ABSTRACT
Introduction: We aimed to compare the COVID-19 outcomes in unvaccinated and CoronaVac vaccinated older adults. Material(s) and Method(s): In this single-center study, patients aged >=65 years who were hospitalized for COVID-19 were retrospectively analyzed in two groups: unvaccinated and vaccinated. Result(s): A total of 742 patients were included. The mean age was 76.6+/-7.6 years. Of these, 46.1% (n=342) were male, 76.0% (n=564) were vaccinated. Among patients who were transferred to the intensive care unit (n=217), 206 (27.8%) received invasive mechanical ventilation support and 194 (26.1%) were died. In the multivariate analysis, advanced age (OR=1.03, 95%CI=1.01-1.06, p<0.01) and a high Charlson Comorbidity Index (OR=1.24, 95%CI=1.12-1.38, p<0.01) were predictors of mortality, while being vaccinated (OR=0.75, 95%CI=0.62-0.91, p<0.01) was associated with survival. Vaccination reduced the need for intensive care by 26.5% and mortality by 24.9 %. When the vaccinated group was evaluated, high Charlson Comorbidity Index (OR=1.428, 95%CI=1.14-1.64, p<0.01) was an independent predictor for mortality. However, booster vaccination in the last 130 days was the only protective factor that reduced mortality (p=0.04, 95%CI=0.43-0.99, OR=0.66) in multivariate analysis. Booster dose vaccination in the last 130 days reduced mortality by 33.8%. Conclusion(s): CoronaVac vaccination improved survival in hospitalized older adult patients (>=65 years old) with COVID-19. However, delaying the booster dose for more than 130 days were significantly associated with decreased survival. Therefore, older adults who completed their primary vaccination series with CoronaVac should not delay their booster dose to reduce the risk of death. Copyright © 2022, Geriatrics Society. All rights reserved.
ABSTRACT
The aim of this clinical trial was to control the cytokine storm by administering mesenchymal stem cells (MSCs) to critically-ill COVID-19 patients, to evaluate the healing effect, and to systematically investigate how the treatment works. Patients with moderate and critical COVID-19 clinical manifestations were separated as Group 1 (moderate cases, n = 10, treated conventionally), Group 2 (critical cases, n = 10, treated conventionally), and Group 3 (critical cases, n = 10, treated conventionally plus MSCs transplantation therapy of three consecutive doses on treatment days 0, 3, and 6, (as 3 × 106 cells/kg, intravenously). The treatment mechanism of action was investigated with evaluation markers of the cytokine storm, via biochemical parameters, levels of proinflammatory and anti-inflammatory cytokines, analyses of tissue regeneration via the levels of growth factors, apoptosis markers, chemokines, matrix metalloproteinases, and granzyme-B, and by the assessment of the immunomodulatory effects via total oxidant/antioxidant status markers and the levels of lymphocyte subsets. In the assessment of the overall mortality rates of all the cases, six patients in Group-2 and three patients in Group-3 died, and there was no loss in Group-1. Proinflammatory cytokines IFNγ, IL-6, IL-17A, IL-2, IL-12, anti-inflammatory cytokines IL-10, IL-13, IL-1ra, and growth factors TGF-ß, VEGF, KGF, and NGF levels were found to be significant in Group-3. When Group-2 and Group-3 were compared, serum ferritin, fibrinogen and CRP levels in Group-3 had significantly decreased. CD45 +, CD3 +, CD4 +, CD8 +, CD19 +, HLA-DR +, and CD16 + / CD56 + levels were evaluated. In the statistical comparison of the groups, significance was only determined in respect of neutrophils. The results demonstrated the positive systematic and cellular effects of MSCs application on critically ill COVID-19 patients in a versatile way. This effect plays an important role in curing and reducing mortality in critically ill patients.