19 were older, had multiple co-morbidities, were more likely to be vaccinated, and less likely to experience severe respiratory disease, systemic inflammation, coagulopathy, and death.
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Affiliation(s)
- Noah Kojima
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Adams
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wesley H Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manjusha Gaglani
- Department of Pediatrics, Baylor Scott & White Health and Texas A&M University College of Medicine, Temple and Dallas, Texas, USA
| | - Tresa McNeal
- Department of Medical Education, Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Department of Medical Education, Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Matthew E Prekker
- Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Harith Ali
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nida Qadir
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cori A Withers
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam S Lauring
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St. Louis, Missouri, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ian D Jones
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jillian P Rhoads
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Diya Surie
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith L McMorrow
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manish M Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Aydın F, Özçakar ZB, Avar Aydın PÖ, Mekik Akar E, Çakar N. Exertional leg pain represents a severe disease phenotype in childhood familial Mediterranean fever. Postgrad Med 2023; 135:588-592. [PMID: 37309906 DOI: 10.1080/00325481.2023.2224649] [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: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease. Recurrent fever, serositis, and arthritis are common findings of the disease. In addition, musculoskeletal complaints such as exertional leg pain can be overlooked, although they are common and affect patients' quality of life. The aim of this study was to evaluate the frequency of exertional leg pain in pediatric FMF patients and to analyze the association of this finding with other characteristics of FMF. METHODS The files of FMF patients were retrospectively evaluated. The clinical characteristics and disease severity of the patients with exertional leg pain were compared with the patients without exertional leg pain. International severity scoring system for FMF (ISSF) and Mor severity score were used for assessment. RESULTS The study included 541 FMF patients (287 females), 149 (27.5%) with exertional leg pain. The median colchicine dosage was significantly higher in patients with exertional leg pain (p = 0.02), arthritis (p = 0.001) and arthralgia (p˂0.001) were encountered more frequently in the attacks of these patients. The median disease severity scores calculated by both Mor severity scale and ISSF were significantly higher in patients with exertional leg pain compared to those without (p˂0.001). In the group of patients with exertional leg pain, the M694V mutation, either in one allele or in two alleles, was found to be significantly more common (p = 0.006 and p˂0.001, respectively). CONCLUSIONS Exertional leg pain in pediatric FMF patients is the component of moderate-to-severe disease course, and this may be considerably associated with the presence of M694V mutation.
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Affiliation(s)
- Fatma Aydın
- Ankara University School of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
| | - Zeynep Birsin Özçakar
- Ankara University School of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology and Nephrology, Ankara, Turkey
| | - Pınar Özge Avar Aydın
- Ankara University School of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
| | - Ece Mekik Akar
- Ankara University School of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Nilgün Çakar
- Ankara University School of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
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10
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Sai Bharath BV, Tudu PK, Dash SC, Sahoo N. Association of Serum Ferritin With Severity of Disease in Real-Time Reverse Transcription-Polymerase Chain Reaction Negative COVID-19 Patients. Cureus 2023; 15:e41065. [PMID: 37519620 PMCID: PMC10375251 DOI: 10.7759/cureus.41065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is still causing disastrous effects in various parts of the world through recurring waves. Real-time reverse transcription polymerase chain reaction (RT-PCR)-negative COVID-19 is particularly challenging as these patients are less likely to receive treatment and more likely to progress to severe disease. Thus, it is imperative to find markers that can predict the severity of disease at an early stage. The objective of the present study was to analyze the association of ferritin levels with severe disease in RT-PCR-negative COVID-19 patients. METHODS A prospective cross-sectional analytical study was conducted in adults with COVID-19 pneumonia with a negative RT-PCR test from October 2020 to September 2021. Hematologic, biochemical, and inflammatory parameters were investigated within 24 h of hospitalization. Demographic, clinical, and laboratory findings were compared between patients with and without severe disease. RESULTS A total of 220 patients were included. The mean age of the study participants was 47.3 ± 14.2 years, and 55.5% (n=122) were male. C-reactive protein, D-dimer, and ferritin levels were significantly higher in patients with severe disease (p<0.01). Receiver operating characteristic curve analyses were performed, and ferritin was found as significant predictor of severe disease (area under the curve=0.642, p<0.001). CONCLUSION Early analysis of ferritin can predict the severity of disease in COVID-19 patients, irrespective of the RT-PCR status.
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Affiliation(s)
| | - Promod K Tudu
- Department of General Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, IND
| | - Subhash C Dash
- Department of General Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, IND
| | - Nalinikanta Sahoo
- Department of General Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, IND
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Farzaneh Asoudeh, Armin Ebrahimzadeh, Seyed Mojtaba Ghoreishy, Hossein Imani, Seyed Mohammad Mousavi, Nikan Zargarzadeh, Somaye Rigi, Emma Persad, Mohsen Taghizadeh, Alireza Milajerdi. The association between dietary intakes of zinc, vitamin C and COVID-19 severity and related symptoms: A cross-sectional study. Clin Nutr ESPEN 2023. [ DOI: 10.1016/j.clnesp.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/11/2023] [Accepted: 03/15/2023] [Indexed: 03/24/2023]
Abstract
Background The Coronavirus disease 2019 (COVID-19) pandemic has had a devastating impact on health systems, food supplies, and population health. This is the first study to examine the association between zinc and vitamin C intakes and the risk of disease severity and symptoms among COVID-19 patients. Methods This cross-sectional study included 250 recovered COVID-19 patients aged 18-65 years from June to September 2021. Data on demographics, anthropometrics, medical history, and disease severity and symptoms were collected. Dietary intake was evaluated using a web-based, 168-item food frequency questionnaire (FFQ). The severity of the disease was determined using the most recent version of the NIH COVID-19 Treatment Guidelines. Using multivariable binary logistic regression, the association between zinc and vitamin C intakes and the risk of disease severity and symptoms in COVID-19 patients was evaluated. Results The mean age of participants in this study was 44.1±12.1, 52.4% of them were female, and 46% had a severe form of the disease. Participants with higher zinc intakes had lower levels of inflammatory cytokines, such as C-reactive protein (CRP) (13.6 vs. 25.8 mg/l) and erythrocyte sedimentation rate (ESR) (15.9 vs. 29.3). In a fully adjusted model, a higher zinc intake was also associated with a lower risk of severe disease (OR: 0.43; 95% CI: 0.21, 0.90, P-trend = 0.03). Similarly, participants with higher vitamin C intakes had lower CRP (10.3 vs. 31.5 mg/l) and ESR serum concentrations (15.6 Vs. 35.6) and lower odds of severe disease after controlling for potential covariates (OR: 0.31; 95% CI: 0.14, 0.65, P-trend = <0.01). Furthermore, an inverse association was found between dietary zinc intake and COVID-19 symptoms, such as dyspnea, cough, weakness, nausea and vomiting, and sore throat. Higher vitamin C intake was associated with a lower risk of dyspnea, cough, fever, chills, weakness, myalgia, nausea and vomiting, and sore throat. Conclusion In the current study, higher zinc and vitamin C intakes were associated with decreased odds of developing severe COVID-19 and its common symptoms.
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12
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Krishnan A, Schneider CV, Schattenberg JM, Alqahtani SA. Risk of severe disease and mortality of COVID-19 in patients with Budd-Chiari syndrome: A population-based matched cohort study. Liver Int 2023; 43:1141-1144. [PMID: 36825357 DOI: 10.1111/liv.15553] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND & AIMS Budd-Chiari syndrome (BCS) is a rare and potentially life-threatening disorder characterized by obstruction of the hepatic outflow tract. It is unknown whether patients with BCS represent a high risk for severe disease and mortality from coronavirus disease 2019 (COVID-19). Thus, we aimed to assess hospitalization rates, severe disease, all-cause mortality, intensive care unit (ICU) requirement and acute kidney injury (AKI) from COVID-19 diagnoses. METHODS & RESULTS We identified 467 patients with BCS with COVID-19, 96 427 non-chronic liver disease (CLD) and 9652 non-BCS CLD. The BCS and non-CLD cohorts (n = 467 each) and BCS and non-BCS CLD (n = 440 each) were well balanced after propensity matching. When compared to the non-CLD cohort, the BCS group had a higher risk of all-cause mortality (5.1% vs. 2.4%, HR 2.18; 95% CI, 1.08-4.40), severe disease (6.0% vs. 2.4%, HR 2.20; 95% CI, 1.09-4.43), hospitalization (24.6% vs. 13.1%, HR 1.77; 95% CI, 1.30-2.42) and AKI (7.9% vs. 2.8%, HR 2.57; 95% CI, 1.37-4.85), but no significant differences in ICU requirements (2.4% vs. 2.1%, HR 0.75; 95% CI, 0.27-2.08) at 60-days time points. When compared to the non-BCS CLD cohort, the BCS group had a higher risk of all-cause mortality (3.6% vs. 2.5%, HR 3.94; 95% CI, 1.31-11.79), hospitalization (29.8% vs. 21.6%, HR 1.43; 95% CI, 1.09-1.86), but differences in ICU requirements (HR 0.90 (0.38-2.12)), AKI (HR 1.41 (0.86-2.30)) or severe disease (HR 1.92 (0.99-3.71)) did not reach statistical significance at 60-day follow up. CONCLUSION In conclusion, COVID-19 infection in patients with BCS is associated with poor outcomes. Patients with BCS infected with COVID-19 carry a significantly higher risk of hospitalization and all-cause mortality and a possible effect on severe disease and AKI compared with COVID-19 patients without CLD or with non-BCS-CLD.
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Affiliation(s)
- Arunkumar Krishnan
- Section of Gastroenterology and Hepatology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Carolin V Schneider
- Department of Medicine III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Saleh A Alqahtani
- Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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13
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Berinstein JA, Steiner CA, Rifkin S, Alexander Perry D, Micic D, Shirley D, Higgins PDR, Young VB, Lee A, Rao K. A Predictive Model to Identify Complicated Clostridiodes difficile Infection. Open Forum Infect Dis 2023; 10:ofad049. [PMID: 36820317 PMCID: PMC9938520 DOI: 10.1093/ofid/ofad049] [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: 10/06/2022] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Background Clostridioides difficile infection (CDI) is a leading cause of health care-associated infection and may result in organ dysfunction, colectomy, and death. Published risk scores to predict severe complications from CDI demonstrate poor performance upon external validation. We hypothesized that building and validating a model using geographically and temporally distinct cohorts would more accurately predict risk for complications from CDI. Methods We conducted a multicenter retrospective cohort study of adults diagnosed with CDI. After randomly partitioning the data into training and validation sets, we developed and compared 3 machine learning algorithms (lasso regression, random forest, stacked ensemble) with 10-fold cross-validation to predict disease-related complications (intensive care unit admission, colectomy, or death attributable to CDI) within 30 days of diagnosis. Model performance was assessed using the area under the receiver operating curve (AUC). Results A total of 3646 patients with CDI were included, of whom 217 (6%) had complications. All 3 models performed well (AUC, 0.88-0.89). Variables of importance were similar across models, including albumin, bicarbonate, change in creatinine, non-CDI-related intensive care unit admission, and concomitant non-CDI antibiotics. Sensitivity analyses indicated that model performance was robust even when varying derivation cohort inclusion and CDI testing approach. However, race was an important modifier, with models showing worse performance in non-White patients. Conclusions Using a large heterogeneous population of patients, we developed and validated a prediction model that estimates risk for complications from CDI with good accuracy. Future studies should aim to reduce the disparity in model accuracy between White and non-White patients and to improve performance overall.
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Affiliation(s)
| | | | | | - D Alexander Perry
- Division of Infectious Diseases, University of Arizona, Tucson, Arizona, USA
| | - Dejan Micic
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, Illinois, USA
| | - Daniel Shirley
- Division of Infectious Diseases, University of Wisconsin, Madison, Wisconsin, USA
| | - Peter D R Higgins
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Vincent B Young
- Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan, USA,Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Allen Lee
- Correspondence: Allen Lee, MD, MS, 3912 Taubman Center, 1500 E. Medical Center Drive, SPC 5362, Ann Arbor, MI 48109 (); or Krishna Rao, MD, MS, 1150 West Medical Center Drive, MSRB I, Room 1510B, Ann Arbor, MI, 48109 ()
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14
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Trobajo-Sanmartín C, Miqueleiz A, Guevara M, Fernández-Huerta M, Burgui C, Casado I, Baigorria F, Navascués A, Ezpeleta C, Castilla J. Comparison of the Risk of Hospitalization and Severe Disease Among Co-circulating Severe Acute Respiratory Syndrome Coronavirus 2 Variants. J Infect Dis 2023; 227:332-338. [PMID: 36179126 DOI: 10.1093/infdis/jiac385] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 07/01/2022] [Accepted: 09/18/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We compare the risk of coronavirus disease 2019 (COVID-19) outcomes among co-circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants between January 2021 and May 2022 in Navarra, Spain. METHODS We compared the frequency of hospitalization and severe disease (intensive care unit admission or death) due to COVID-19 among the co-circulating variants. Variants analyzed were nonvariants of concern (non-VOCs), Alpha, Delta, Omicron BA.1, and Omicron BA.2. Logistic regression models were used to estimate adjusted odds ratio (aOR). RESULTS The Alpha variant had a higher risk of hospitalization (aOR, 1.86 [95 confidence interval {CI}, 1.282.71]) and severe disease (aOR, 2.40 [95 CI, 1.314.40]) than non-VOCs. The Delta variant did not show a significantly different risk of hospitalization (aOR, 0.73 [95 CI, .401.30]) and severe disease (aOR, 3.04 [95 CI, .5716.22]) compared to the Alpha variant. The Omicron BA.1 significantly reduced both risks relative to the Delta variant (aORs, 0.28 [95 CI, .16.47] and 0.23 [95 CI, .12.46], respectively). The Omicron BA.2 reduced the risk of hospitalization compared to BA.1 (aOR, 0.52 [95 CI, .29.95]). CONCLUSIONS The Alpha and Delta variants showed an increased risk of hospitalization and severe disease, which decreased considerably with the Omicron BA.1 and BA.2. Surveillance of variants can lead to important differences in severity.
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Affiliation(s)
- Camino Trobajo-Sanmartín
- Instituto de Salud Pblica de Navarra, Pamplona, Spain
- CIBER Epidemiologa y Salud Pblica, Madrid, Spain
- Navarra Institute for Health Research, Pamplona, Spain
| | - Ana Miqueleiz
- Navarra Institute for Health Research, Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Marcela Guevara
- Instituto de Salud Pblica de Navarra, Pamplona, Spain
- CIBER Epidemiologa y Salud Pblica, Madrid, Spain
- Navarra Institute for Health Research, Pamplona, Spain
| | - Miguel Fernández-Huerta
- Navarra Institute for Health Research, Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Cristina Burgui
- Instituto de Salud Pblica de Navarra, Pamplona, Spain
- CIBER Epidemiologa y Salud Pblica, Madrid, Spain
- Navarra Institute for Health Research, Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pblica de Navarra, Pamplona, Spain
- CIBER Epidemiologa y Salud Pblica, Madrid, Spain
- Navarra Institute for Health Research, Pamplona, Spain
| | | | - Ana Navascués
- Navarra Institute for Health Research, Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Carmen Ezpeleta
- Navarra Institute for Health Research, Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pblica de Navarra, Pamplona, Spain
- CIBER Epidemiologa y Salud Pblica, Madrid, Spain
- Navarra Institute for Health Research, Pamplona, Spain
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Promlek T, Hansirisathit T, Kunno J, Thanunchai M. The Effects of CoronaVac and ChAdOx1 nCoV-19 in Reducing Severe Illness in Thailand: A Retrospective Cohort Study. Trop Med Infect Dis 2023; 8:tropicalmed8020095. [PMID: 36828511 PMCID: PMC9960383 DOI: 10.3390/tropicalmed8020095] [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: 12/20/2022] [Revised: 01/16/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Two primary vaccines for coronavirus disease 2019 (COVID-19) have been rolled out in the mass vaccination campaign that started simultaneously with the spread of the delta variant. To explore the vaccines' effect on reducing viral load and disease severity, we conducted a retrospective cohort study in Thai patients aged ≥18 years who were confirmed COVID-19 positive by RT-PCR. Compared to unvaccinated patients, Ct values and the number of severe cases among vaccine regimens were analyzed. Ct values of vaccinated patients were not significantly different from unvaccinated patients, despite an increase of Ct values in a booster dose. The adjusted odd ratio for prevention of delta-related severe diseases was 0.47, 95% CI: 0.30-0.76 and 0.06, 95% CI: 0.01-0.45 after receiving one dose and two doses, respectively. No severe illness was found in booster-vaccinated individuals. Focusing on the vaccine types, one dose of ChAdOx1 nCoV-19 gave significant protection, whereas one dose of CoronaVac did not (0.49, 95% CI: 0.30-0.79, p = 0.003 vs. 0.28, 95% CI: 0.04-2.16, p = 0.223). Two-dose vaccination showed robust protective effects in all subpopulations regardless of vaccine type. Vaccinations with two primary vaccines could not reduce viral load in patients with COVID-19, but could prevent severe illness.
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Affiliation(s)
- Thanyarat Promlek
- Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
| | - Tonsan Hansirisathit
- Department of Central Laboratory, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
| | - Jadsada Kunno
- Department of Research and Medical Innovation, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
| | - Maytawan Thanunchai
- Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence: ; Tel.: +66-89264-8729
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16
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Abstract
INTRODUCTION Multiple COVID-19 vaccines have been approved and employed in the fight against the pandemic. However, these vaccines have limited long-term effectiveness against severe cases and a decreased ability to prevent mild disease. AREAS COVERED This review discusses the relevant factors influencing the efficacy of the vaccines against mild and severe infection, analyzes the possible underlying mechanisms contributing to the different outcomes in terms of vaccine function and disease progression, and proposes improvements for the next generation of vaccines. EXPERT OPINION The reduced efficacy of the COVID-19 vaccine in the prevention of viral infection is closely related to the emergence of novel SARS-CoV-2 variants and their rapid transmission ability. Fundamentally, the immune responses induced by COVID-19 vaccines cannot effectively halt virus replication in the upper respiratory tract because only a limited number of specific antibodies reach these areas and decrease in concentration over time. However, the established immune response can provide sufficient protection against severe diseases by blocking viral infection of the lower respiratory tract or lung owing to sufficient antibody repertoires and memory responses. Considering this situation, future COVID-19 vaccines should have the potential to replenish the mucosal immune response in the respiratory tract to prevent viral infection.
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Affiliation(s)
- Huijie Yang
- Divsion of respiratory virus vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Ying Xie
- Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical College, Kunming, China
| | - Changgui Li
- Divsion of respiratory virus vaccines, National Institutes for Food and Drug Control, Beijing, China
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17
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Chemaitelly H, Nagelkerke N, Ayoub HH, Coyle P, Tang P, Yassine HM, Al-Khatib HA, Smatti MK, Hasan MR, Al-Kanaani Z, Al-Kuwari E, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul-Rahim HF, Nasrallah GK, Al-Kuwari MG, Butt AA, Al-Romaihi HE, Al-Thani MH, Al-Khal A, Bertollini R, Abu-Raddad LJ. Duration of immune protection of SARS-CoV-2 natural infection against reinfection. J Travel Med 2022; 29:6731972. [PMID: 36179099 PMCID: PMC9619565 DOI: 10.1093/jtm/taac109] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [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: 08/04/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The future of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic hinges on virus evolution and duration of immune protection of natural infection against reinfection. We investigated the duration of protection afforded by natural infection, the effect of viral immune evasion on duration of protection and protection against severe reinfection, in Qatar, between 28 February 2020 and 5 June 2022. METHODS Three national, matched, retrospective cohort studies were conducted to compare the incidence of SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) severity among unvaccinated persons with a documented SARS-CoV-2 primary infection, to incidence among those infection-naïve and unvaccinated. Associations were estimated using Cox proportional hazard regression models. RESULTS Effectiveness of pre-Omicron primary infection against pre-Omicron reinfection was 85.5% [95% confidence interval (CI): 84.8-86.2%]. Effectiveness peaked at 90.5% (95% CI: 88.4-92.3%) in the 7th month after the primary infection, but waned to ~ 70% by the 16th month. Extrapolating this waning trend using a Gompertz curve suggested an effectiveness of 50% in the 22nd month and < 10% by the 32nd month. Effectiveness of pre-Omicron primary infection against Omicron reinfection was 38.1% (95% CI: 36.3-39.8%) and declined with time since primary infection. A Gompertz curve suggested an effectiveness of < 10% by the 15th month. Effectiveness of primary infection against severe, critical or fatal COVID-19 reinfection was 97.3% (95% CI: 94.9-98.6%), irrespective of the variant of primary infection or reinfection, and with no evidence for waning. Similar results were found in sub-group analyses for those ≥50 years of age. CONCLUSIONS Protection of natural infection against reinfection wanes and may diminish within a few years. Viral immune evasion accelerates this waning. Protection against severe reinfection remains very strong, with no evidence for waning, irrespective of variant, for over 14 months after primary infection.
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Affiliation(s)
- Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Research Department, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.,World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Nico Nagelkerke
- Infectious Disease Epidemiology Group, Research Department, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Houssein H Ayoub
- Mathematics Program, Department of Mathematics, Statistics, and Physics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Peter Coyle
- Hamad Medical Corporation, Doha, Qatar.,Biomedical Research Center, QU Health, Qatar University, Doha, Qatar.,Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, UK
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar.,Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Hebah A Al-Khatib
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar.,Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Maria K Smatti
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar.,Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | | | | | | | | | | | | | | | - Hanan F Abdul-Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Gheyath K Nasrallah
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar.,Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | | | - Adeel A Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA.,Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine, Cornell University,New York, NY, USA
| | | | | | | | | | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Research Department, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.,World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA.,Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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18
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Corrao G, Franchi M, Cereda D, Bortolan F, Leoni O, Jara J, Valenti G, Pavesi G. Factors associated with severe or fatal clinical manifestations of SARS-CoV-2 infection after receiving the third dose of vaccine. J Intern Med 2022; 292:829-836. [PMID: 35943414 PMCID: PMC9539163 DOI: 10.1111/joim.13551] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND Little is known about vulnerability to severe COVID-19 illness after vaccination completion with three doses of vaccine against COVID-19. OBJECTIVES To identify individual features associated with increased risk of severe clinical manifestation of SARS-CoV-2 infections after receiving the third dose of vaccine against COVID-19. METHODS We performed a nested case-control study based on 3,360,116 citizens from Lombardy, Italy, aged 12 years or older who received the third dose of vaccine against COVID-19 from 20 September through 31 December 2021. Individuals were followed from 14 days after vaccination completion until the occurrence of severe COVID-19 illness, death unrelated to COVID-19, emigration or 15 March 2022. For each case, controls were randomly selected to be 1:10 matched for the date of vaccination completion and municipality of residence. The association between candidate predictors and outcome was assessed through multivariable conditional logistic regression models. RESULTS During 12,538,330 person-months of follow-up, 5171 cases of severe illness occurred. As age increased, a trend towards increasing odds of severe illness was observed. Male gender was a significant risk factor. As the number of contacts with the Regional Health Service increased, a trend towards increasing odds of severe illness was observed. Having had a previous SARS-CoV-2 infection was a significant protective factor. Having received the Moderna vaccine significantly decreased the odds of severe illness. Significant higher odds were associated with 42 diseases/conditions. Odds ratios ranged from 1.23 (diseases of the musculoskeletal system) to 5.00 (autoimmune disease). CONCLUSIONS This study provides useful insights for establishing priority in fourth-dose vaccination programs.
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Affiliation(s)
- Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,Directorate General for Health, Lombardy Region, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Danilo Cereda
- Directorate General for Health, Lombardy Region, Milan, Italy
| | | | - Olivia Leoni
- Directorate General for Health, Lombardy Region, Milan, Italy
| | | | | | - Giovanni Pavesi
- Directorate General for Health, Lombardy Region, Milan, Italy
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19
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Asfuroğlu Kalkan E, Kalkan Ç, Kaçar S, Barutçu S, Yüksel M, Güçbey Türker Ö, Göre B, Canlı T, Asfuroğlu U, Barutçu Asfuroğlu B, Hamamcı M, Kılıç V, Köseoğlu T, Özaslan E, Ödemiş B, Kılıç M, Yüksel İ, Ersoy O, Altıparmak E, Ateş İ, Soykan İ. Similarities and Differences Between Gerontal and Young Patients with Acute Pancreatitis: Evaluation of Clinical Characteristics and Outcomes. Turk J Gastroenterol 2022; 33:874-884. [PMID: 36205509 PMCID: PMC9623137 DOI: 10.5152/tjg.2022.22227] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Acute pancreatitis is an abrupt inflammatory disease of the exocrine pancreas and it can occur in different severities. It is becoming more common and more mortal in the gerontal population. The aim of our study was to explore the similarities and differences between young and gerontal patients with acute pancreatitis, with a special emphasis on patients over 80 years of age. Methods: Medical records of patients (n = 1150) with acute pancreatitis were analyzed retrospectively. Several scoring systems including Bedside index for severity in acute pancreatitis, Ranson’s score, Harmless acute pancreatitis score, Acute Physiology and Chronic Health Evaluation, Balthazar Grade, Glasgow score, and Japanese severity score were applied at admission. Patients were divided into 3 groups; group I, young group (n = 706), if they were aged <65 years; group II, older group (n = 338), if they were aged ≥65 years to <80 years; group III, octogenarian group (n = 106), if they were aged ≥ 0 years. Results: In total, 1150 patients with acute pancreatitis were analyzed. Octogenarian group (n = 42, 39.6%) showed a more severe acute pancreatitis compared to patients in group I (n = 15, 2.1%) and II (n = 50, 14.8%, P < .001). Complications were more common in patients in group III (P < .001). Mortality rate was higher in patients in group III (n = 53, 50%) compared to group I (n = 8, 1.1%) and group II (n = 53, 15.7%) (P < .001). Conclusion: Gerontal patients with acute pancreatitis tend to have more severe disease and systemic and local complications. Mortality rates were higher in older patients compared to younger patients.
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Affiliation(s)
- Emra Asfuroğlu Kalkan
- Department of Internal Medicine, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Çağdaş Kalkan
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Sabite Kaçar
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Sezgin Barutçu
- Department of Gastroenterology, Gaziantep University Hospital, Gaziantep, Turkey
| | - Mahmut Yüksel
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Özge Güçbey Türker
- Department of Internal Medicine, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Burak Göre
- Department of Internal Medicine, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Tolga Canlı
- Department of Internal Medicine, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Umut Asfuroğlu
- Department of Radiology, Ministry of Health, Abdulkadir Yüksel Hospital, Gaziantep, Turkey
| | | | - Mevlüt Hamamcı
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Vedat Kılıç
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Tankut Köseoğlu
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Ersan Özaslan
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Bülent Ödemiş
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Mesut Kılıç
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - İlhami Yüksel
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Osman Ersoy
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Emin Altıparmak
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - İhsan Ateş
- Department of Internal Medicine, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - İrfan Soykan
- Department of Gastroenterology, Ankara University Faculty of Medicine, İbni-Sina Hospital, Ankara, Turkey,Corresponding author: İrfan Soykan, e-mail:
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20
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Reyna-Villasmil E, Caponcello MG, Maldonado N, Olivares P, Caroccia N, Bonazzetti C, Tazza B, Carrara E, Giannella M, Tacconelli E, Rodríguez-Baño J, Palacios-Baena ZR; ORCHESTRA Study. Association of Patients' Epidemiological Characteristics and Comorbidities with Severity and Related Mortality Risk of SARS-CoV-2 Infection: Results of an Umbrella Systematic Review and Meta-Analysis. Biomedicines 2022; 10. [PMID: 36289699 DOI: 10.3390/biomedicines10102437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/21/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to assess the association between patients’ epidemiological characteristics and comorbidities with SARS-CoV-2 infection severity and related mortality risk. An umbrella systematic review, including a meta-analysis examining the association between patients’ underlying conditions and severity (defined as need for hospitalization) and mortality of COVID-19, was performed. Studies were included if they reported pooled risk estimates of at least three underlying determinants for hospitalization, critical disease (ICU admission, mechanical ventilation), and hospital mortality in patients diagnosed with SARS-CoV-2 infection. Evidence was summarized as pooled odds ratios (pOR) for disease outcomes with 95% confidence intervals (95% CI). Sixteen systematic reviews investigating the possible associations of comorbidities with severity or death from COVID-19 disease were included. Hospitalization was associated with age > 60 years (pOR 3.50; 95% CI 2.97−4.36), smoking habit (pOR 3.50; 95% CI 2.97−4.36), and chronic pulmonary disease (pOR 2.94; 95% CI 2.14−4.04). Chronic pulmonary disease (pOR 2.82; 95% CI 1.92−4.14), cerebrovascular disease (pOR 2.74; 95% CI 1.59−4.74), and cardiovascular disease (pOR 2.44; 95% CI 1.97−3.01) were likely to be associated with increased risk of critical COVID-19. The highest risk of mortality was associated with cardiovascular disease (pOR 3.59; 95% CI 2.83−4.56), cerebrovascular disease (pOR 3.11; 95% CI 2.35−4.11), and chronic renal disease (pOR 3.02; 95% CI 2.61−3.49). In conclusion, this umbrella systematic review provides a comprehensive summary of meta-analyses examining the impact of patients’ characteristics on COVID-19 outcomes. Elderly patients and those cardiovascular, cerebrovascular, and chronic renal disease should be prioritized for pre-exposure and post-exposure prophylaxis and early treatment.
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21
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Dikranian L, Barry S, Ata A, Chiotos K, Gist K, Bhalala U, Danesh V, Heavner S, Gharpure V, Bjornstad EC, Irby O, Heneghan JA, Montgomery V, Gupta N, Miller A, Walkey A, Tripathi S, Boman K, Bansal V, Kumar V, Kashyap R, Sayed I, Woll C. SARS-CoV-2 With Concurrent Respiratory Viral Infection as a Risk Factor for a Higher Level of Care in Hospitalized Pediatric Patients. Pediatr Emerg Care 2022; 38:472-476. [PMID: 36040468 PMCID: PMC9426307 DOI: 10.1097/pec.0000000000002814] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE As of early 2021, there have been over 3.5 million pediatric cases of SARS-CoV-2, including 292 pediatric deaths in the United States. Although most pediatric patients present with mild disease, they are still at risk for developing significant morbidity requiring hospitalization and intensive care unit (ICU) level of care. This study was performed to evaluate if the presence of concurrent respiratory viral infections in pediatric patients admitted to the hospital with SARS-CoV-2 was associated with an increased rate of ICU level of care. DESIGN A multicenter, international, noninterventional, cross-sectional study using data provided through The Society of Critical Care Medicine Discovery Network Viral Infection and Respiratory Illness Universal Study database. SETTING The medical ward and ICU of 67 participating hospitals. PATIENTS Pediatric patients younger than 18 years hospitalized with SARS-CoV-2. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 922 patients were included. Among these patients, 391 required ICU level care and 31 had concurrent non-SARS-CoV-2 viral coinfection. In a multivariate analysis, after accounting for age, positive blood culture, positive sputum culture, preexisting chronic medical conditions, the presence of a viral respiratory coinfection was associated with need for ICU care (odds ratio, 3.6; 95% confidence interval, 1.6-9.4; P < 0.01). CONCLUSIONS This study demonstrates an association between concurrent SARS-CoV-2 infection with viral respiratory coinfection and the need for ICU care. Further research is needed to identify other risk factors that can be used to derive and validate a risk-stratification tool for disease severity in pediatric patients with SARS-CoV-2.
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Affiliation(s)
- Lea Dikranian
- From the Pediatric Emergency Medicine, Division of Emergency Medicine, Childrens Hospital of Michigan, Detroit, MI
| | - Suzanne Barry
- Section of Critical Care Medicine, Department of Pediatrics
| | - Ashar Ata
- Departments of Surgery and Emergency Medicine, Albany Medical Center, Albany, NY
| | - Katie Chiotos
- Division of Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia PA
| | - Katja Gist
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Utpal Bhalala
- University of Texas Medical Branch, Driscoll Health System, Corpus Christi, TX
| | | | | | - Varsha Gharpure
- Department of Pediatrics, Advocate Children's Hospital, Park Ridge, IL
| | - Erica C. Bjornstad
- Division of Nephrology, Department of Pediatrics, University of Alabama Birmingham, Birmingham, AL
| | - Olivia Irby
- Division of Critical Care Medicine, Department of Pediatrics, Arkansas Childrens Hospital, Little Rock, AK
| | - Julia A. Heneghan
- Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Vicki Montgomery
- Division of Critical Care Medicine, Department of Pediatrics, University of Louisville and Norton Childrens Hospital, Louisville, KY
| | - Neha Gupta
- Department of Pediatrics, Section of Critical Care Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK
| | - Aaron Miller
- St. Louis University School of Medicine, St. Louis, MO
| | - Allan Walkey
- The Pulmonary Center, Division of Pulmonary, Allergy, Sleep and Critical Care; Department of Medicine; Boston University School of Medicine, Boston, MA
| | - Sandeep Tripathi
- Department of Pediatrics OSF Saint Francis Medical Center/University of Illinois College of Medicine at Peoria, Peoria, IL
| | - Karen Boman
- Division of Nephrology and Hypertension, Department of Medicine; Mayo Clinic, Rochester, MN
| | - Vikas Bansal
- Division of Research, Hospital Corporation of America Healthcare, Nashville, TN
| | - Vishakha Kumar
- Division of Nephrology and Hypertension, Department of Medicine; Mayo Clinic, Rochester, MN
| | - Rahul Kashyap
- Division of Research, Hospital Corporation of America Healthcare, Nashville, TN
| | - Imran Sayed
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Childrens Hospital Colorado, Aurora, CO
| | - Christopher Woll
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Albany Medical Center, Albany, NY
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22
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Stålcrantz J, Kristoffersen AB, Bøås H, Veneti L, Seppälä E, Aasand N, Hungnes O, Kvåle R, Bragstad K, Buanes EA, Whittaker R. Milder disease trajectory among COVID-19 patients hospitalised with the SARS-CoV-2 Omicron variant compared with the Delta variant in Norway. Scand J Public Health 2022; 50:676-682. [PMID: 35799474 DOI: 10.1177/14034948221108548] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Using individual-level national registry data, we conducted a cohort study to estimate differences in the length of hospital stay, and risk of admission to an intensive care unit and in-hospital death among patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant, compared with patients infected with Delta variant in Norway. We included 409 (38%) patients infected with Omicron and 666 (62%) infected with Delta who were hospitalised with coronavirus disease 2019 (COVID-19) as the main cause of hospitalisation between 6 December 2021 and 6 February 2022. Omicron patients had a 48% lower risk of intensive care admission (adjusted hazard ratios (aHR): 0.52, 95% confidence interval (CI): 0.34-0.80) and a 56% lower risk of in-hospital death (aHR: 0.44, 95%CI: 0.24-0.79) compared with Delta patients. Omicron patients had a shorter length of stay (with or without ICU stay) compared with Delta patients in the age groups from 18 to 79 years and those who had at least completed their primary vaccination. This supports growing evidence of reduced disease severity among hospitalised Omicron patients compared with Delta patients.
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Affiliation(s)
- Jeanette Stålcrantz
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway.,European Program for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Håkon Bøås
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Lamprini Veneti
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Elina Seppälä
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Nina Aasand
- Department of Infectious Disease Registries, Norwegian Institute of Public Health, Oslo, Norway
| | - Olav Hungnes
- Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Reidar Kvåle
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Karoline Bragstad
- Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Eirik Alnes Buanes
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Norwegian Intensive Care and Pandemic Registry, Haukeland University Hospital, Bergen, Norway
| | - Robert Whittaker
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
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23
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Sacco C, Petrone D, Del Manso M, Mateo-Urdiales A, Fabiani M, Bressi M, Bella A, Pezzotti P, Rota MC, Riccardo F. Risk and protective factors for SARS-CoV-2 reinfections, surveillance data, Italy, August 2021 to March 2022. Euro Surveill 2022; 27. [PMID: 35593164 PMCID: PMC9121659 DOI: 10.2807/1560-7917.es.2022.27.20.2200372] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We explored the risk factors associated with SARS-CoV-2 reinfections in Italy between August 2021 and March 2022. Regardless of the prevalent virus variant, being unvaccinated was the most relevant risk factor for reinfection. The risk of reinfection increased almost 18-fold following emergence of the Omicron variant compared with Delta. A severe first SARS-CoV-2 infection and age over 60 years were significant risk factors for severe reinfection.
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Affiliation(s)
- Chiara Sacco
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Daniele Petrone
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Martina Del Manso
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Bressi
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Cristina Rota
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Flavia Riccardo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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- The members of the Italian Integrated Surveillance of COVID-19 study group are acknowledged at the end of the article
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24
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Queiro R, Seoane-Mato D, Laiz A, Galindez Agirregoikoa E, Montilla C, Park HS, Pinto Tasende JA, Bethencourt Baute JJ, Joven Ibáñez B, Toniolo E, Ramírez J, Pruenza García-Hinojosa C. Severe Disease in Patients With Recent-Onset Psoriatic Arthritis. Prediction Model Based on Machine Learning. Front Med (Lausanne) 2022; 9:891863. [PMID: 35572968 PMCID: PMC9097678 DOI: 10.3389/fmed.2022.891863] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/05/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives To identify patient- and disease-related characteristics that make it possible to predict higher disease severity in recent-onset PsA. Methods We performed a multicenter observational prospective study (2-year follow-up, regular annual visits). The study population comprised patients aged ≥ 18 years who fulfilled the CASPAR criteria and less than 2 years since the onset of symptoms. Severe disease was defined at each visit as fulfillment of at least 1 of the following criteria: need for systemic treatment, Health Assessment Questionnaire (HAQ) > 0.5, polyarthritis. The dataset contained data for the independent variables from the baseline visit and follow-up visit number 1. These were matched with the outcome measures from follow-up visits 1 and 2, respectively. We trained a logistic regression model and random forest-type and XGBoost machine learning algorithms to analyze the association between the outcome measure and the variables selected in the bivariate analysis. Results The sample comprised 158 patients. At the first follow-up visit, 78.2% of the patients who attended the clinic had severe disease. This percentage decreased to 76.4% at the second visit. The variables predicting severe disease were patient global pain, treatment with synthetic DMARDs, clinical form at diagnosis, high CRP, arterial hypertension, and psoriasis affecting the gluteal cleft and/or perianal area. The mean values of the measures of validity of the machine learning algorithms were all ≥ 80%. Conclusion Our prediction model of severe disease advocates rigorous control of pain and inflammation, also addressing cardiometabolic comorbidities, in addition to actively searching for hidden psoriasis.
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Affiliation(s)
- Rubén Queiro
- Faculty of Medicine, Rheumatology Service & the Principality of Asturias Institute for Health Research (ISPA), Universidad de Oviedo, Oviedo, Spain
| | | | - Ana Laiz
- Rheumatology and Autoimmune Disease Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Carlos Montilla
- Rheumatology Service, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Hye Sang Park
- Rheumatology and Autoimmune Disease Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose A. Pinto Tasende
- Rheumatology Service-INIBIC, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | | | - Elide Toniolo
- Rheumatology Service, Hospital Universitari Son Llàtzer, Palma, Spain
| | - Julio Ramírez
- Arthritis Unit, Rheumatology Department, Hospital Clínic Barcelona, Barcelona, Spain
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25
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Ulndreaj A, Wang M, Misaghian S, Paone L, Sigal GB, Stengelin M, Campbell C, Van Nynatten LR, Soosaipillai A, Ghorbani A, Mathew A, Fraser DD, Diamandis EP, Prassas I. Patients with severe COVID-19 do not have elevated autoantibodies against common diagnostic autoantigens. Clin Chem Lab Med 2022; 60:1116-1123. [PMID: 35475723 DOI: 10.1515/cclm-2022-0239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/14/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative pathogen of coronavirus disease 2019 (COVID-19) presents occasionally with an aberrant autoinflammatory response, including the presence of elevated circulating autoantibodies in some individuals. Whether the development of autoantibodies against self-antigens affects COVID-19 outcomes remains unclear. To better understand the prognostic role of autoantibodies in COVID-19, we quantified autoantibodies against 23 markers that are used for diagnosis of autoimmune disease. To this end, we used serum samples from patients with severe [intensive care unit (ICU)] and moderate (ward) COVID-19, across two to six consecutive time points, and compared autoantibody levels to uninfected healthy and ICU controls. METHODS Acute and post-acute serum (from 1 to 26 ICU days) was collected from 18 ICU COVID-19-positive patients at three to six time points; 18 ICU COVID-19-negative patients (sampled on ICU day 1 and 3); 21 ward COVID-19-positive patients (sampled on hospital day 1 and 3); and from 59 healthy uninfected controls deriving from two cohorts. Levels of IgG autoantibodies against 23 autoantigens, commonly used for autoimmune disease diagnosis, were measured in serum samples using MSD® U-PLEX electrochemiluminescence technology (MSD division Meso Scale Discovery®), and results were compared between groups. RESULTS There were no significant elevations of autoantibodies for any of the markers tested in patients with severe COVID-19. CONCLUSIONS Sample collections at longer time points should be considered in future studies, for assessing the possible development of autoantibody responses following infection with SARS-CoV-2.
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Affiliation(s)
- Antigona Ulndreaj
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Mingyue Wang
- Meso Scale Diagnostics, LLC. (MSD), Rockville, MD, USA
| | | | - Louis Paone
- Meso Scale Diagnostics, LLC. (MSD), Rockville, MD, USA
| | | | | | | | - Logan R Van Nynatten
- Lawson Health Research Institute, London, ON, Canada.,Department of Pediatrics, Clinical Neurological Sciences and Physiology and Pharmacology, Western University, London, ON, Canada
| | - Antoninus Soosaipillai
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Atefeh Ghorbani
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Anu Mathew
- Meso Scale Diagnostics, LLC. (MSD), Rockville, MD, USA
| | - Douglas D Fraser
- Lawson Health Research Institute, London, ON, Canada.,Department of Pediatrics, Clinical Neurological Sciences and Physiology and Pharmacology, Western University, London, ON, Canada
| | - Eleftherios P Diamandis
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Clinical Biochemistry, University Health Network, Toronto, ON, Canada
| | - Ioannis Prassas
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
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Abstract
INTRODUCTION Procalcitonin (PCT) is an emerging prognostic marker in coronavirus disease 2019 (COVID-19). Whether PCT can detect secondary bacterial infections or reflect target tissue injury in this setting is still unclear. Here we performed a meta-analysis to review the prognostic value of PCT for severe disease and adverse outcome events in COVID-19. METHODS We searched relevant publications in online databases. Studies were included if they reported categorical data according to disease severity and/or outcomes. We analysed extracted data using fixed or random-effects meta-analysis models, as appropriate, depending on the presence of significant heterogeneity. RESULTS Data from 14 studies (3492 patients) were included in the analysis. Overall, 163 of 256 patients with elevated PCT had severe disease (63.7%) compared with 553 of 2047 with negative PCT (27.0%) (OR: 5.92; 95% CI: 3.20 to 10.94). Elevated PCT was also associated with adverse outcomes (OR: 13.1; 95% CI: 7.37 to 23.1). PCT was increased in 22.8% and 30.6% of patients with the severe course and adverse outcome, respectively. Rates of secondary bacterial infections ranged from 4.7% to 19.5% and were associated with increased risk of severe course or fatal outcomes (OR: 20.8; 95% CI: 11.6 to 37.4). CONCLUSIONS Elevated PCT levels could identify a subset of COVID-19 patients at increased risk of severe disease and adverse outcome. Its limitations include low sensitivity and undefined cost-utility ratio. Whether PCT may be used for detecting secondary bacterial infections and guiding antibiotic therapy in COVID-19 is still undefined.
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Affiliation(s)
- Natale Vazzana
- Department of Internal Medicine, 'C. Magati' Hospital, AUSL Reggio Emilia, Scandiano, Italy
| | - Francesco Dipaola
- Department of Internal Medicine, 'C. Magati' Hospital, AUSL Reggio Emilia, Scandiano, Italy
| | - Silvia Ognibene
- Department of Internal Medicine, 'C. Magati' Hospital, AUSL Reggio Emilia, Scandiano, Italy
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27
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Costantini VP, Nguyen K, Lyski Z, Novosad S, Bardossy AC, Lyons AK, Gable P, Kutty PK, Lutgring JD, Brunton A, Thornburg NJ, Brown AC, McDonald LC, Messer W, Vinjé J. Development and Validation of an Enzyme Immunoassay for Detection and Quantification of SARS-CoV-2 Salivary IgA and IgG. J Immunol 2022; 208:1500-1508. [PMID: 35228262 PMCID: PMC8916996 DOI: 10.4049/jimmunol.2100934] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/04/2022] [Indexed: 12/14/2022]
Abstract
Oral fluids offer a noninvasive sampling method for the detection of Abs. Quantification of IgA and IgG Abs in saliva allows studies of the mucosal and systemic immune response after natural infection or vaccination. We developed and validated an enzyme immunoassay (EIA) to detect and quantify salivary IgA and IgG Abs against the prefusion-stabilized form of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein expressed in suspension-adapted HEK-293 cells. Normalization against total Ab isotype was performed to account for specimen differences, such as collection time and sample volume. Saliva samples collected from 187 SARS-CoV-2 confirmed cases enrolled in 2 cohorts and 373 prepandemic saliva samples were tested. The sensitivity of both EIAs was high (IgA, 95.5%; IgG, 89.7%) without compromising specificity (IgA, 99%; IgG, 97%). No cross-reactivity with endemic coronaviruses was observed. The limit of detection for SARS-CoV-2 salivary IgA and IgG assays were 1.98 ng/ml and 0.30 ng/ml, respectively. Salivary IgA and IgG Abs were detected earlier in patients with mild COVID-19 symptoms than in severe cases. However, severe cases showed higher salivary Ab titers than those with a mild infection. Salivary IgA titers quickly decreased after 6 wk in mild cases but remained detectable until at least week 10 in severe cases. Salivary IgG titers remained high for all patients, regardless of disease severity. In conclusion, EIAs for both IgA and IgG had high specificity and sensitivity for the confirmation of current or recent SARS-CoV-2 infections and evaluation of the IgA and IgG immune response.
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Affiliation(s)
- Veronica P Costantini
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA;
| | - Kenny Nguyen
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Zoe Lyski
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR
| | - Shannon Novosad
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ana C Bardossy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Amanda K Lyons
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Paige Gable
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Preeta K Kutty
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joseph D Lutgring
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Amanda Brunton
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR
| | - Natalie J Thornburg
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Allison C Brown
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - L Clifford McDonald
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - William Messer
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR.,School of Public Health, Oregon Health & Science University, Portland, OR; and.,Division of Infectious Diseases, Department of Medicine, Oregon Health & Science University, Portland, OR
| | - Jan Vinjé
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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28
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BOZKURT F, COŞKUN Ö, YELEÇ S, BEKÇİBAŞI M, ASENA M, BAĞLI İ. Evaluation of clinical and laboratory findings in severe group COVID-19 pregnants without comorbidity. Turk J Med Sci 2022; 52:11-20. [PMID: 36161599 PMCID: PMC10734852 DOI: 10.3906/sag-2105-116] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 02/22/2022] [Accepted: 07/07/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND COVID - 19 disease may be seen with different clinical presentations in pregnant women. Comorbid diseases are important factors affecting the progression of this disease. In this study, we aimed to evaluate the clinical and laboratory findings in pregnant women with COVID - 19 who had no comorbid disease. METHODS This retrospective designed study included 217 patients with Covid PCR positive in typically COVID - 19 clinic. The patients were classified into asymptomatic, nonsevere, and severe disease groups. The symptoms, laboratory results, hospital followups and intensive care records of the patients and the findings of new borns are presented. RESULTS Most of the patients (78%) were in the third trimester of pregnancy, and 103 patients in the study group had severe disease. Fever in the non-severe group and respiratory distress in the severe group were the most common symptoms in the patients. The severe clinical manifestations were specifically observed in the third trimester patients. In the severe group, neutrophil, lactat dehydrogenase, ferritin, CK - MB, IL - 6, and hospital stay were statistically higher than those in other groups (p < 0.05). Increase in BUN and creatine were the most predictive parameters in intensive care admission. While the intensive care unit (ICU) requirement was higher in patients in the severe group, premature birth was observed more frequently in the severe group (p < 0.05) .
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Affiliation(s)
- Fatma BOZKURT
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, University of Health Science, Gazi Yaşargil Education and Research Hospital, Diyarbakır,
Turkey
| | - Ömer COŞKUN
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, University of Health Science, Gazi Yaşargil Education and Research Hospital, Diyarbakır,
Turkey
| | - Sevda YELEÇ
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Health Science, Gazi Yaşargil Education and Research Hospital, Diyarbakır,
Turkey
| | - Muhammed BEKÇİBAŞI
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bismil State Hospital, Diyarbakır,
Turkey
| | - Muhammet ASENA
- Department of Child Health And Diseases, Faculty of Medicine, University of Health Science, Gazi Yaşargil Education and Research Hospital, Diyarbakır,
Turkey
| | - İhsan BAĞLI
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Health Science, Gazi Yaşargil Education and Research Hospital, Diyarbakır,
Turkey
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29
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Foulkes AS, Selvaggi C, Shinnick D, Lumish H, Kim E, Cao T, Thaweethai T, Qian J, Lu F, Yan J, Cheng D, He W, Clerkin KJ, Madhavan MV, Meigs JB, Triant VA, Lubitz SA, Gupta A, Bassett IV, Reilly MP. Understanding the Link Between Obesity and Severe COVID-19 Outcomes: Causal Mediation by Systemic Inflammatory Response. J Clin Endocrinol Metab 2022; 107:e698-e707. [PMID: 34473294 PMCID: PMC8499919 DOI: 10.1210/clinem/dgab629] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obesity is an established risk factor for severe COVID-19 outcomes. The mechanistic underpinnings of this association are not well-understood. OBJECTIVE To evaluate the mediating role of systemic inflammation in obesity-associated COVID-19 outcomes. METHODS This hospital-based, observational study included 3828 SARS-CoV-2-infected patients who were hospitalized February to May 2020 at Massachusetts General Hospital (MGH) or Columbia University Irving Medical Center/New York Presbyterian Hospital (CUIMC/NYP). We use mediation analysis to evaluate whether peak inflammatory biomarkers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], D-dimer, ferritin, white blood cell count and interleukin-6) are in the causal pathway between obesity (BMI ≥ 30) and mechanical ventilation or death within 28 days of presentation to care. RESULTS In the MGH cohort (n = 1202), obesity was associated with greater likelihood of ventilation or death (OR = 1.73; 95% CI = [1.25, 2.41]; P = 0.001) and higher peak CRP (P < 0.001) compared with nonobese patients. The estimated proportion of the association between obesity and ventilation or death mediated by CRP was 0.49 (P < 0.001). Evidence of mediation was more pronounced in patients < 65 years (proportion mediated = 0.52 [P < 0.001] vs 0.44 [P = 0.180]). Findings were more moderate but consistent for peak ESR. Mediation by other inflammatory markers was not supported. Results were replicated in CUIMC/NYP cohort (n = 2626). CONCLUSION Findings support systemic inflammatory pathways in obesity-associated severe COVID-19 disease, particularly in patients < 65 years, captured by CRP and ESR. Contextualized in clinical trial findings, these results reveal therapeutic opportunity to target systemic inflammatory pathways and monitor interventions in high-risk subgroups and particularly obese patients.
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Affiliation(s)
- Andrea S Foulkes
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Caitlin Selvaggi
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Daniel Shinnick
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Heidi Lumish
- Division of Cardiology, Columbia University, New York, NY 10027, USA
| | - Eunyoung Kim
- Division of Cardiology, Columbia University, New York, NY 10027, USA
| | - Tingyi Cao
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Tanayott Thaweethai
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Jing Qian
- Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003, USA
| | - Frances Lu
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Joyce Yan
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - David Cheng
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Wei He
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Kevin J Clerkin
- Division of Cardiology, Columbia University, New York, NY 10027, USA
| | - Mahesh V Madhavan
- Division of Cardiology, Columbia University, New York, NY 10027, USA
| | - James B Meigs
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Virginia A Triant
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Steven A Lubitz
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Aakriti Gupta
- Division of Cardiology, Columbia University, New York, NY 10027, USA
| | - Ingrid V Bassett
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Muredach P Reilly
- Division of Cardiology, Columbia University, New York, NY 10027, USA
- Irving Institute for Clinical and Translational Research, Columbia University, New York, NY 10032, USA
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30
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Nakamura T, Mori H, Saunders T, Chishaki H, Nose Y. Impact of Workplace on the Risk of Severe COVID-19. Front Public Health 2022; 9:731239. [PMID: 35071150 PMCID: PMC8766507 DOI: 10.3389/fpubh.2021.731239] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022] Open
Abstract
Indiscriminate regional lockdowns aim to prevent the coronavirus disease 2019 (COVID-19) infection by restricting the movement of people; however, this comes with psychological, social, and economic costs. Measures are needed that complement lockdowns and reduce adverse effects. Epidemiological studies, to date, have identified high-risk populations, but not workplaces appropriate for closure. This study was conducted to provide evidence-based measures that used exact and reliable follow-up data of the PCR-positive COVID-19 cases to complement lockdowns. The data are not subjected to selection or follow-up biases, since the Japanese government, by law, must register and follow all the PCR-positive cases until either recovery or death. Direct customer exposure may affect the quantity of viral inoculum received, which, in turn, may affect the risk of the severity of disease at infection. Therefore, the professions of the cases were grouped according to their frequency of direct customer exposure (FDCE) based on subjective observations, which resulted in five workplaces; hospital, school, food service, outdoor service, and indoor office being identified. Analyzing the follow-up data, we obtained precise estimates for the risk of severe disease, defined as intensive care unit (ICU) hospitalization or death, for the workplaces adjusted for age, sex, family status, and comorbidity. Major findings are as follows: hospital and school are the lowest risk, food and outdoor services are, despite higher FDCE, safer than indoor office. Unemployed and unclear are the highest risk, despite low FDCE. These results suggest the following workplace-specific measures complementing the lockdown: school should not be closed and indiscriminate closing of food and outdoor service industries should be avoided, since it would be more effective to reinforce their efforts to promote adherence to public health guidelines among students and customers. These actions would also reduce the adverse effects of the lockdown. This study is the first to address the causality between the workplaces and severe disease. We introduce FDCE and adherence to public health guidelines (APHGs) to associate the workplace characteristics with the risk of COVID-19 severity, which provided the basis for the measures complementing lockdowns.
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Affiliation(s)
- Tsuyoshi Nakamura
- Faculty of Environmental Science, Nagasaki University, Nagasaki, Japan
| | - Hiroyuki Mori
- Department of Life Creation, Nagasaki Women's College, Nagasaki, Japan
| | - Todd Saunders
- Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Hiroaki Chishaki
- Department of Family Practice, National Health Insurance Clinic, Nakatsu, Oita, Japan
| | - Yoshiaki Nose
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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31
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Perera N, de Silva A, Kumbukage M, Rambukwella R, Indrakumar J. Neutrophil Lymphocyte Ratio as a Marker of In-Hospital Deterioration in COVID-19: Observations From a Resource Constraint Setting. Clin Pathol 2022; 15:2632010X221090898. [PMID: 35450133 PMCID: PMC9016554 DOI: 10.1177/2632010x221090898] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/10/2022] [Indexed: 12/19/2022]
Abstract
Introduction and Objectives: The study was conducted to assess the association of neutrophil lymphocyte
ratio (NLR) in COVID-19 and to identify the cut-off value that predicts
mortality, need of respiratory support and admission to high-dependency or
intensive care. Methods: A retrospective observational study was conducted to collect demographic
data, clinical variables, the neutrophil-lymphocyte ratio on-admission and
the outcome of confirmed COVID-19 patients admitted to a tertiary care
center in Sri Lanka. Results: There were 208 patients with a median age of 56 years (IQR 43-67) and 98
(47.1%) males. The median neutrophil count was 4.07 × 103/µL (IQR
2.97-6.79) and the median lymphocyte count was 1.74 × 103/µL (IQR
1.36-4.75). The calculated NLR ranged from 0.12 to 48.28 with a median value
of 2.32 (IQR 1.37-4.76). A NLR value >3.6 predicted development of severe
disease requiring respiratory support, transfer to a high-dependency or an
intensive care unit and/or succumbing to the illness with a sensitivity 80%
and specificity 80% (area under the curve 0.8, 95% CI 0.72-0.88,
P < .0001). The adjusted odds ratio of NLR > 3.6
on predicting severe disease was 11.1, 95% CI 4.5- 27.0,
P < .0001. Conclusions: A NLR > 3.6 is a useful variable to be included in risk prediction scores
in Sri Lanka.
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Affiliation(s)
- Nilanka Perera
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Western Province, Sri Lanka
| | - Ashani de Silva
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Western Province, Sri Lanka
| | - Mahesh Kumbukage
- Research unit, Family Health Bureau, Colombo, Western Province, Sri Lanka
| | - Roshan Rambukwella
- Research unit, Family Health Bureau, Colombo, Western Province, Sri Lanka
| | - Jegarajah Indrakumar
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Western Province, Sri Lanka
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32
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Kodavoor Vadiraj P, Thareja S, Raman N, Karantha SC, Jayaraman M, Vardhan V. Does Raised Transaminases Predict Severity and Mortality in Patients with COVID 19? J Clin Exp Hepatol 2022; 12:1114-23. [PMID: 35125781 DOI: 10.1016/j.jceh.2022.01.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/13/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The most dreaded pandemic grappling world now, the Coronavirus Disease 2019 (COVID-19), chiefly involves the respiratory system; nevertheless, it is a multisystem disorder. Its involvement of the hepatic system is considerable; however, still emerging are its clinical implications and the effects on morbidity and mortality. AIM The aim of this study is to report on the various aspects of its hepatic involvement by describing the alterations in tests of liver function and its significance in the disease outcome in a cohort of hospitalized COVID-19 patients at a tertiary center in northern India. METHODS This is a retrospective cohort study conducted in a tertiary-care hospital in northern India. All confirmed hospitalized COVID-19 cases aged 15 and above from Apr to Oct 2020 with no pre-existing liver disease were included. The primary endpoint was death at 28 days. Statistical analysis included descriptive analysis, sensitivity-specificity, and univariable and multivariable regression analysis as well as survival analysis. RESULTS A total of 708 patients with COVID-19 fulfilled the inclusion criteria included 561 (79.2%) males and 147 (20.8%) females. The median age was 49 (IQR = 25) years. Mild and moderate/severe disease were seen in 508 (71.8%) and 200 (28.2) patients, respectively. Serum bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were elevated in 6.92%, 69.91%, and 80.22% of patients, respectively. In univariable logistic regression, AST [odds ratio; OR 1.008 95% CI (1.005-1.012) per 1 IU/L increase] and ALT [OR 1.005 95% CI (1.002-1.007) per 1 IU/L increase] were significantly associated with the odds of moderate to severe disease but only AST was significant after adjustment to age, sex, and comorbidity [adjusted odds ratio; aOR 1.007 95% CI (1.003-1.011) per 1 IU/L increase]. Serum albumin was negatively associated with the odds of moderate to severe disease and remained significant in the adjusted model [aOR 0.217 95%CI (0.149-0.316) per 1 g/dL increase].Ninety-six patients succumbed to illness [case fatality rate; CFR 13.6%). In adjusted Cox Proportional-Hazards Model for mortality, AST [adjusted hazard ratio; aHR 1.002 95% CI (1.000-1.003) per 1 IU/L increase] and serum albumin [aHR 0.396 95% CI (0.285-0.549) per 1 g/dL increase] showed significant association with mortality. CONCLUSION Liver function abnormalities are common in patients with COVID-19. In particular, AST and serum albumin levels are effective predictors of disease severity and mortality and can be used as markers of fatal disease in the management as well as prognostication of COVID-19.
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Key Words
- ACG, American College of Gastroenterology
- ALC, Absolute Lymphocyte Count
- ALP, Alkaline Phosphatase
- ALT, Alanine Aminotransferase/Alanine Transaminase
- ANC, Absolute Neutrophil Count
- AST, Aspartate Aminotransferase/Aspartate Transaminase
- AUC, Area Under the Curve
- COVID-19
- COVID-19, Coronavirus Disease 2019
- CRP, C Reactive Protein
- GGT, Gamma Glutamyl Transferase
- Hb, Hemoglobin
- IQR, Interquartile Range
- NLR, Neutrophil to Lymphocyte Ratio
- OR, Odds Ratio
- PLT, Platelet
- PT, Prothrombin Time
- ROC, Receiver Operating characteristic Curve
- RT PCR, Real Time Transcription Polymerase chain reaction
- SpO2, Saturation of oxygen by pulse oximetry
- TLC, Total Leukocyte Count
- ULN, Upper Limit of Normal
- liver functions
- mortality
- serum albumin
- severe disease
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Abu-Raddad LJ, Chemaitelly H, Ayoub HH, Yassine HM, Benslimane FM, Al Khatib HA, Tang P, Hasan MR, Coyle P, AlMukdad S, Al Kanaani Z, Al Kuwari E, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul Rahim HF, Nasrallah GK, Al Kuwari MG, Butt AA, Al Romaihi HE, Al-Thani MH, Al Khal A, Bertollini R. Severity, Criticality, and Fatality of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Beta Variant. Clin Infect Dis 2021; 75:e1188-e1191. [PMID: 34657152 PMCID: PMC9402694 DOI: 10.1093/cid/ciab909] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 08/01/2021] [Indexed: 01/19/2023] Open
Abstract
Beta (B.1.351)-variant coronavirus disease 2019 (COVID-19) disease was investigated in Qatar. Compared with the Alpha (B.1.1.7) variant, odds (95% confidence interval) of progressing to severe disease, critical disease, and COVID-19-related death were 1.24-fold (1.11-1.39), 1.49-fold (1.13-1.97), and 1.57-fold (1.03-2.43) higher, respectively, for the Beta variant.
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Affiliation(s)
- Laith J Abu-Raddad
- Correspondence: L. J. Abu-Raddad, Infectious Disease Epidemiology Group, World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Qatar Foundation– Education City, P.O. Box 24144, Doha, Qatar ()
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation—Education City, Doha, Qatar,World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation—Education City, Doha, Qatar
| | - Houssein H Ayoub
- Mathematics Program, Department of Mathematics, Statistics, and Physics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar,Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Fatiha M Benslimane
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar,Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Hebah A Al Khatib
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar,Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha, Qatar
| | | | - Peter Coyle
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar,Hamad Medical Corporation, Doha, Qatar,Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, United Kingdom
| | - Sawsan AlMukdad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation—Education City, Doha, Qatar,World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation—Education City, Doha, Qatar
| | | | | | | | | | | | | | - Hanan F Abdul Rahim
- Department of Public Health, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Gheyath K Nasrallah
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar,Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | | | - Adeel A Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA,Hamad Medical Corporation, Doha, Qatar
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Qian W, Ye Y, Zuo L, Song T, Xu Q, Wang Y, Qian J, Tian Y. Immune checkpoint inhibitors use and effects on prognosis of COVID-19 infection: a systematic review and meta-analysis. Immunotherapy 2021; 13:1271-1282. [PMID: 34431319 PMCID: PMC8388614 DOI: 10.2217/imt-2021-0007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
Aim: We aimed to quantify the effects of immune checkpoint inhibitors (ICIs) on the prognosis of COVID-19. Materials & methods: A meta-analysis was conducted and the hospitalization, severe disease and mortality rates were assessed. Thirteen studies comprising of 4614 cancer patients with COVID-19 were included. Results: When compared with cancer patients without prior ICI exposure, patients with prior ICI treatment exhibited a higher rate of hospitalization (odds ratio [OR] 2.0, 95% CI 1.19-3.38, p = 0.01). However, the OR of severe disease and mortality in ICI exposed cases was similar to non-ICI exposed patients (OR 1.55, 95% CI 0.69-3.51, p = 0.29; OR 1.12, 95% CI 0.85-1.48, p = 0.42, respectively). Conclusion: It is uncertain whether prior exposure to ICIs increases the risk of severe disease and death, however the observed OR suggest a higher rate of hospitalization.
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Affiliation(s)
- Wenwei Qian
- Department of General Surgery, Jinling Hospital, Medical School of Southeast University, No. 305 East Zhongshan Road, Nanjing, PR China
| | - Ying Ye
- Emergency Center, Affiliated Hospital of Xuzhou Medical College. 99 Huaihaixi Road, Xuzhou, Jiangsu, 221002, China
| | - Lugen Zuo
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, China
| | - Ting Song
- Department of Infectious Diseases, The Sixth People’s Hospital of Qingdao, No. 9 Fushun Road, Qingdao, Shandong, 266033, China
| | - Qing Xu
- Department of Oncology, Tongji University Cancer Center, The Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology & Nutrition, The University of MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jun Qian
- Department of Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Yun Tian
- Department of Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
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Tembhare PR, Sriram H, Chatterjee G, Khanka T, Gokarn A, Mirgh S, Rajendra A, Chaturvedi A, Ghogale SG, Deshpande N, Girase K, Dalvi K, Rajpal S, Patkar N, Trivedi B, Joshi A, Murthy V, Shetty N, Nair S, More A, Kamtalwar S, Chavan P, Bhat V, Bhat P, Subramanian PG, Gupta S, Khattry N. Comprehensive immune cell profiling depicts an early immune response associated with severe coronavirus disease 2019 in cancer patients. Immunol Cell Biol 2021; 100:61-73. [PMID: 34582592 PMCID: PMC8652640 DOI: 10.1111/imcb.12504] [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: 06/04/2021] [Revised: 08/22/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022]
Abstract
Recent studies have highlighted multiple immune perturbations related to severe acute respiratory syndrome coronavirus 2 infection-associated respiratory disease [coronavirus disease 2019 (COVID-19)]. Some of them were associated with immunopathogenesis of severe COVID-19. However, reports on immunological indicators of severe COVID-19 in the early phase of infection in patients with comorbidities such as cancer are scarce. We prospectively studied about 200 immune response parameters, including a comprehensive immune-cell profile, inflammatory cytokines and other parameters, in 95 patients with COVID-19 (37 cancer patients without active disease and intensive chemo/immunotherapy, 58 patients without cancer) and 21 healthy donors. Of 95 patients, 41 had severe disease, and the remaining 54 were categorized as having a nonsevere disease. We evaluated the association of immune response parameters with severe COVID-19. By principal component analysis, three immune signatures defining characteristic immune responses in COVID-19 patients were found. Immune cell perturbations, in particular, decreased levels of circulating dendritic cells (DCs) along with reduced levels of CD4 T-cell subsets such as regulatory T cells (Tregs ), type 1 T helper (Th1) and Th9; additionally, relative expansion of effector natural killer (NK) cells were significantly associated with severe COVID-19. Compared with patients without cancer, the levels of terminal effector CD4 T cells, Tregs , Th9, effector NK cells, B cells, intermediate-type monocytes and myeloid DCs were significantly lower in cancer patients with mild and severe COVID-19. We concluded that severely depleted circulating myeloid DCs and helper T subsets in the initial phase of infection were strongly associated with severe COVID-19 independent of age, type of comorbidity and other parameters. Thus, our study describes the early immune response associated with severe COVID-19 in cancer patients without intensive chemo/immunotherapy.
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Affiliation(s)
- Prashant R Tembhare
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Harshini Sriram
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Gaurav Chatterjee
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Twinkle Khanka
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Anant Gokarn
- Department of Medical Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Sumeet Mirgh
- Department of Medical Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Akhil Rajendra
- Department of Medical Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Anumeha Chaturvedi
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Sitaram G Ghogale
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Nilesh Deshpande
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Karishma Girase
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Kajal Dalvi
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Sweta Rajpal
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Nikhil Patkar
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Bhakti Trivedi
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Center, HBNI University, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Nitin Shetty
- Department of Radio-Diagnosis, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgical Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Ashwini More
- Department of Medicine, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Sujeet Kamtalwar
- Department of Medicine, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Preeti Chavan
- Composite Laboratory and Microbiology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Vivek Bhat
- Composite Laboratory and Microbiology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Prashant Bhat
- Medical Administration, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Papagudi G Subramanian
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Navin Khattry
- Department of Medical Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
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Costantini VP, Nguyen K, Lyski Z, Novosad S, Bardossy AC, Lyons AK, Gable P, Kutty PK, Lutgring JD, Brunton A, Thornburg N, Brown AC, McDonald LC, Messer W, Vinjé J. Development and validation of an enzyme immunoassay for detection and quantification of SARS-CoV-2 salivary IgA and IgG. medRxiv 2021:2021.09.03.21263078. [PMID: 34518840 PMCID: PMC8437314 DOI: 10.1101/2021.09.03.21263078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/21/2022]
Abstract
Oral fluids offer a non-invasive sampling method for the detection of antibodies. Quantification of IgA and IgG antibodies in saliva allows studies of the mucosal and systemic immune response after natural infection or vaccination. We developed and validated an enzyme immunoassay (EIA) to detect and quantify salivary IgA and IgG antibodies against the prefusion-stabilized form of the SARS-CoV-2 spike protein. Normalization against total antibody isotype was performed to account for specimen differences, such as collection time and sample volume. Saliva samples collected from 187 SARS-CoV-2 confirmed cases enrolled in 2 cohorts and 373 pre-pandemic saliva samples were tested. The sensitivity of both EIAs was high (IgA: 95.5%; IgG: 89.7%) without compromising specificity (IgA: 99%; IgG: 97%). No cross reactivity with seasonal coronaviruses was observed. The limit of detection for SARS-CoV-2 salivary IgA and IgG assays were 1.98 ng/mL and 0.30 ng/mL, respectively. Salivary IgA and IgG antibodies were detected earlier in patients with mild COVID-19 symptoms than in severe cases. However, severe cases showed higher salivary antibody titers than those with a mild infection. Salivary IgA titers quickly decreased after 6 weeks in mild cases but remained detectable until at least week 10 in severe cases. Salivary IgG titers remained high for all patients, regardless of disease severity. In conclusion, EIAs for both IgA and IgG had high specificity and sensitivity for the confirmation of current or recent SARS-CoV-2 infections and evaluation of the IgA and IgG immune response.
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Affiliation(s)
- Veronica P Costantini
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Kenny Nguyen
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, 37830
| | - Zoe Lyski
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Shannon Novosad
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Ana C Bardossy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Amanda K Lyons
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Paige Gable
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Preeta K Kutty
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Joseph D Lutgring
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Amanda Brunton
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Natalie Thornburg
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Allison C Brown
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - L Clifford McDonald
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - William Messer
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR, 97239, USA
- School of Public Health, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jan Vinjé
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
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Limaye MA, Roman AS, Trostle ME, Venkatesh P, Lantigua Martinez M, Brubaker SG, Chervenak J, Wei LS, Sahani P, Grossman TB, Meyer JA, Penfield CA. Predictors of severe and critical disease in pregnant women with SARS-CoV-2. J Matern Fetal Neonatal Med 2021; 35:7536-7540. [PMID: 34470122 PMCID: PMC8425435 DOI: 10.1080/14767058.2021.1951216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVE SARS-CoV-2 continues to spread widely in the US and worldwide. Pregnant women are more likely to develop severe or critical illness than their non-pregnant counterparts. Known risk factors for severe and critical disease outside of pregnancy, such as asthma, diabetes, and obesity have not been well-studied in pregnancy. We aimed to determine which clinical and pregnancy-related factors were associated with severe and critical COVID illness in pregnancy. STUDY DESIGN This was a retrospective cohort study of women with confirmed intrauterine pregnancy and positive nasopharyngeal swab for SARS-CoV-2 who presented to an academic medical center in New York City from 1 March 2020 to 1 July 2020. Severe and critical COVID-19 disease was defined by World Health Organization criteria. Women with severe/critical disease were compared to women with asymptomatic/mild disease. Continuous variables were compared with Mann-Whitney or t-test and categorical variables were compared using chi-square and Fisher's exact. Statistical significance was set at p < .05. Multivariable logistic regression was performed including variables that were significantly different between groups. RESULTS Two hundred and thirty-three patients were included, 186 (79.8%) with asymptomatic/mild disease and 47 (20.2%) with severe/critical disease. Women with asymptomatic/mild disease were compared to those with severe/critical disease. Women with severe/critical disease were more likely to have a history of current or former smoking (19.6 vs. 5.4%, p = .004), COVID-19 diagnosis in the 2nd trimester (42.6 vs. 11.8%, p = .001), and asthma or other respiratory condition (21.3 vs. 7.0%, p = .01). Women with severe/critical disease were more likely to have cesarean delivery (35.5 vs. 15.6%, p < .01) and preterm delivery <37 weeks (25.8 vs. 3.8%, p < .01). After adjustment, history of smoking remained significantly predictive of severe/critical disease [aOR 3.84 (95% CI, 1.25-11.82)]. CONCLUSION Pregnant women with a history of smoking, asthma, or other respiratory condition, and COVID-19 diagnosis in the second trimester of pregnancy were more likely to develop severe/critical disease. These findings may be useful in counseling women on their individual risk of developing the severe or critical disease in pregnancy and may help determine which women are good candidates for vaccination during pregnancy.
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Affiliation(s)
- Meghana A Limaye
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ashley S Roman
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Megan E Trostle
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Pooja Venkatesh
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Meralis Lantigua Martinez
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sara G Brubaker
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Judith Chervenak
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lili S Wei
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Parita Sahani
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Tracy B Grossman
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Jessica A Meyer
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Christina A Penfield
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
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Zerbo O, Lewis N, Fireman B, Goddard K, Skarbinski J, Sejvar JJ, Azziz-Baumgartner E, Klein NP. Population-based assessment of risks for severe COVID-19 disease outcomes. Influenza Other Respir Viruses 2021; 16:159-165. [PMID: 34432371 PMCID: PMC8652998 DOI: 10.1111/irv.12901] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
Among approximately 4.6 million members of Kaiser Permanente Northern California, we examined associations of severe COVID‐19 with demographic factors and comorbidities. As of July 23, 2021, 16 182 had been hospitalized, 2416 admitted to an ICU, and 1525 died due to COVID‐19. Age was strongly associated with hospitalization, ICU admission, and death. Black persons and Hispanic ethnicity had higher risk of death compared with Whites. Among the comorbidities examined, Alzheimer's disease was associated with the highest risk for hospitalization (aHR 3.19, CI: 2.88–3.52) and death (aHR 4.04, CI: 3.32–4.91). Parkinson's disease had the second highest risk of death (aHR = 2.07, CI: 1.50–2.87).
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Affiliation(s)
- Ousseny Zerbo
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California, USA
| | - Ned Lewis
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California, USA
| | - Bruce Fireman
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California, USA
| | - Kristin Goddard
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jacek Skarbinski
- Department of Infectious Diseases, Kaiser Permanente Northern California, Oakland, California, USA
| | - James J Sejvar
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Nicola P Klein
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California, USA
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Huang R, Xie L, He J, Dong H, Liu T. Association between the peripheral blood eosinophil counts and COVID-19: A meta-analysis. Medicine (Baltimore) 2021; 100:e26047. [PMID: 34114990 PMCID: PMC8202592 DOI: 10.1097/md.0000000000026047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/04/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The conclusions about the relationship between eosinophil counts and the severity of coronavirus disease 2019 (COVID-19) were controversial, so we updated the evidences and reassessed it. METHODS We searched the PubMed, Cochrane library, Excerpta Medica Database, and Web of Science to compare the eosinophil counts about non-severe disease group (mild pneumonia, moderate pneumonia, non-critical disease and recovery group) and severe disease group (severe pneumonia, critical pneumonia, critical disease and death group) in COVID-19. RESULTS A total of 1228 patients from 10 studies were included. Compared with non-severe group, severe group had strikingly lower average eosinophil counts (SMD 0.65, 95% confidence intervals [CI] 0.29-1.01; P < .001). The result of subgroup analysis of different countries showed SMD 0.66, 95% CI 0.26-1.06; P < .001. Another subgroup analysis between mild-moderate pneumonia versus severe-critical pneumonia showed SMD 0.69, 95% CI 0.25-1.13; P < .001, and no significant risk of publication bias (Begg test 0.063 and Egger test 0.057) in this subgroup. The heterogeneity was substantial, but the sensitivity analyses showed no significant change when individual study was excluded, which suggested the crediblity and stablity of our results. CONCLUSIONS The eosinophil counts had important value as an indicator of severity in patients with COVID-19. PROSPERO REGISTRATION NUMBER CRD42020205497.
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Sahu AK, Aggarwal P, Ekka M, Nayer J, Bhoi S, Kumar A, Luthra K. Assessing the serum chymase level as an early predictor of dengue severity. J Med Virol 2021; 93:3330-3337. [PMID: 32857465 DOI: 10.1002/jmv.26468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/18/2020] [Revised: 08/10/2020] [Accepted: 08/25/2020] [Indexed: 12/17/2022]
Abstract
We conducted a prospective, observational study to assess the serum chymase level, a mast cell derived protease, as a predictor of dengue severity. NS1-positive non-severe dengue patients of age ≥14 years with duration of fever ≤4 days were included in the study. At the time of admission, the serum sample was taken for chymase estimation. Patients were followed up to four days after they became afebrile to find out the final diagnosis. Total of 338 non-severe dengue patients were recruited (mean age: 29.15 years; male: 66%). On follow-up, 26 patients (7.8%) developed severe dengue. Only chymase level (adjusted odds ratio [aOR]: 1.787; 95% confidence interval [CI]: 1.309-2.440) and platelet count at admission (aOR: 0.981; 95% CI: 0.968-0.993) were able to predict the severity after adjustment for all variables. But, for prediction of severe dengue, the area under receiver's operating curve of chymase was 0.835 (95% CI: 0.765-0.905), which was significantly higher than that of the platelet count at admission (0.760, 95% CI: 0.650-0.870) (p < .001). Patients who developed severe dengue in due course of illness had significantly higher serum chymase level at admission as compared with the rest of the patients. Similar findings were noted across all age-groups. At an optimum cut-off value of 1.35 ng/ml, chymase had a positive likelihood ratio (LR) of 3.5 and a negative LR of 0.15, for predicting severe dengue. This study demonstrated the potential ability of serum chymase levels at admission, as a biomarker for prediction of severe dengue in due course of illness.
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Affiliation(s)
- Ankit Kumar Sahu
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Meera Ekka
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jamshed Nayer
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kalpana Luthra
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
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DeBolt CA, Bianco A, Limaye MA, Silverstein J, Penfield CA, Roman AS, Rosenberg HM, Ferrara L, Lambert C, Khoury R, Bernstein PS, Burd J, Berghella V, Kaplowitz E, Overbey JR, Stone J. Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls. Am J Obstet Gynecol 2021; 224:510.e1-510.e12. [PMID: 33221292 PMCID: PMC7677036 DOI: 10.1016/j.ajog.2020.11.022] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023]
Abstract
Background In March 2020, as community spread of severe acute respiratory syndrome coronavirus 2 became increasingly prevalent, pregnant women seemed to be equally susceptible to developing coronavirus disease 2019. Although the disease course usually appears mild, severe and critical cases of coronavirus disease 2019 seem to lead to substantial morbidity, including intensive care unit admission with prolonged hospital stay, intubation, mechanical ventilation, and even death. Although there are recent reports regarding the impact of coronavirus disease 2019 on pregnancy, there is a lack of information regarding the severity of coronavirus disease 2019 in pregnant vs nonpregnant women. Objective We aimed to describe the outcomes of severe and critical cases of coronavirus disease 2019 in pregnant vs nonpregnant, reproductive-aged women. Study Design This is a multicenter, retrospective, case-control study of women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection hospitalized with severe or critical coronavirus disease 2019 in 4 academic medical centers in New York City and 1 in Philadelphia between March 12, 2020, and May 5, 2020. The cases consisted of pregnant women admitted specifically for severe or critical coronavirus disease 2019 and not for obstetrical indications. The controls consisted of reproductive-aged, nonpregnant women admitted for severe or critical coronavirus disease 2019. The primary outcome was a composite morbidity that includes the following: death, a need for intubation, extracorporeal membrane oxygenation, noninvasive positive pressure ventilation, or a need for high-flow nasal cannula O2 supplementation. The secondary outcomes included intensive care unit admission, length of stay, a need for discharge to long-term acute care facilities, and discharge with a home O2 requirement. Results A total of 38 pregnant women with severe acute respiratory syndrome coronavirus 2 polymerase chain reaction-confirmed infections were admitted to 5 institutions specifically for coronavirus disease 2019, 29 (76.3%) meeting the criteria for severe disease status and 9 (23.7%) meeting the criteria for critical disease status. The mean age and body mass index were markedly higher in the nonpregnant control group. The nonpregnant cohort also had an increased frequency of preexisting medical comorbidities, including diabetes, hypertension, and coronary artery disease. The pregnant women were more likely to experience the primary outcome when compared with the nonpregnant control group (34.2% vs 14.9%; P=.03; adjusted odds ratio, 4.6; 95% confidence interval, 1.2–18.2). The pregnant patients experienced higher rates of intensive care unit admission (39.5% vs 17.0%; P<.01; adjusted odds ratio, 5.2; 95% confidence interval, 1.5–17.5). Among the pregnant women who underwent delivery, 72.7% occurred through cesarean delivery and the mean gestational age at delivery was 33.8±5.5 weeks in patients with severe disease status and 35±3.5 weeks in patients with critical coronavirus disease 2019 status. Conclusion Pregnant women with severe and critical coronavirus disease 2019 are at an increased risk for certain morbidities when compared with nonpregnant controls. Despite the higher comorbidities of diabetes and hypertension in the nonpregnant controls, the pregnant cases were at an increased risk for composite morbidity, intubation, mechanical ventilation, and intensive care unit admission. These findings suggest that pregnancy may be associated with a worse outcome in women with severe and critical cases of coronavirus disease 2019. Our study suggests that similar to other viral infections such as severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus, pregnant women may be at risk for greater morbidity and disease severity.
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Bajpai J, Kant S, Pradhan A, Verma AK. Remdesivir - Current evidence & perspective in management of COVID-19 infection. J Family Med Prim Care 2021; 10:1808-1813. [PMID: 34195107 PMCID: PMC8208188 DOI: 10.4103/jfmpc.jfmpc_1754_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/27/2020] [Revised: 10/27/2020] [Accepted: 02/19/2021] [Indexed: 02/05/2023] Open
Abstract
Coronavirus infection or COVID 19 was first reported in December 2019 in Wuhan, China, and has rapidly spread to more than 200 countries. The pandemic has also taken a toll of over 2.2 million. But the elusive search for an effective antidote is still on. Pending multiple and robust randomized controlled studies, some drugs are being used globally based on in-vitro studies, in -vivo evidence, observational studies, and small nonrandomized studies. Remdesivir is a nucleotide analog. It inhibits viral RNA-dependent RNA polymerase enzyme. Several studies have hitherto demonstrated the promising in-vitro and in-vivo antiviral activities of the molecule against severe acute respiratory syndrome coronavirus (SARS-CoV-1) and the Middle East respiratory syndrome coronavirus (MERS-CoV) strains. It has now exhibited potential in vitro activity against SARS-CoV-2 strains too. Based on pivotal studies, remdesivir is now being used to treat moderate to severe patients through emergency use authorizations and other access programs around the world. This review aims to summarize the evidence and clinical trials of remdesivir as a potential therapeutic option for COVID-19.
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Affiliation(s)
- Jyoti Bajpai
- Department of Respiratory Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Surya Kant
- Department of Respiratory Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajay K. Verma
- Department of Respiratory Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Gajbhiye RK, Mahajan NN, Waghmare RB, Zala S, Chaaithanya IK, Kuppusamy P, Bhurke AV, Pious M, Surve S, Modi DN, Mahale SD. Clinical characteristics, outcomes, & mortality in pregnant women with COVID-19 in Maharashtra, India: Results from PregCovid registry. Indian J Med Res 2021; 153:629-636. [PMID: 34596595 PMCID: PMC8555584 DOI: 10.4103/ijmr.ijmr_1938_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background & objectives The PregCovid registry was established to document the clinical presentations, pregnancy outcomes and mortality of pregnant and post-partum women with COVID-19. Methods The PregCovid registry prospectively collects information in near-real time on pregnant and post-partum women with a laboratory-confirmed diagnosis of SARS-CoV-2 from 19 medical colleges across the State of Maharashtra, India. Data of 4203 pregnant women collected during the first wave of the COVID-19 pandemic (March 2020-January 2021) was analyzed. Results There were 3213 live births, 77 miscarriages and 834 undelivered pregnancies. The proportion of pregnancy/foetal loss including stillbirths was six per cent. Five hundred and thirty-four women (13%) were symptomatic, of which 382 (72%) had mild, 112 (21%) had moderate, and 40 (7.5%) had severe disease. The most common complication was preterm delivery (528, 16.3%) and hypertensive disorders in pregnancy (328, 10.1%). A total of 158 (3.8%) pregnant and post-partum women required intensive care, of which 152 (96%) were due to COVID-19 related complications. The overall case fatality rate (CFR) in pregnant and post-partum women with COVID-19 was 0.8 per cent (34/4203). Higher CFR was observed in Pune (9/853, 1.1%), Marathwada (4/351, 1.1%) regions as compared to Vidarbha (9/1155, 0.8%), Mumbai Metropolitan (11/1684, 0.7%), and Khandesh (1/160, 0.6%) regions. Comorbidities of anaemia, tuberculosis and diabetes mellitus were associated with maternal deaths. Interpretation & conclusions The study demonstrates the adverse outcomes including severe COVID-19 disease, pregnancy loss and maternal death in women with COVID-19 in Maharashtra, India.
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Affiliation(s)
- Rahul K. Gajbhiye
- Department of Clinical Research Lab, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Niraj N. Mahajan
- Department of Obstetrics & Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Rakesh B. Waghmare
- Medical Education & Drugs Department, Government of Maharashtra, Mumbai, Maharashtra, India
| | - Sarika Zala
- Department of Clinical Research Lab, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Itta Krishna Chaaithanya
- Department of Molecular Immunology & Microbiology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Periyasamy Kuppusamy
- Department of Clinical Research Lab, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Aishwarya V. Bhurke
- Department of Clinical Research Lab, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Merlin Pious
- Department of Clinical Research Lab, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Suchitra Surve
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Deepak N. Modi
- Department of Molecular & Cellular Biology Laboratory, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Smita D. Mahale
- ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
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Bavishi C, Whelton PK, Mancia G, Corrao G, Messerli FH. Renin-angiotensin-system inhibitors and all-cause mortality in patients with COVID-19: a systematic review and meta-analysis of observational studies. J Hypertens 2021; 39:784-794. [PMID: 33560054 PMCID: PMC8362761 DOI: 10.1097/hjh.0000000000002784] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS We sought to evaluate the association of angiotensin-converting-enzyme inhibitors (ACEI) or AT1 blockers (ARB) therapy with clinical outcomes in patients with coronavirus disease 2019 (COVID-19). METHODS AND RESULTS Electronic databases were searched to identify published studies that reported clinical outcomes in patients with COVID-19 who were or were not taking an ACEI/ARB. We studied all-cause mortality and/or severe disease outcomes. Fully adjusted effect estimates from individual studies were pooled using a random-effects model. In total, 34 (31 cohort-based and three case-control) studies met our eligibility criteria. Due to the inherent differences between cohort and case-control studies, we did not combine results of these studies but used them to identify the consistency of their results. The 31 cohort studies provided outcome data for 87 951 patients with COVID-19, of whom 22 383/83 963 (26.7%) were on ACEI/ARB therapy. In pooled analysis, we found no association between the use of ACEI/ARB and all-cause mortality/severe disease [relative risk: 0.94, 95% confidence interval (CI): 0.86-1.03, I2 = 57%, P = 0.20] or occurrence of severe disease (relative risk: 0.93, 95% CI: 0.74-1.17, I2 = 56%, P = 0.55). Analysis of three population-based case-control studies identified no significant association between ACEI/ARB (pooled odds ratio: 1.00, 95% CI: 0.81-1.23, I2 = 0, P = 0.98) and all-cause mortality/severe disease. In 13 of the 31 cohort studies as well as in three case-control studies that reported outcomes separately for ACEI and ARB, there was no differential effect for mortality/severe disease outcomes. CONCLUSION In patients with COVID-19, we found no association between ACEI/ARB treatment and mortality/severe disease. ACEI/ARB should not be discontinued, unless clinically indicated.
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Affiliation(s)
- Chirag Bavishi
- Department of Cardiology, Lifespan Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | | | - Giovanni Corrao
- Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Franz H. Messerli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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Torres MC, Lima de Mendonça MC, Damasceno dos Santos Rodrigues C, Fonseca V, Ribeiro MS, Brandão AP, Venâncio da Cunha R, Dias AI, Santos Vilas Boas L, Felix AC, Alves Pereira M, de Oliveira Pinto LM, Sakuntabhai A, Bispo de Filippis AM. Dengue Virus Serotype 2 Intrahost Diversity in Patients with Different Clinical Outcomes. Viruses 2021; 13:v13020349. [PMID: 33672226 PMCID: PMC7926750 DOI: 10.3390/v13020349] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/07/2021] [Accepted: 02/13/2021] [Indexed: 02/07/2023] Open
Abstract
Intrahost genetic diversity is thought to facilitate arbovirus adaptation to changing environments and hosts, and it might also be linked to viral pathogenesis. Dengue virus serotype 2 (DENV-2) has circulated in Brazil since 1990 and is associated with severe disease and explosive outbreaks. Intending to shed light on the viral determinants for severe dengue pathogenesis, we sought to analyze the DENV-2 intrahost genetic diversity in 68 patient cases clinically classified as dengue fever (n = 31), dengue with warning signs (n = 19), and severe dengue (n = 18). Unlike previous DENV intrahost diversity studies whose approaches employed PCR, here we performed viral whole-genome deep sequencing from clinical samples with an amplicon-free approach, representing the real intrahost diversity scenario. Striking differences were detected in the viral population structure between the three clinical categories, which appear to be driven mainly by different infection times and selection pressures, rather than being linked with the clinical outcome itself. Diversity in the NS2B gene, however, showed to be constrained, irrespective of clinical outcome and infection time. Finally, 385 non-synonymous intrahost single-nucleotide variants located along the viral polyprotein, plus variants located in the untranslated regions, were consistently identified among the samples. Of them, 124 were exclusively or highly detected among cases with warning signs and among severe cases. However, there was no variant that by itself appeared to characterize the cases of greater severity, either due to its low intrahost frequency or the conservative effect on amino acid substitution. Although further studies are necessary to determine their real effect on viral proteins, this heightens the possibility of epistatic interactions. The present analysis represents an initial effort to correlate DENV-2 genetic diversity to its pathogenic potential and thus contribute to understanding the virus’s dynamics within its human host.
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Affiliation(s)
- Maria Celeste Torres
- Laboratório de Flavivírus, Instituto Oswaldo Cruz, Fiocruz, 21040-360 Rio de Janeiro, Brazil; (M.C.L.d.M.); (C.D.d.S.R.); (A.M.B.d.F.)
- Correspondence:
| | - Marcos Cesar Lima de Mendonça
- Laboratório de Flavivírus, Instituto Oswaldo Cruz, Fiocruz, 21040-360 Rio de Janeiro, Brazil; (M.C.L.d.M.); (C.D.d.S.R.); (A.M.B.d.F.)
| | | | - Vagner Fonseca
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, 4041 Durban, South Africa;
- Laboratório de Genética Celular e Molecular, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, Brazil
- Coordenação Geral dos Laboratórios de Saúde Pública/Secretaria de Vigilância em Saúde, Ministério da Saúde, (CGLAB/SVS-MS) Brasília, 70719-040 Distrito Federal, Brazil
| | - Mario Sergio Ribeiro
- Superintendência Secretaria de Vigilância em Saúde do Estado do Rio de Janeiro, 20031-142 Rio de Janeiro, Brazil;
| | - Ana Paula Brandão
- Laboratório Central Noel Nutels/LACEN, 20231-092 Rio de Janeiro, Brazil;
| | - Rivaldo Venâncio da Cunha
- Coordenação de Vigilância em Saúde e Laboratórios de Referência da Fundação Oswaldo Cruz, FIOCRUZ, 21040-360 Rio de Janeiro, Brazil;
| | - Ana Isabel Dias
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, 05403-000 São Paulo, Brazil; (A.I.D.); (L.S.V.B.); (A.C.F.)
| | - Lucy Santos Vilas Boas
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, 05403-000 São Paulo, Brazil; (A.I.D.); (L.S.V.B.); (A.C.F.)
| | - Alvina Clara Felix
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, 05403-000 São Paulo, Brazil; (A.I.D.); (L.S.V.B.); (A.C.F.)
| | | | | | - Anavaj Sakuntabhai
- Functional Genetics of Infectious Diseases, Department of Global Health, Institut Pasteur, 75015 Paris, France;
| | - Ana Maria Bispo de Filippis
- Laboratório de Flavivírus, Instituto Oswaldo Cruz, Fiocruz, 21040-360 Rio de Janeiro, Brazil; (M.C.L.d.M.); (C.D.d.S.R.); (A.M.B.d.F.)
| | - on behalf of ZikAction Consortium
- Laboratório de Flavivírus, Instituto Oswaldo Cruz, Fiocruz, 21040-360 Rio de Janeiro, Brazil; (M.C.L.d.M.); (C.D.d.S.R.); (A.M.B.d.F.)
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Sahu AK, Mathew R, Aggarwal P, Nayer J, Bhoi S, Satapathy S, Ekka M. Clinical Determinants of Severe COVID-19 Disease - A Systematic Review and Meta-Analysis. J Glob Infect Dis 2021; 13:13-19. [PMID: 33911447 PMCID: PMC8054797 DOI: 10.4103/jgid.jgid_136_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 06/12/2020] [Revised: 08/06/2020] [Accepted: 08/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background: A systematic review and meta-analysis of available studies was performed to investigate the clinical characteristics that can predict COVID-19 disease severity. Materials and Methods: Databases including PubMed, Embase, and Web of Science were searched from December 31, 2019, to May 24, 2020. Random-effects meta-analysis was used for summarizing the Pooled odds ratio (pOR) of individual clinical characteristics to describe their association with severe COVID-19 disease. Results: A total of 3895 articles were identified, and finally, 22 studies comprising 4380 patients were included. Severe disease was more common in males than females (pOR: 1.36, 95% confidence interval [CI]: 1.08–1.70). Clinical features that were associated with significantly higher odds of severe disease were abdominal pain (pOR: 6.58, 95% CI: 1.56–27.67), breathlessness (pOR: 3.94, 95% CI: 2.55–6.07), and hemoptysis (pOR: 3.35, 95% CI: 1.05–10.74). pOR was highest for chronic obstructive pulmonary disease (pOR: 2.92, 95% CI: 1.70–5.02), followed by obesity (pOR: 2.84, 95% CI: 1.19–6.77), malignancy (pOR: 2.38, 95% CI: 1.25–4.52), diabetes (pOR: 2.29, 95% CI: 1.56–3.39), hypertension (pOR: 1.72, 95% CI: 1.23–2.42), cardiovascular disease (pOR: 1.61, 95% CI: 1.31–1.98) and chronic kidney disease (pOR: 1.46, 95% CI: 1.06–2.02), for predicting severe COVID-19. Conclusion: Our analysis describes the association of specific symptoms and comorbidities with severe COVID-19 disease. Knowledge of these clinical determinants will assist the clinicians in the risk-stratification of these patients for better triage and clinical management.
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Affiliation(s)
- Ankit Kumar Sahu
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Roshan Mathew
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jamshed Nayer
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Swayamjeet Satapathy
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Meera Ekka
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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Abstract
PURPOSE OF REVIEW We examine the interplay between the HIV and COVID-19 epidemics, including the impact of HIV on COVID-19 susceptibility and severe disease, the effect of the COVID-19 epidemic on HIV prevention and treatment, and the influence of the HIV epidemic on responses to COVID-19. RECENT FINDINGS Evidence to date does not suggest that people living with HIV (PLWH) have a markedly higher susceptibility to SARS-CoV-2 infection, with disparities in the social determinants of health and comorbidities likely having a greater influence. The majority of literature has not supported a higher risk for severe disease among PLWH in Europe and the United States, although a large, population-based study in South Africa reported a higher rate of death due to COVID-19. Higher rates of comorbidities associated with COVID-19 disease severity among PLWH is an urgent concern. COVID-19 is leading to decreased access to HIV prevention services and HIV testing, and worsening HIV treatment access and virologic suppression, which could lead to worsening HIV epidemic control. CONCLUSION COVID-19 is threatening gains against the HIV epidemic, including the U.S. Ending the HIV Epidemic goals. The ongoing collision of these two global pandemics will continue to need both study and interventions to mitigate the effects of COVID-19 on HIV efforts worldwide.
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Affiliation(s)
- Lillian B. Brown
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - Matthew A. Spinelli
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - Monica Gandhi
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
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Fabrizi F, Alfieri CM, Cerutti R, Lunghi G, Messa P. COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis. Pathogens 2020; 9:pathogens9121052. [PMID: 33334023 PMCID: PMC7765425 DOI: 10.3390/pathogens9121052] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background: coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome—coronavirus-2 (SARS-CoV-2)—is an ongoing pandemic with high morbidity and mortality rates. Preliminary evidence suggests that acute kidney injury (AKI) is uncommon in patients with COVID-19 and associated with poor outcomes. Study aims and design: we performed a systematic review of the literature with a meta-analysis of clinical studies to evaluate the frequency of AKI and dialysis requirement in patients who underwent hospitalization due to COVID-19. The incidence of AKI according to the death risk was calculated in these patients. The random-effects model of DerSimonian and Laird was adopted, with heterogeneity and stratified analyses. Results: thirty-nine clinical studies (n = 25,566 unique patients) were retrieved. The pooled incidence of AKI was 0.154 (95% CI, 0.107; 0.201; p < 0.0001) across the studies. Significant heterogeneity was found (p = 0.0001). The overall frequency of COVID-19-positive patients who underwent renal replacement therapy (RRT) was 0.043 (95% CI, 0.031; 0.055; p < 0.0001); no publication bias was found (Egger’s test, p = 0.11). The pooled estimate of AKI incidence in patients with severe COVID-19 was 0.53 (95% CI, 0.427; 0.633) and heterogeneity occurred (Q = 621.08, I2 = 97.26, p = 0.0001). According to our meta-regression, age (p < 0.007) and arterial hypertension (p < 0.001) were associated with AKI occurrence in hospitalized COVID-19 positive patients. The odds ratio (OR) for the incidence of AKI in deceased COVID-19 positive patients was greater than among survivors, 15.4 (95% CI, 20.99; 11.4; p < 0.001). Conclusions: AKI is a common complication in hospitalized COVID-19 positive patients. Additional studies are under way to assess the risk of AKI in COVID-19 patients and to deepen the mechanisms of kidney injury.
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Affiliation(s)
- Fabrizio Fabrizi
- Division of Nephrology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (C.M.A.); (R.C.); (P.M.)
- Correspondence: ; Tel.: +39-2-55034552; Fax: +39-2-55034550
| | - Carlo M. Alfieri
- Division of Nephrology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (C.M.A.); (R.C.); (P.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
| | - Roberta Cerutti
- Division of Nephrology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (C.M.A.); (R.C.); (P.M.)
| | - Giovanna Lunghi
- Virology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy;
| | - Piergiorgio Messa
- Division of Nephrology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (C.M.A.); (R.C.); (P.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
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Asim M, Sathian B, Banerjee I, Robinson J. A contemporary insight of metabolomics approach for COVID-19: Potential for novel therapeutic and diagnostic targets. Nepal J Epidemiol 2020; 10:923-927. [PMID: 33495710 PMCID: PMC7812325 DOI: 10.3126/nje.v10i4.33964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic is caused by rapidly spreading pathogenic virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that affects vast majority of population worldwide. Although, around 80% of the cases had mild infection but still remaining 20% had developed respiratory failure and dysfunction of other organs that necessitate urgent oxygen therapy or specific interventions. Therefore, it is imperative to establish novel prognostic approaches to screen patients at high-risk of developing severe complications. The primary focus of current research for COVID-19 is to discover safe and efficacious vaccine for prevention and effective treatment for better management of the patients to overcome the pandemic. To achieve this goal, it is imperative to have better understanding of the molecular pathways involved in the pathophysiology and progression of severe COVID-19. The surge for reliable diagnostics and therapeutics targets for COVID-19 highlighted the great potential of high-throughput approach like metabolomics which may enable the development of personalized medicine.
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Affiliation(s)
- Mohammad Asim
- Surgery Department, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Brijesh Sathian
- Geriatrics and long term care Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
- Centre for Midwifery, Maternal and Perinatal Health, Bournemouth University, Bournemouth, England, United Kingdom
| | | | - Jared Robinson
- Sir Seewoosagur Ramgoolam Medical College, Belle Rive, Mauritius
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50
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Ji P, Zhu J, Zhong Z, Li H, Pang J, Li B, Zhang J. Association of elevated inflammatory markers and severe COVID-19: A meta-analysis. Medicine (Baltimore) 2020; 99:e23315. [PMID: 33217868 PMCID: PMC7676531 DOI: 10.1097/md.0000000000023315] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/08/2020] [Accepted: 10/21/2020] [Indexed: 01/11/2023] Open
Abstract
Our study aimed to assess the existing evidence on whether severe coronavirus disease 2019 (COVID-19) is associated with elevated inflammatory markers.The PubMed, Embase, Web of Science, Scopus, Chinese National Knowledge Infrastructure, WanFang, and China Science and Technology Journal databases were searched to identify studies published between January 1 and April 21, 2020 that assayed inflammatory markers in COVID-19 patients. Three reviewers independently examined the literature, extracted relevant data, and assessed the risk of publication bias before including the meta-analysis studies.Fifty-six studies involving 8719 COVID-19 patients were identified. Meta-analysis showed that patients with severe disease showed elevated levels of white blood cell count (WMD: 1.15, 95% CI: 0.78-1.52), C-reactive protein (WMD: 38.85, 95% CI: 31.19-46.52), procalcitonin (WMD: 0.08, 95% CI: 0.06-0.11), erythrocyte sedimentation rate (WMD: 10.15, 95% CI: 5.03-15.46), interleukin-6 (WMD: 23.87, 95% CI: 15.95-31.78), and interleukin-10 (WMD: 2.12, 95% CI: 1.97-2.28). Similarly, COVID-19 patients who died during follow-up showed significantly higher levels of white blood cell count (WMD: 4.11, 95% CI: 3.25-4.97), C-reactive protein (WMD: 74.18, 95% CI: 56.63-91.73), procalcitonin (WMD: 0.26, 95% CI: 0.11-0.42), erythrocyte sedimentation rate (WMD: 10.94, 95% CI: 4.79-17.09), and interleukin-6 (WMD: 59.88, 95% CI: 19.46-100.30) than survivors.Severe COVID-19 is associated with higher levels of inflammatory markers than a mild disease, so tracking these markers may allow early identification or even prediction of disease progression.
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