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Blankestijn JM, Abdel-Aziz MI, Baalbaki N, Bazdar S, Beekers I, Beijers RJHCG, Bloemsma LD, Cornelissen MEB, Gach D, Houweling L, Holverda S, Jacobs JJL, Jonker R, van der Lee I, Linders PMA, Mohamed Hoesein FAA, Noij LCE, Nossent EJ, van de Pol MA, Schaminee DW, Schols AMWJ, Schuurman LT, Sondermeijer B, Geelhoed JJM, van den Bergh JP, Weersink EJM, de Wit-van Wijck Y, Maitland-van der Zee AH. Long COVID exhibits clinically distinct phenotypes at 3-6 months post-SARS-CoV-2 infection: results from the P4O2 consortium. BMJ Open Respir Res 2024; 11:e001907. [PMID: 38663887 PMCID: PMC11043734 DOI: 10.1136/bmjresp-2023-001907] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Four months after SARS-CoV-2 infection, 22%-50% of COVID-19 patients still experience complaints. Long COVID is a heterogeneous disease and finding subtypes could aid in optimising and developing treatment for the individual patient. METHODS Data were collected from 95 patients in the P4O2 COVID-19 cohort at 3-6 months after infection. Unsupervised hierarchical clustering was performed on patient characteristics, characteristics from acute SARS-CoV-2 infection, long COVID symptom data, lung function and questionnaires describing the impact and severity of long COVID. To assess robustness, partitioning around medoids was used as alternative clustering. RESULTS Three distinct clusters of patients with long COVID were revealed. Cluster 1 (44%) represented predominantly female patients (93%) with pre-existing asthma and suffered from a median of four symptom categories, including fatigue and respiratory and neurological symptoms. They showed a milder SARS-CoV-2 infection. Cluster 2 (38%) consisted of predominantly male patients (83%) with cardiovascular disease (CVD) and suffered from a median of three symptom categories, most commonly respiratory and neurological symptoms. This cluster also showed a significantly lower forced expiratory volume within 1 s and diffusion capacity of the lung for carbon monoxide. Cluster 3 (18%) was predominantly male (88%) with pre-existing CVD and diabetes. This cluster showed the mildest long COVID, and suffered from symptoms in a median of one symptom category. CONCLUSIONS Long COVID patients can be clustered into three distinct phenotypes based on their clinical presentation and easily obtainable information. These clusters show distinction in patient characteristics, lung function, long COVID severity and acute SARS-CoV-2 infection severity. This clustering can help in selecting the most beneficial monitoring and/or treatment strategies for patients suffering from long COVID. Follow-up research is needed to reveal the underlying molecular mechanisms implicated in the different phenotypes and determine the efficacy of treatment.
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Affiliation(s)
- Jelle M Blankestijn
- Department of Pulmonary Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Mahmoud I Abdel-Aziz
- Department of Pulmonary Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Clinical Pharmacy, Assiut University Faculty of Pharmacy, Assiut, Egypt
| | - Nadia Baalbaki
- Department of Pulmonary Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Somayeh Bazdar
- Department of Pulmonary Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Inés Beekers
- ORTEC, Zoetermeer, Zuid-Holland, The Netherlands
| | - Rosanne J H C G Beijers
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Universiteit Maastricht School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Lizan D Bloemsma
- Department of Pulmonary Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Merel E B Cornelissen
- Department of Pulmonary Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Debbie Gach
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Universiteit Maastricht School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Laura Houweling
- Department of Pulmonary Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Environmental Epidemiology, Utrecht University Institute for Risk Assessment Sciences, Utrecht, The Netherlands
| | | | | | - Reneé Jonker
- Department of Pulmonary Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Ivo van der Lee
- Department of Pulmonology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Paulien M A Linders
- Department of Pulmonary Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | - Lieke C E Noij
- Department of Pulmonary Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Esther J Nossent
- Department of Pulmonary Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Marianne A van de Pol
- Department of Pulmonary Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Daphne W Schaminee
- Department of Pulmonary Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Annemie M W J Schols
- Universiteit Maastricht School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Lisanne T Schuurman
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Universiteit Maastricht School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | | | - J J Miranda Geelhoed
- Department of Respiratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Joop P van den Bergh
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Els J M Weersink
- Department of Pulmonary Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | - Anke H Maitland-van der Zee
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Pediatric Respiratory Medicine, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
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Baalbaki N, Blankestijn JM, Abdel-Aziz MI, de Backer J, Bazdar S, Beekers I, Beijers RJHCG, van den Bergh JP, Bloemsma LD, Bogaard HJ, van Bragt JJMH, van den Brink V, Charbonnier JP, Cornelissen MEB, Dagelet Y, Davies EH, van der Does AM, Downward GS, van Drunen CM, Gach D, Geelhoed JJM, Glastra J, Golebski K, Heijink IH, Holtjer JCS, Holverda S, Houweling L, Jacobs JJL, Jonker R, Kos R, Langen RCJ, van der Lee I, Leliveld A, Mohamed Hoesein FAA, Neerincx AH, Noij L, Olsson J, van de Pol M, Pouwels SD, Rolink E, Rutgers M, Șahin H, Schaminee D, Schols AMWJ, Schuurman L, Slingers G, Smeenk O, Sondermeijer B, Skipp PJ, Tamarit M, Verkouter I, Vermeulen R, de Vries R, Weersink EJM, van de Werken M, de Wit-van Wijck Y, Young S, Nossent EJ, Maitland-van der Zee AH. Precision Medicine for More Oxygen (P4O2)-Study Design and First Results of the Long COVID-19 Extension. J Pers Med 2023; 13:1060. [PMID: 37511673 PMCID: PMC10381397 DOI: 10.3390/jpm13071060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/30/2023] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has led to the death of almost 7 million people, however, with a cumulative incidence of 0.76 billion, most people survive COVID-19. Several studies indicate that the acute phase of COVID-19 may be followed by persistent symptoms including fatigue, dyspnea, headache, musculoskeletal symptoms, and pulmonary functional-and radiological abnormalities. However, the impact of COVID-19 on long-term health outcomes remains to be elucidated. Aims: The Precision Medicine for more Oxygen (P4O2) consortium COVID-19 extension aims to identify long COVID patients that are at risk for developing chronic lung disease and furthermore, to identify treatable traits and innovative personalized therapeutic strategies for prevention and treatment. This study aims to describe the study design and first results of the P4O2 COVID-19 cohort. Methods: The P4O2 COVID-19 study is a prospective multicenter cohort study that includes nested personalized counseling intervention trial. Patients, aged 40-65 years, were recruited from outpatient post-COVID clinics from five hospitals in The Netherlands. During study visits at 3-6 and 12-18 months post-COVID-19, data from medical records, pulmonary function tests, chest computed tomography scans and biological samples were collected and questionnaires were administered. Furthermore, exposome data was collected at the patient's home and state-of-the-art imaging techniques as well as multi-omics analyses will be performed on collected data. Results: 95 long COVID patients were enrolled between May 2021 and September 2022. The current study showed persistence of clinical symptoms and signs of pulmonary function test/radiological abnormalities in post-COVID patients at 3-6 months post-COVID. The most commonly reported symptoms included respiratory symptoms (78.9%), neurological symptoms (68.4%) and fatigue (67.4%). Female sex and infection with the Delta, compared with the Beta, SARS-CoV-2 variant were significantly associated with more persisting symptom categories. Conclusions: The P4O2 COVID-19 study contributes to our understanding of the long-term health impacts of COVID-19. Furthermore, P4O2 COVID-19 can lead to the identification of different phenotypes of long COVID patients, for example those that are at risk for developing chronic lung disease. Understanding the mechanisms behind the different phenotypes and identifying these patients at an early stage can help to develop and optimize prevention and treatment strategies.
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Affiliation(s)
- Nadia Baalbaki
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, 1105 AZ Amsterdam, The Netherlands
| | - Jelle M Blankestijn
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, 1105 AZ Amsterdam, The Netherlands
| | - Mahmoud I Abdel-Aziz
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, 1105 AZ Amsterdam, The Netherlands
- Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
| | | | - Somayeh Bazdar
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, 1105 AZ Amsterdam, The Netherlands
| | - Inés Beekers
- ORTEC BV, Department of Health, Houtsingel 5, 2719 EA Zoetermeer, The Netherlands
| | - Rosanne J H C G Beijers
- Department of Respiratory Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, 6200 MD Maastricht, The Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, 5912 BL Venlo, The Netherlands
| | - Lizan D Bloemsma
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, 1105 AZ Amsterdam, The Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Job J M H van Bragt
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, 1105 AZ Amsterdam, The Netherlands
| | - Vera van den Brink
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | | | - Merel E B Cornelissen
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, 1105 AZ Amsterdam, The Netherlands
| | - Yennece Dagelet
- Breathomix B.V., Bargelaan 200, 2333 CW Leiden, The Netherlands
| | - Elin Haf Davies
- Aparito Netherlands B.V., Galileiweg 8, BioPartner 3 Building, 2333 BD Leiden, The Netherlands
| | - Anne M van der Does
- Department of Pulmonology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - George S Downward
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584 CL Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Cornelis M van Drunen
- Department of Otorhinolaryngology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Debbie Gach
- Department of Respiratory Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, 6200 MD Maastricht, The Netherlands
| | - J J Miranda Geelhoed
- Department of Pulmonology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jorrit Glastra
- Quantib-U, Westblaak 106, 3012 KM Rotterdam, The Netherlands
| | - Kornel Golebski
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Department of Otorhinolaryngology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Irene H Heijink
- Department of Pulmonology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Department Pathology & Medical Biology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Judith C S Holtjer
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584 CL Utrecht, The Netherlands
| | | | - Laura Houweling
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584 CL Utrecht, The Netherlands
| | - John J L Jacobs
- ORTEC BV, Department of Health, Houtsingel 5, 2719 EA Zoetermeer, The Netherlands
| | - Renée Jonker
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Renate Kos
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, 1105 AZ Amsterdam, The Netherlands
| | - Ramon C J Langen
- Department of Respiratory Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Ivo van der Lee
- Department of Pulmonology, Spaarne Hospital, 2134 TM Hoofddorp, The Netherlands
| | - Asabi Leliveld
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Firdaus A A Mohamed Hoesein
- Department of Radiology, University Medical Center Utrecht and Utrecht University, 3508 GA Utrecht, The Netherlands
| | - Anne H Neerincx
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, 1105 AZ Amsterdam, The Netherlands
| | - Lieke Noij
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, 1105 AZ Amsterdam, The Netherlands
| | - Johan Olsson
- Smartfish AS, Oslo Science Park, Gaustadalléen 21, 0349 Oslo, Norway
| | - Marianne van de Pol
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Simon D Pouwels
- Department of Pulmonology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Department Pathology & Medical Biology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Emiel Rolink
- Long Alliantie Nederland, Address Stationsplein 125, 3818 LE Amersfoort, The Netherlands
| | - Michael Rutgers
- Longfonds, Stationsplein 125, 3818 LE Amersfoort, The Netherlands
| | - Havva Șahin
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Daphne Schaminee
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, 6200 MD Maastricht, The Netherlands
| | - Lisanne Schuurman
- Department of Respiratory Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, 6200 MD Maastricht, The Netherlands
| | - Gitte Slingers
- Breathomix B.V., Bargelaan 200, 2333 CW Leiden, The Netherlands
| | - Olie Smeenk
- Sodaq, Bussumerstraat 34, 1211 BL Hilversum, The Netherlands
| | | | - Paul J Skipp
- TopMD Precision Medicine Ltdincorporated, Southhampton SO45 3PN, UK
| | - Marisca Tamarit
- Breathomix B.V., Bargelaan 200, 2333 CW Leiden, The Netherlands
| | - Inge Verkouter
- ORTEC BV, Department of Health, Houtsingel 5, 2719 EA Zoetermeer, The Netherlands
| | - Roel Vermeulen
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584 CL Utrecht, The Netherlands
| | - Rianne de Vries
- Breathomix B.V., Bargelaan 200, 2333 CW Leiden, The Netherlands
| | - Els J M Weersink
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Marco van de Werken
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Yolanda de Wit-van Wijck
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, 1105 AZ Amsterdam, The Netherlands
| | - Stewart Young
- Philips GmbH Innovative Technologies, 4646 AG Eindhoven, The Netherlands
| | - Esther J Nossent
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Anke H Maitland-van der Zee
- Department of Pulmonary Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, 1105 AZ Amsterdam, The Netherlands
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van Raaij BFM, Veltman JD, Hameete JF, Stöger JL, Geelhoed JJM. Diagnostic performance of eNose technology in COVID-19 patients after hospitalization. BMC Pulm Med 2023; 23:134. [PMID: 37081422 PMCID: PMC10117233 DOI: 10.1186/s12890-023-02407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Volatile organic compounds (VOCs) produced by human cells reflect metabolic and pathophysiological processes which can be detected with the use of electronic nose (eNose) technology. Analysis of exhaled breath may potentially play an important role in diagnosing COVID-19 and stratification of patients based on pulmonary function or chest CT. METHODS Breath profiles of COVID-19 patients were collected with an eNose device (SpiroNose) 3 months after discharge from the Leiden University Medical Centre and matched with breath profiles from healthy individuals for analysis. Principal component analysis was performed with leave-one-out cross validation and visualised with receiver operating characteristics. COVID-19 patients were stratified in subgroups with a normal pulmonary diffusion capacity versus patients with an impaired pulmonary diffusion capacity (DLCOc < 80% of predicted) and in subgroups with a normal chest CT versus patients with COVID-19 related chest CT abnormalities. RESULTS The breath profiles of 135 COVID-19 patients were analysed and matched with 174 healthy controls. The SpiroNose differentiated between COVID-19 after hospitalization and healthy controls with an AUC of 0.893 (95-CI, 0.851-0.934). There was no difference in VOCs patterns in subgroups of COVID-19 patients based on diffusion capacity or chest CT. CONCLUSIONS COVID-19 patients have a breath profile distinguishable from healthy individuals shortly after hospitalization which can be detected using eNose technology. This may suggest ongoing inflammation or a common repair mechanism. The eNose could not differentiate between subgroups of COVID-19 patients based on pulmonary diffusion capacity or chest CT.
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Affiliation(s)
- B F M van Raaij
- Department of Internal Medicine, Section of Geriatrics and Gerontology, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, Leiden, Netherlands.
| | - J D Veltman
- Department of Pulmonary Diseases, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - J F Hameete
- Department of Pulmonary Diseases, Leiden University Medical Centre, Leiden, Netherlands
| | - J L Stöger
- Department of Radiology, Leiden University Medical Centre, Leiden, Netherlands
| | - J J M Geelhoed
- Department of Pulmonary Diseases, Leiden University Medical Centre, Leiden, Netherlands
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4
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Elffers TW, de Graaf MA, Regeer MV, Omara S, Schalij MJ, Groeneveld GH, Roukens AHE, Geelhoed JJM, Antoni ML. Myocardial function in COVID-19 patients after hospital discharge: a descriptive study comparing the first and second 'wave' patients. Int J Cardiovasc Imaging 2022; 38:1951-1960. [PMID: 37726605 PMCID: PMC9013213 DOI: 10.1007/s10554-022-02590-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/03/2022] [Indexed: 12/02/2022]
Abstract
In hospitalized COVID-19 patients, myocardial injury and echocardiographic abnormalities have been described. The present study investigates cardiac function in COVID-19 patients 6 weeks post-discharge and evaluates its relation to New York Heart Association (NYHA) class. Furthermore cardiac function post-discharge between the first and second wave COVID-19 patients was compared. We evaluated 146 patients at the outpatient clinic of the Leiden University Medical Centre. NYHA class of II or higher was reported by 53% of patients. Transthoracic echocardiography was used to assess cardiac function. Overall, in 27% of patients reduced left ventricular (LV) ejection fraction was observed and in 29% of patients LV global longitudinal strain was impaired (> - 16%). However no differences were observed in these parameters reflecting LV function between the first and second wave patients. Right ventricular (RV) dysfunction as assessed by tricuspid annular systolic planar excursion (< 17 mm) was present in 14% of patients, this was also not different between the first and second wave patients (15% vs. 12%; p = 0.63); similar results were found for RV fraction area change and RV strain. Reduced LV and RV function were not associated with NYHA class. In COVID-19 patients at 6 weeks post-discharge, mild abnormalities in cardiac function were found. However these were not related to NYHA class and there was no difference in cardiac function between the first and second wave patients. Long term symptoms post-COVID might therefore not be explained by mildly abnormal cardiac function.
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Affiliation(s)
- T W Elffers
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - M A de Graaf
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - M V Regeer
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - S Omara
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - M J Schalij
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - G H Groeneveld
- Department of Infectious Diseases and Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - A H E Roukens
- Department of Infectious Diseases and Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - J J M Geelhoed
- Department of Pulmonology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M L Antoni
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, Leiden, The Netherlands.
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5
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Dirikgil E, Brons K, Duindam M, Groeneveld GH, Geelhoed JJM, Heringhaus C, van der Boog PJM, Rabelink TJ, Bos WJW, Chavannes NH, Atsma DE, Teng YKO. COVID-box Experiences of Patients and Health Care Professionals (COVID-box Project): Single-Center, Retrospective, Observational Study. JMIR Form Res 2022; 6:e38263. [PMID: 35816688 PMCID: PMC9337621 DOI: 10.2196/38263] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background During the COVID-19 pandemic, several home monitoring programs have described the success of reducing hospital admissions, but only a few studies have investigated the experiences of patients and health care professionals. Objective The objective of our study was to determine patients’ and health care professionals’ experiences and satisfaction with employing the COVID-box. Methods In this single-center, retrospective, observational study, patients and health care professionals were asked to anonymously fill out multiple-choice questionnaires with questions on a 5-point or 10-point Likert scale. The themes addressed by patients were the sense of reassurance and safety, experiences with teleconsultations, their appreciation for staying at home, and the instructions for using the COVID-box. The themes addressed by health care professionals who treated patients with the COVID-box were the characteristics of the COVID-box, the technical support service and general satisfaction, and their expectations and support for this telemonitoring concept. Scores were interpreted as insufficient (≤2 or ≤5, respectively), sufficient (3 or 6-7, respectively), or good (≥4 or ≥8, respectively) on a 5-point or 10-point Likert scale. Results A total of 117 patients and 25 health care professionals filled out the questionnaires. The median score was 4 (IQR 4-5) for the sense of safety, the appreciation for staying at home, and experiences with teleconsultations, with good scores from 76.5% (88/115), 86% (56/65), and 83.6% (92/110) of the patients, respectively. Further, 74.4% (87/117) of the patients scored the home monitoring program with a score of ≥8. Health care professionals scored the COVID-box with a minimum median score of 7 (IQR 7-10) on a 10-point scale for all domains (ie, the characteristics of the COVID-box and the technical support service and general satisfaction). For the sense of safety, user-friendliness, and additional value of the COVID-box, the median scores were 8 (IQR 8-10), 8 (IQR 7-9), and 10 (IQR 8-10), respectively, with good scores from 86% (19/22), 75% (15/20), and 96% (24/25) of the health care professionals, respectively. All health care professionals (25/25, 100%) gave a score of ≥8 for supporting this home monitoring concept, with a median score of 10 (IQR 10-10). Conclusions The positive experiences and satisfaction of involved users are key factors for the successful implementation of a novel eHealth solution. In our study, patients, as well as health care professionals, were highly satisfied with the use of the home monitoring program—the COVID-box project. Remote home monitoring may be an effective approach in cases of increased demand for hospital care and high pressure on health care systems.
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Affiliation(s)
- Ebru Dirikgil
- Department of Nephrology, Leiden University Medical Center, Leiden, Netherlands
| | - Kim Brons
- Directorate of Quality and Patient Safety, Leiden University Medical Center, Leiden, Netherlands
| | - Michael Duindam
- Directorate of Quality and Patient Safety, Leiden University Medical Center, Leiden, Netherlands
| | - Geert H Groeneveld
- Department of Infectious diseases, Leiden University Medical Center, Leiden, Netherlands
| | - J J Miranda Geelhoed
- Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands
| | - Christian Heringhaus
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, Netherlands
| | | | - Ton J Rabelink
- Department of Nephrology, Leiden University Medical Center, Leiden, Netherlands
| | - Willem Jan W Bos
- Department of Nephrology, Leiden University Medical Center, Leiden, Netherlands
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Douwe E Atsma
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Y K Onno Teng
- Department of Nephrology, Leiden University Medical Center, Leiden, Netherlands
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Nakshbandi G, Moor CC, Nossent EJ, Geelhoed JJM, Baart SJ, Boerrigter BG, Aerts JGJV, Nijman SFM, Santema HY, Hellemons ME, Wijsenbeek MS. Home monitoring of lung function, symptoms and quality of life after admission with COVID-19 infection: The HOMECOMIN' study. Respirology 2022; 27:501-509. [PMID: 35441433 PMCID: PMC9115460 DOI: 10.1111/resp.14262] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 12/15/2021] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 01/20/2023]
Abstract
Background and objective To develop targeted and efficient follow‐up programmes for patients hospitalized with coronavirus disease 2019 (COVID‐19), structured and detailed insights in recovery trajectory are required. We aimed to gain detailed insights in long‐term recovery after COVID‐19 infection, using an online home monitoring programme including home spirometry. Moreover, we evaluated patient experiences with the home monitoring programme. Methods In this prospective multicentre study, we included adults hospitalized due to COVID‐19 with radiological abnormalities. For 6 months after discharge, patients collected weekly home spirometry and pulse oximetry measurements, and reported visual analogue scales on cough, dyspnoea and fatigue. Patients completed the fatigue assessment scale (FAS), global rating of change (GRC), EuroQol‐5D‐5L (EQ‐5D‐5L) and online tool for the assessment of burden of COVID‐19 (ABCoV tool). Mixed models were used to analyse the results. Results A total of 133 patients were included in this study (70.1% male, mean age 60 years [SD 10.54]). Patients had a mean baseline forced vital capacity of 3.25 L (95% CI: 2.99–3.44 L), which increased linearly in 6 months with 19.1% (Δ0.62 L, p < 0.005). Patients reported substantial fatigue with no improvement over time. Nevertheless, health status improved significantly. After 6 months, patients scored their general well‐being almost similar as before COVID‐19. Overall, patients considered home spirometry useful and not burdensome. Conclusion Six months after hospital admission for COVID‐19, patients' lung function and quality of life were still improving, although fatigue persisted. Home monitoring enables detailed follow‐up for patients with COVID‐19 at low burden for patients and for the healthcare system.
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Affiliation(s)
- Gizal Nakshbandi
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Catharina C Moor
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Esther J Nossent
- Department of Pulmonary Medicine, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
| | - J J Miranda Geelhoed
- Department of Respiratory Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sara J Baart
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Bart G Boerrigter
- Department of Pulmonary Medicine, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
| | - Joachim G J V Aerts
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Suzan F M Nijman
- Department of Pulmonary Medicine, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
| | - Helger Y Santema
- Department of Respiratory Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Merel E Hellemons
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marlies S Wijsenbeek
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
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7
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Aman J, Duijvelaar E, Botros L, Kianzad A, Schippers JR, Smeele PJ, Azhang S, Bartelink IH, Bayoumy AA, Bet PM, Boersma W, Bonta PI, Boomars KAT, Bos LDJ, van Bragt JJMH, Braunstahl GJ, Celant LR, Eger KAB, Geelhoed JJM, van Glabbeek YLE, Grotjohan HP, Hagens LA, Happe CM, Hazes BD, Heunks LMA, van den Heuvel M, Hoefsloot W, Hoek RJA, Hoekstra R, Hofstee HMA, Juffermans NP, Kemper EM, Kos R, Kunst PWA, Lammers A, van der Lee I, van der Lee EL, Maitland-van der Zee AH, Mau Asam PFM, Mieras A, Muller M, Neefjes L, Nossent EJ, Oswald LMA, Overbeek MJ, Pamplona C, Paternotte N, Pronk N, de Raaf MA, van Raaij BFM, Reijrink M, Schultz MJ, Serpa Neto A, Slob EM, Smeenk FWJM, Smit MR, Smits AJ, Stalenhoef JE, Tuinman PR, Vanhove ALEM, Wessels JN, van Wezenbeek JCC, Vonk Noordegraaf A, de Man FS, Bogaard HJ. Imatinib in patients with severe COVID-19: a randomised, double-blind, placebo-controlled, clinical trial. Lancet Respir Med 2021; 9:957-968. [PMID: 34147142 PMCID: PMC8232929 DOI: 10.1016/s2213-2600(21)00237-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The major complication of COVID-19 is hypoxaemic respiratory failure from capillary leak and alveolar oedema. Experimental and early clinical data suggest that the tyrosine-kinase inhibitor imatinib reverses pulmonary capillary leak. METHODS This randomised, double-blind, placebo-controlled, clinical trial was done at 13 academic and non-academic teaching hospitals in the Netherlands. Hospitalised patients (aged ≥18 years) with COVID-19, as confirmed by an RT-PCR test for SARS-CoV-2, requiring supplemental oxygen to maintain a peripheral oxygen saturation of greater than 94% were eligible. Patients were excluded if they had severe pre-existing pulmonary disease, had pre-existing heart failure, had undergone active treatment of a haematological or non-haematological malignancy in the previous 12 months, had cytopenia, or were receiving concomitant treatment with medication known to strongly interact with imatinib. Patients were randomly assigned (1:1) to receive either oral imatinib, given as a loading dose of 800 mg on day 0 followed by 400 mg daily on days 1-9, or placebo. Randomisation was done with a computer-based clinical data management platform with variable block sizes (containing two, four, or six patients), stratified by study site. The primary outcome was time to discontinuation of mechanical ventilation and supplemental oxygen for more than 48 consecutive hours, while being alive during a 28-day period. Secondary outcomes included safety, mortality at 28 days, and the need for invasive mechanical ventilation. All efficacy and safety analyses were done in all randomised patients who had received at least one dose of study medication (modified intention-to-treat population). This study is registered with the EU Clinical Trials Register (EudraCT 2020-001236-10). FINDINGS Between March 31, 2020, and Jan 4, 2021, 805 patients were screened, of whom 400 were eligible and randomly assigned to the imatinib group (n=204) or the placebo group (n=196). A total of 385 (96%) patients (median age 64 years [IQR 56-73]) received at least one dose of study medication and were included in the modified intention-to-treat population. Time to discontinuation of ventilation and supplemental oxygen for more than 48 h was not significantly different between the two groups (unadjusted hazard ratio [HR] 0·95 [95% CI 0·76-1·20]). At day 28, 15 (8%) of 197 patients had died in the imatinib group compared with 27 (14%) of 188 patients in the placebo group (unadjusted HR 0·51 [0·27-0·95]). After adjusting for baseline imbalances between the two groups (sex, obesity, diabetes, and cardiovascular disease) the HR for mortality was 0·52 (95% CI 0·26-1·05). The HR for mechanical ventilation in the imatinib group compared with the placebo group was 1·07 (0·63-1·80; p=0·81). The median duration of invasive mechanical ventilation was 7 days (IQR 3-13) in the imatinib group compared with 12 days (6-20) in the placebo group (p=0·0080). 91 (46%) of 197 patients in the imatinib group and 82 (44%) of 188 patients in the placebo group had at least one grade 3 or higher adverse event. The safety evaluation revealed no imatinib-associated adverse events. INTERPRETATION The study failed to meet its primary outcome, as imatinib did not reduce the time to discontinuation of ventilation and supplemental oxygen for more than 48 consecutive hours in patients with COVID-19 requiring supplemental oxygen. The observed effects on survival (although attenuated after adjustment for baseline imbalances) and duration of mechanical ventilation suggest that imatinib might confer clinical benefit in hospitalised patients with COVID-19, but further studies are required to validate these findings. FUNDING Amsterdam Medical Center Foundation, Nederlandse Organisatie voor Wetenschappelijk Onderzoek/ZonMW, and the European Union Innovative Medicines Initiative 2.
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Affiliation(s)
- Jurjan Aman
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Erik Duijvelaar
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Liza Botros
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Azar Kianzad
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Job R Schippers
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Patrick J Smeele
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sara Azhang
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Pulmonology, Haaglanden Medisch Centrum, The Hague, Netherlands
| | - Imke H Bartelink
- Department of Pharmacy, Amsterdam UMC, VUMC, Amsterdam, Netherlands
| | - Ahmed A Bayoumy
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Pulmonology, Chest Unit, Suez Canal University, Suez, Egypt
| | - Pierre M Bet
- Department of Pharmacy, Amsterdam UMC, VUMC, Amsterdam, Netherlands
| | - Wim Boersma
- Department of Pulmonology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Karin A T Boomars
- Department of Pulmonology, Erasmus Medisch Centrum, Rotterdam, Netherlands
| | - Lieuwe D J Bos
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands; Department of Intensive Care, Amsterdam UMC, AMC, Amsterdam, Netherlands
| | - Job J M H van Bragt
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Sint Franciscus Ziekenhuis, Rotterdam, Netherlands
| | - Lucas R Celant
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Katrien A B Eger
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Yurika L E van Glabbeek
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hans P Grotjohan
- Department of Pulmonology, Isala Ziekenhuizen, Zwolle, Netherlands
| | - Laura A Hagens
- Department of Intensive Care, Amsterdam UMC, AMC, Amsterdam, Netherlands
| | - Chris M Happe
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Boaz D Hazes
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Leo M A Heunks
- Department of Intensive Care, Amsterdam UMC, VUMC, Amsterdam, Netherlands
| | | | | | - Rianne J A Hoek
- Department of Pharmacy, Amsterdam UMC, VUMC, Amsterdam, Netherlands
| | - Romke Hoekstra
- Department of Pulmonology, Antonius Ziekenhuis, Sneek, Netherlands
| | - Herman M A Hofstee
- Department of Internal Medicine, Haaglanden Medisch Centrum, The Hague, Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care, Amsterdam UMC, AMC, Amsterdam, Netherlands; Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | | | - Renate Kos
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Peter W A Kunst
- Department of Pulmonology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Ariana Lammers
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ivo van der Lee
- Department of Pulmonology, Spaarne Gasthuis, Haarlem, Netherlands
| | - E Laurien van der Lee
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Pearl F M Mau Asam
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Adinda Mieras
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mirte Muller
- Department of Pulmonology, Catharina Ziekenhuis, Eindhoven, Netherlands
| | - Liesbeth Neefjes
- Department of Pulmonology, Catharina Ziekenhuis, Eindhoven, Netherlands
| | - Esther J Nossent
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Laurien M A Oswald
- Department of Pulmonology, Sint Franciscus Ziekenhuis, Rotterdam, Netherlands
| | - Maria J Overbeek
- Department of Pulmonology, Haaglanden Medisch Centrum, The Hague, Netherlands
| | - Carolina Pamplona
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nienke Paternotte
- Department of Pulmonology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
| | - Niels Pronk
- Department of Pulmonology, Gelre Ziekenhuis, Apeldoorn, Netherlands
| | - Michiel A de Raaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Bas F M van Raaij
- Department of Pulmonology Leiden University Medical Center, Leiden, Netherlands
| | - Merlijn Reijrink
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam UMC, AMC, Amsterdam, Netherlands
| | - Ary Serpa Neto
- Department of Critical Care Medicine and Institute of Education and Research, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Elise M Slob
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Marry R Smit
- Department of Intensive Care, Amsterdam UMC, AMC, Amsterdam, Netherlands
| | - A Josien Smits
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Janneke E Stalenhoef
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care, Amsterdam UMC, VUMC, Amsterdam, Netherlands
| | - Arthur L E M Vanhove
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jessie N Wessels
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jessie C C van Wezenbeek
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Harm J Bogaard
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
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8
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Klok FA, Boon GJAM, Barco S, Endres M, Geelhoed JJM, Knauss S, Rezek SA, Spruit MA, Vehreschild J, Siegerink B. The Post-COVID-19 Functional Status scale: a tool to measure functional status over time after COVID-19. Eur Respir J 2020; 56:13993003.01494-2020. [PMID: 32398306 PMCID: PMC7236834 DOI: 10.1183/13993003.01494-2020] [Citation(s) in RCA: 284] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 12/31/2022]
Abstract
Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, most attention has focused on containing transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and addressing the surge of critically ill patients in acute care settings. Indeed, as of 29 April 2020, over 3 million confirmed cases have been accounted for globally [1]. In the coming weeks and months, emphasis will gradually involve also post-acute care of COVID-19 survivors. It is anticipated that COVID-19 may have a major impact on physical, cognitive, mental and social health status, also in patients with mild disease presentation [2]. Previous outbreaks of coronaviruses have been associated with persistent pulmonary function impairment, muscle weakness, pain, fatigue, depression, anxiety, vocational problems, and reduced quality of life to various degrees [3–5]. An ordinal tool is proposed to measure the full spectrum of functional outcomes following COVID-19. This “Post-COVID-19 Functional Status (PCFS) scale” can be used for tracking functional status over time as well as for research purposes.https://bit.ly/3cofGaa
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Affiliation(s)
- Frederikus A Klok
- Dept of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands .,Center for Thrombosis and Haemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gudula J A M Boon
- Dept of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefano Barco
- Center for Thrombosis and Haemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Dept of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Samuel Knauss
- Dept of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Spencer A Rezek
- Institute of Therapies and Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Martijn A Spruit
- Dept of Research and Development, CIRO+, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Center (MUMC+), NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jörg Vehreschild
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Dept I for Internal Medicine, Cologne, Germany.,German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.,Dept of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Bob Siegerink
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Dept of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Moor CC, Wapenaar M, Miedema JR, Geelhoed JJM, Chandoesing PP, Wijsenbeek MS. A home monitoring program including real-time wireless home spirometry in idiopathic pulmonary fibrosis: a pilot study on experiences and barriers. Respir Res 2018; 19:105. [PMID: 29843728 PMCID: PMC5975585 DOI: 10.1186/s12931-018-0810-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/10/2018] [Indexed: 11/12/2022] Open
Abstract
In idiopathic pulmonary fibrosis (IPF), home monitoring experiences are limited, not yet real-time available nor implemented in daily care. We evaluated feasibility and potential barriers of a new home monitoring program with real-time wireless home spirometry in IPF. Ten patients with IPF were asked to test this home monitoring program, including daily home spirometry, for four weeks. Measurements of home and hospital spirometry showed good agreement. All patients considered real-time wireless spirometry useful and highly feasible. Both patients and researchers suggested relatively easy solutions for the identified potential barriers regarding real-time home monitoring in IPF.
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Affiliation(s)
- C C Moor
- Department of Respiratory Medicine, Erasmus University Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015, CE, The Netherlands
| | - M Wapenaar
- Department of Respiratory Medicine, Erasmus University Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015, CE, The Netherlands
| | - J R Miedema
- Department of Respiratory Medicine, Erasmus University Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015, CE, The Netherlands
| | - J J M Geelhoed
- Department of Respiratory Medicine, Erasmus University Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015, CE, The Netherlands
| | - P P Chandoesing
- Department of Respiratory Medicine, Erasmus University Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015, CE, The Netherlands
| | - M S Wijsenbeek
- Department of Respiratory Medicine, Erasmus University Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015, CE, The Netherlands.
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Abstract
Idiopathic pulmonary fibrosis (IPF) is a devastating, progressive and ultimately fatal lung disease. The combination of poor prognosis, uncertainty of disease course and severe symptom burden heavily impacts patients' and their families' quality of life. Though new antifibrotic drugs have been shown to decrease disease progression, the effect on health-related quality of life (HRQOL) has not been convincingly demonstrated. In a relentless disease such as IPF, striving to optimize HRQOL should complement the endeavour to prolong life. Unfortunately, there is a paucity of interventions improving symptoms and functionality for patients with IPF, and research focusing on symptom improvement, and assessing and optimizing HRQOL, is limited. This review summarizes the most recent insights into measuring and improving quality of life for patients with IPF, and discusses challenges in the management of this devastating disease. Moreover, we postulate a new model for continuous care in IPF - 'the ABCDE of IPF care': Assessing patients' needs; Backing patients by giving information and support; delivering Comfort care by focusing on treating symptoms and taking into account Comorbidities; striving to prolong life by Disease modification; helping and preparing patients and their caregivers for the eventual End-of-life events that are likely to occur.
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Affiliation(s)
- Mirjam J G van Manen
- Department of Respiratory Medicine, Erasmus Medical Center, University Hospital Rotterdam, The Netherlands
| | - J J Miranda Geelhoed
- Department of Respiratory Medicine, Erasmus Medical Center, University Hospital Rotterdam, The Netherlands
| | - Nelleke C Tak
- Department of Respiratory Medicine, Erasmus Medical Center, University Hospital Rotterdam, The Netherlands
| | - Marlies S Wijsenbeek
- Department of Respiratory Medicine, Erasmus Medical Center, University Hospital Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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Heppe DHM, Taal HR, Ernst GDS, Van Den Akker ELT, Lequin MMH, Hokken-Koelega ACS, Geelhoed JJM, Jaddoe VWV. Bone age assessment by dual-energy X-ray absorptiometry in children: an alternative for X-ray? Br J Radiol 2011; 85:114-20. [PMID: 21586503 DOI: 10.1259/bjr/23858213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of the study was to validate dual-energy X-ray absorptiometry (DXA) as a method to assess bone age in children. METHODS Paired dual-energy X-ray absorptiometry (DXA) scans and X-rays of the left hand were performed in 95 children who attended the paediatric endocrinology outpatient clinic of University Hospital Rotterdam, the Netherlands. We compared bone age assessments by DXA scan with those performed by X-ray. Bone age assessment was performed by two blinded observers according to the reference method of Greulich and Pyle. Intra-observer and interobserver reproducibility were investigated using the intraclass correlation coefficient (ICC), and agreement was tested using Bland and Altman plots. RESULTS The intra-observer ICCs for both observers were 0.997 and 0.991 for X-ray and 0.993 and 0.987 for DXA assessments. The interobserver ICC was 0.993 and 0.991 for X-ray and DXA assessments, respectively. The mean difference between bone age assessed by X-ray and DXA was 0.11 years. The limits of agreement ranged from -0.82 to 1.05 years, which means that 95% of all differences between the methods were covered by this range. CONCLUSIONS Results of bone age assessment by DXA scan are similar to those obtained by X-ray. The DXA method seems to be an alternative for assessing bone age in a paediatric hospital-based population.
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Affiliation(s)
- D H M Heppe
- The Generation R Study Group, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
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12
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Geelhoed JJM, El Marroun H, Verburg BO, van Osch-Gevers L, Hofman A, Huizink AC, Moll HA, Verhulst FC, Helbing WA, Steegers EAP, Jaddoe VWV. Maternal smoking during pregnancy, fetal arterial resistance adaptations and cardiovascular function in childhood. BJOG 2011; 118:755-62. [PMID: 21385303 DOI: 10.1111/j.1471-0528.2011.02900.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To unravel the mechanisms underlying the previously demonstrated associations between low birthweight and cardiovascular disease in adulthood, we examined whether maternal smoking during pregnancy leads to fetal arterial resistance adaptations, and subsequently to fetal growth retardation and changes in postnatal blood pressure and cardiac development. DESIGN Prospective cohort study from early fetal life onwards. SETTING Academic hospital. POPULATION Analyses were based on 1120 children aged 2 years. METHODS Maternal smoking during pregnancy [non-smoking, first trimester smoking, continued smoking (< 5 and ≥ 5 cigarettes/day)] was assessed by questionnaire. MAIN OUTCOME MEASURES Third trimester placental and fetal arterial resistance indices and fetal growth were assessed by ultrasound and Doppler measurements. Postnatal blood pressure and cardiac structures (aortic root diameter, left atrial diameter, left ventricular mass) were measured at 2 years of age. RESULTS First trimester smoking was not associated with third trimester placental and fetal blood flow adaptations. Continued smoking of ≥ 5 cigarettes/day was associated with an increased resistance in uterine, umbilical and middle cerebral arteries, and with a decreased flow and diameter of the ascending aorta. Among mothers who continued to smoke, the third trimester estimated fetal weights and birthweights were most affected in children with the highest umbilical artery resistance. Fetal arterial resistance indices were also associated with aortic root diameter and left atrial diameter. CONCLUSIONS Fetal arterial resistance adaptations may be involved in the pathways leading from maternal smoking during pregnancy to low birthweight and cardiovascular developmental changes in childhood in the offspring.
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Affiliation(s)
- J J M Geelhoed
- The Generation R Study Group Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
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Geelhoed JJM, van Duijn C, van Osch-Gevers L, Steegers EAP, Hofman A, Helbing WA, Jaddoe VWV. Glucocorticoid receptor-9beta polymorphism is associated with systolic blood pressure and heart growth during early childhood. The Generation R Study. Early Hum Dev 2011; 87:97-102. [PMID: 21146942 DOI: 10.1016/j.earlhumdev.2010.11.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 09/28/2010] [Accepted: 11/09/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND glucocorticoid receptor-9β polymorphism (rs6198) is associated with the susceptibility for cardiovascular disease. AIM to examine whether the GR-9 β variant is also associated with blood pressure and heart growth in early childhood. STUDY DESIGN this study was embedded in a population-based prospective cohort study from fetal life onwards. Analyses were based on 857 children. OUTCOME MEASURES Left cardiac structures (aortic root diameter, left atrial diameter and left ventricular mass), shortening fraction and heart beat were measured postnatally at the ages of 1.5, 6 and 24 months. Blood pressure was measured at 24 months of age. RESULTS the distribution of the GR-9β genotype showed 75.1% homozygous reference, 23.5% heterozygous and 1.4% homozygous variant subjects. No differences in cardiovascular outcomes were observed at the ages of 1.5 and 6 months. At the age of 24 months, homozygous variants showed an increased systolic blood pressure of 2.65 mmHg (95% CI: 0.16, 5.14), an increased heart rate of 9.10 beats per minute (95% CI: 1.28, 16.7) and an increased left ventricular mass of 4.99 g (95% CI: 1.33, 8.65) compared to homozygous references. This means an increase of 2.6%, 8.6% and 16%, respectively. GR-9 β polymorphism was significantly associated with left ventricular mass growth during the first 2 years. CONCLUSION our findings suggest that genetically determined differences in cortisol exposure affect cardiovascular development in early life.
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Affiliation(s)
- J J Miranda Geelhoed
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.
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14
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Geelhoed JJM, Fraser A, Tilling K, Benfield L, Davey Smith G, Sattar N, Nelson SM, Lawlor DA. Preeclampsia and gestational hypertension are associated with childhood blood pressure independently of family adiposity measures: the Avon Longitudinal Study of Parents and Children. Circulation 2010; 122:1192-9. [PMID: 20823385 DOI: 10.1161/circulationaha.110.936674] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Offspring of women with hypertensive disorders of pregnancy are at increased risk of cardiovascular complications later in life, but the mechanisms underlying these associations are unclear. Our aim was to examine whether adjusting for birth weight and familial adiposity changed the association of hypertensive disorders of pregnancy with offspring blood pressure. METHODS AND RESULTS Using data from 6343 nine-year-old participants in the Avon Longitudinal Study of Parents and Children, we examined the association between hypertensive disorders of pregnancy (preeclampsia and gestational hypertension) and offspring blood pressure. Both preeclampsia and gestational hypertension were associated with systolic and diastolic blood pressures in the 9-year-old offspring; after adjustment for parental and own adiposity and for other potential confounders, the mean difference in systolic blood pressure was 2.05 mm Hg (95 confidence interval, 0.72 to 3.38) and 2.04 mm Hg (95 confidence interval, 1.42 to 2.67) for preeclampsia and gestational hypertension, respectively, compared with those with no hypertensive disorders of pregnancy. Equivalent results for diastolic blood pressure were 1.00 mm Hg (95 confidence interval, -0.01 to 2.10) and 1.07 mm Hg (95 confidence interval, 0.60 to 1.54). The association of preeclampsia with offspring systolic and diastolic blood pressures attenuated toward the null with further adjustment for birth weight and gestational age, whereas these adjustments did not attenuate the association of gestational hypertension with offspring blood pressure. CONCLUSIONS The associations of hypertensive disorders of pregnancy with higher offspring blood pressure are not explained by familial adiposity. The mechanisms linking preeclampsia and gestational hypertension with offspring blood pressure may differ, with the former mediated at least in part by the effect of preeclampsia on intrauterine growth restriction.
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Affiliation(s)
- J J Miranda Geelhoed
- Generation R Study Group and Departments of Epidemiology and Pediatrics, Erasmus Medical Center, Rotterdam, the Netherlands
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15
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de Jonge LL, van Osch-Gevers L, Geelhoed JJM, Hofman A, Steegers EAP, Helbing WA, Jaddoe VWV. Breastfeeding is not associated with left cardiac structures and blood pressure during the first two years of life. The Generation R Study. Early Hum Dev 2010; 86:463-8. [PMID: 20609534 DOI: 10.1016/j.earlhumdev.2010.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 05/07/2010] [Accepted: 06/03/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Shorter duration of breastfeeding in infancy has been suggested to be associated with an increased risk of cardiovascular disease in adulthood. Early cardiovascular adaptations due to breastfeeding may explain these associations. AIM To investigate whether breastfeeding affects left cardiac structures and blood pressure development in early childhood. STUDY DESIGN Prospective cohort study from fetal life until the age of two years. SUBJECTS Information about the duration and exclusivity of breastfeeding was collected by questionnaires at the ages of 2, 6 and 12 months in 933 children. OUTCOME MEASURES Left cardiac structures (left atrial diameter, aortic root diameter and left ventricular mass), fractional shortening and blood pressure at the ages of 1.5, 6 and 24 months. RESULTS No differences in cardiac structures, fractional shortening and blood pressure were observed between breastfed and non-breastfed children. Duration and exclusivity of breastfeeding were not consistently associated with any cardiac structure, fractional shortening, or blood pressure until the age of 24 months. Also, there was no association of breastfeeding with cardiac growth between 6 months and 24 months. All analyses were adjusted for child age and sex. Additional adjustment for child anthropometrics, maternal age, anthropometrics, family history, maternal cardiovascular risk factors, pregnancy or delivery complications, parity, socio-economic status, smoking status and alcohol consumption during pregnancy did not materially change the effect estimates. CONCLUSIONS Our results do not support the hypothesis that early postnatal cardiovascular adaptations underlie the previously shown associations between breastfeeding and cardiovascular disease in adulthood. Further studies are needed to investigate whether and at what age the associations appear.
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Affiliation(s)
- Layla L de Jonge
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
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16
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Geelhoed JJM, Taal HR, Steegers EAP, Arends LR, Lequin M, Moll HA, Hofman A, van der Heijden AJ, Jaddoe VWV. Kidney growth curves in healthy children from the third trimester of pregnancy until the age of two years. The Generation R Study. Pediatr Nephrol 2010; 25:289-98. [PMID: 19898876 PMCID: PMC7811527 DOI: 10.1007/s00467-009-1335-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 09/02/2009] [Accepted: 09/16/2009] [Indexed: 11/29/2022]
Abstract
Information about growth of kidney structures in early life is limited. In a population-based prospective cohort study, from foetal life onwards, we constructed reference curves for kidney growth from the third trimester of pregnancy until early childhood, using data from 1,158 healthy children. Kidney size, defined as length, width, depth and volume, was measured in the third trimester of pregnancy and at the postnatal ages of 6 months and 24 months. Analyses were based on more than 2,500 kidney measurements. In the third trimester of pregnancy and at 6 months of age all kidney measurements were larger in boys than in girls. At 24 months of age, these gender differences were only significant for left kidney structures and right kidney length. Both groups showed trends towards smaller left kidney measurements than right kidney measurements at all ages. Gender-specific reference curves based on post-conceptional and postnatal ages were constructed for left and right kidney length, width, depth and volume. We concluded that kidney size is influenced by age and gender. Left kidney size tended to be smaller than right kidney size, except for kidney length. The reference curves can be used for assessing kidney structures by ultrasound in foetal life and early childhood.
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Affiliation(s)
- J. J. Miranda Geelhoed
- The Generation R Study Group (AE-006), Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - H. Rob Taal
- The Generation R Study Group (AE-006), Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric A. P. Steegers
- Department of Obstetrics & Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lidia R. Arends
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maarten Lequin
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henriëtte A. Moll
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Vincent W. V. Jaddoe
- The Generation R Study Group (AE-006), Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
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Geelhoed JJM, Mook-Kanamori DO, Witteman JCM, Hofman A, van Duijn CM, Moll HA, Steegers EAP, Hokken-Koelega ACS, Jaddoe VWV. Variation in the IGF1 gene and growth in foetal life and infancy. The Generation R Study. Clin Endocrinol (Oxf) 2008; 68:382-9. [PMID: 17888024 DOI: 10.1111/j.1365-2265.2007.03050.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objective of this study was to examine whether variants of the IGF1 gene are associated with growth patterns from foetal life until infancy. STUDY DESIGN AND MEASUREMENTS This study was embedded in the Generation R Study, a population-based prospective cohort study of foetal life. Foetal growth (head circumference, abdominal circumference, femur length, estimated foetal weight) was assessed by ultrasound in early, mid- and late pregnancy. Growth in infancy was assessed at birth (weight) and at the ages of 6 weeks, 6 months and 14 months (head circumference, length, weight). The IGF1 promoter region genotype was determined in 738 children. RESULTS Eight alleles of the IGF1 promoter region were identified. In total, 43% of the subjects were homozygous for the most common 192-bp allele (wild-type), 45% were heterozygous, and 12% were noncarriers of the 192-bp allele. No differences were found in birthweight between the three groups. However, noncarriers had a lower estimated foetal weight in mid-pregnancy (P = 0.040), followed by an increased growth rate until 6 months (P < 0.005) in comparison to the 192-bp homozygotes. A similar difference in growth rate was found for length (P < 0.001). CONCLUSIONS Variants of the IGF1 promoter region are not associated with birthweight. However, noncarriers of the 192-bp allele tend to have a smaller foetal size, followed by an increased growth rate from mid-pregnancy to early infancy. Studies in larger cohorts are necessary to replicate our findings and to examine whether these effects persist throughout childhood.
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Affiliation(s)
- J J Miranda Geelhoed
- The Generation R Study Group, Department of Epidemiology and Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
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18
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Geelhoed JJM, VAN Osch-Gevers L, Verburg BO, Steegers EAP, Hofman A, Helbing W, Witteman JCM, Jaddoe VWV. Maternal anthropometrics in pregnancy are associated with left ventricular mass in infancy. The generation R study. Pediatr Res 2008; 63:62-6. [PMID: 18043515 DOI: 10.1203/pdr.0b013e31815b4449] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Pregnancy and early life factors may permanently affect left ventricular growth and development in the offspring. The aim of this study was to examine the associations of maternal anthropometrics during pregnancy with left ventricular mass (LVM) in infancy. This study was embedded in the Generation R Study, a population-based prospective cohort study from fetal life onwards. Maternal anthropometrics were obtained in early (gestational age <18 wk), mid- (gestational age 18-25 wk), and late (gestational age >25 wk) pregnancy. Echocardiographic follow-up measurements were performed in 791 infants aged 6 wk and 6 mo. We found no associations of maternal height, weight, or body mass index (BMI) measured in early, mid-, and late pregnancy with longitudinally measured left ventricular mass (LVM) from 6 wk to 6 mo. Maternal weight gain until late pregnancy was associated with an increased growth of LVM from 6 wk to 6 mo [difference 0.46 g per week for the highest tertile of weight gain compared with the lowest tertile (p value <0.05)]. We concluded that maternal weight gain until late pregnancy is associated with larger LVM at the age of 6 mo, suggesting that maternal health status during pregnancy may have permanent consequences for LVM in their children. Further studies are needed to identify the underlying causal mechanisms and the long-term consequences.
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Affiliation(s)
- J J Miranda Geelhoed
- The Generation R Study Group, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
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19
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Mook-Kanamori DO, Miranda Geelhoed JJ, Steegers EAP, Witteman JCM, Hofman A, Moll HA, van Duijn CM, Hokken-Koelega ACS, Jaddoe VWV. Insulin gene variable number of tandem repeats is not associated with weight from fetal life until infancy: the Generation R Study. Eur J Endocrinol 2007; 157:741-8. [PMID: 18057381 DOI: 10.1530/eje-07-0378] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to examine whether the insulin gene variable number of tandem repeats (INS VNTR) is associated with growth patterns in fetal life and infancy. DESIGN AND METHODS This study was embedded in the Generation R Study, a population-based prospective cohort study from fetal life until young adulthood. Fetal growth was assessed by ultrasounds in early, mid-, and late pregnancy. Anthropometry in infancy was assessed at birth and at the ages of 6 weeks, 6 months, and 14 months. DNA for genotyping of the INS VNTR promoter region was available in 859 children. RESULTS The genotype distribution was I/I 50.8%, I/III 40.0%, and III/III 9.2%. III/III individuals had a shorter gestational age (P<0.005 versus I/I) and a lower birth weight (P<0.05 versus I/I). There were no differences in birth weight after adjusting for gestational age. Class III homozygotes had a smaller abdominal circumference/head circumference (HC) ratio (P<0.005 versus I/I) in mid-pregnancy, but not in late pregnancy. Also, III/III subjects had a relative decrease in HC (SDS) from mid-pregnancy to the age of 14 months (P<0.05 versus I/I). No other differences in pre- and postnatal growth characteristics and patterns were found. CONCLUSIONS Class III homozygotes were born at an earlier gestational age. No association was found between INS VNTR and birth weight adjusted for gestational age. Our data suggest that the III/III genotype may be associated with asymmetrical growth in mid-pregnancy, but not in late pregnancy.
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Affiliation(s)
- Dennis O Mook-Kanamori
- The Generation R Study Group, Department of Epidemiology and Biostatistics, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Verburg BO, Geelhoed JJM, Steegers EAP, Hofman A, Moll HA, Witteman JCM, Jaddoe VWV. Fetal kidney volume and its association with growth and blood flow in fetal life: The Generation R Study. Kidney Int 2007; 72:754-61. [PMID: 17637711 DOI: 10.1038/sj.ki.5002420] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An adverse fetal environment may lead to smaller kidneys and subsequent hypertension with renal disease in adult life. The aim of our study was to examine whether maternal characteristics, fetal growth, fetal blood flow redistribution, or inadequate placental perfusion in different periods of fetal life affect kidney volume in late fetal life. We also determined if fetal kidney volume was linked to the amount of amniotic fluid. In a population-based prospective study from early fetal life, fetal growth characteristics and fetal blood flow parameters were assessed by ultrasound and Doppler examinations in 1215 women in mid- and late-pregnancy. Kidney volume was measured in late pregnancy. Maternal height and pre-pregnancy weight were associated with kidney volume. After adjustment for the same characteristics in late pregnancy, fetal growth and blood flow in mid-pregnancy were not associated with kidney volume in late pregnancy. In late pregnancy, however, all fetal growth parameters were positively linked with kidney volume. The largest effect on kidney volume was found for abdominal circumference. Signs of fetal blood flow redistribution and increased placental resistance were associated with decreased kidney volume in late pregnancy. Amniotic fluid volume was positively associated with kidney volume. Our study shows that maternal anthropometrics, fetal growth, fetal blood flow redistribution, and raised placental resistance all correlate with kidney volume.
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Affiliation(s)
- B O Verburg
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
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