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1.
J Allergy Clin Immunol ; 2022 Nov 03.
Article in English | MEDLINE | ID: covidwho-2235736

ABSTRACT

BACKGROUND: The global epidemiology of asthma among patients with coronavirus disease 2019 (COVID-19) presents striking geographic differences, defining prevalence zones of high and low co-occurrence of asthma and COVID-19. OBJECTIVE: We aimed to compare asthma prevalence among hospitalized patients with COVID-19 in major global hubs across the world by applying common inclusion criteria and definitions. METHODS: We built a network of 6 academic hospitals in Stanford (Stanford University)/the United States; Frankfurt (Goethe University), Giessen (Justus Liebig University), and Marburg (Philipps University)/Germany; and Moscow (Clinical Hospital 52 in collaboration with Sechenov University)/Russia. We collected clinical and laboratory data for patients hospitalized due to COVID-19. RESULTS: Asthmatic individuals were overrepresented among hospitalized patients with COVID-19 in Stanford and underrepresented in Moscow and Germany as compared with their prevalence among adults in the local community. Asthma prevalence was similar among patients hospitalized in an intensive care unit and patients hospitalized in other than an intensive care unit, which implied that the risk for development of severe COVID-19 was not higher among asthmatic patients. The numbers of males and comorbidities were higher among patients with COVID-19 in the Stanford cohort, and the most frequent comorbidities among these patients with asthma were other chronic inflammatory airway disorders such as chronic obstructive pulmonary disease. CONCLUSION: The observed disparity in COVID-19-associated risk among asthmatic patients across countries and continents is connected to the varying prevalence of underlying comorbidities, particularly chronic obstructive pulmonary disease.

2.
JCI Insight ; 7(13)2022 07 08.
Article in English | MEDLINE | ID: covidwho-1932894

ABSTRACT

BACKGROUNDProlonged symptoms after SARS-CoV-2 infection are well documented. However, which factors influence development of long-term symptoms, how symptoms vary across ethnic groups, and whether long-term symptoms correlate with biomarkers are points that remain elusive.METHODSAdult SARS-CoV-2 reverse transcription PCR-positive (RT-PCR-positive) patients were recruited at Stanford from March 2020 to February 2021. Study participants were seen for in-person visits at diagnosis and every 1-3 months for up to 1 year after diagnosis; they completed symptom surveys and underwent blood draws and nasal swab collections at each visit.RESULTSOur cohort (n = 617) ranged from asymptomatic to critical COVID-19 infections. In total, 40% of participants reported at least 1 symptom associated with COVID-19 six months after diagnosis. Median time from diagnosis to first resolution of all symptoms was 44 days; median time from diagnosis to sustained symptom resolution with no recurring symptoms for 1 month or longer was 214 days. Anti-nucleocapsid IgG level in the first week after positive RT-PCR test and history of lung disease were associated with time to sustained symptom resolution. COVID-19 disease severity, ethnicity, age, sex, and remdesivir use did not affect time to sustained symptom resolution.CONCLUSIONWe found that all disease severities had a similar risk of developing post-COVID-19 syndrome in an ethnically diverse population. Comorbid lung disease and lower levels of initial IgG response to SARS-CoV-2 nucleocapsid antigen were associated with longer symptom duration.TRIAL REGISTRATIONClinicalTrials.gov, NCT04373148.FUNDINGNIH UL1TR003142 CTSA grant, NIH U54CA260517 grant, NIEHS R21 ES03304901, Sean N Parker Center for Allergy and Asthma Research at Stanford University, Chan Zuckerberg Biohub, Chan Zuckerberg Initiative, Sunshine Foundation, Crown Foundation, and Parker Foundation.


Subject(s)
COVID-19 , COVID-19/complications , Humans , Immunoglobulin G , SARS-CoV-2 , Post-Acute COVID-19 Syndrome
3.
Diabetes ; 71, 2022.
Article in English | ProQuest Central | ID: covidwho-1923977

ABSTRACT

Background: Obesity and diabetes are known risk factors for severe acute COVID-19. About half of individuals with obesity have insulin resistance (IR) , which may potentiate severe acute disease and/or predispose to long COVID. Methods: We identified 596 adults from Stanford hospital or clinics confirmed COVID-19+ by rtPCR and categorized according to severity of illness based on the NIH categories1. Pre-COVID predictors including BMI, fasting plasma glucose (FPG) , and triglyceride/HDL-cholesterol ratio (TG/HDL) as a surrogate2 for IR were ed from the EMR using the Stanford Research Repository Tools software. Follow-up surveys were administered via REDCap 2-4x in the first month and 1x per month for 1 year thereafter to assess symptom type and duration. Long COVID was defined as symptom duration > 30 days. Metabolic predictors of acute COVID-severity (BMI, FPG, TG/HDL) were evaluated via multiple linear regression adjusted for sex, age, ethnicity, and other metabolic predictors. A logistic regression to predict long COVID included all metabolic predictors along with age, sex, and ethnicity. Models were repeated with a stepwise approach to increase statistical power given the smaller number of participants with complete data. Results: Participants were 51±18 years of age, 49% female, and 62% racial and ethnic minorities. Mean BMI was 29.5±7.9 kg/m2. NIH illness severity was 7.9% asymptomatic, 37.2% mild, 25.9% moderate, 15.1% severe, and 13.9% critical. Diabetes, lung disease, and hypertension prevalence were 27%, 18%, and 34%, respectively. Mean follow-up was 94±99 and incidence of long COVID was 47.1%. BMI, FPG, and TG/HDL were independently associated with acute COVID-severity in the cohort as a whole (r=0.187, P<0.001;r=0.180, P=0.002;r=0.180, P=0.009) , while only TG/HDL was associated with long COVID (r=0.173, p=0.013) . Conclusions: Findings suggest that IR, independent of sex, age, ethnicity, obesity and hyperglycemia, confers increased risk for both severe acute COVID-and long COVID.

5.
Allergy ; 77(1): 173-185, 2022 01.
Article in English | MEDLINE | ID: covidwho-1255322

ABSTRACT

BACKGROUND: It is unclear whether asthma and its allergic phenotype are risk factors for hospitalization or severe disease from SARS-CoV-2. METHODS: All patients over 28 days old testing positive for SARS-CoV-2 between March 1 and September 30, 2020, were retrospectively identified and characterized through electronic analysis at Stanford. A sub-cohort was followed prospectively to evaluate long-term COVID-19 symptoms. RESULTS: 168,190 patients underwent SARS-CoV-2 testing, and 6,976 (4.15%) tested positive. In a multivariate analysis, asthma was not an independent risk factor for hospitalization (OR 1.12 [95% CI 0.86, 1.45], p = .40). Among SARS-CoV-2-positive asthmatics, allergic asthma lowered the risk of hospitalization and had a protective effect compared with non-allergic asthma (OR 0.52 [0.28, 0.91], p = .026); there was no association between baseline medication use as characterized by GINA and hospitalization risk. Patients with severe COVID-19 disease had lower eosinophil levels during hospitalization compared with patients with mild or asymptomatic disease, independent of asthma status (p = .0014). In a patient sub-cohort followed longitudinally, asthmatics and non-asthmatics had similar time to resolution of COVID-19 symptoms, particularly lower respiratory symptoms. CONCLUSIONS: Asthma is not a risk factor for more severe COVID-19 disease. Allergic asthmatics were half as likely to be hospitalized with COVID-19 compared with non-allergic asthmatics. Lower levels of eosinophil counts (allergic biomarkers) were associated with a more severe COVID-19 disease trajectory. Recovery was similar among asthmatics and non-asthmatics with over 50% of patients reporting ongoing lower respiratory symptoms 3 months post-infection.


Subject(s)
Asthma , COVID-19 , Asthma/diagnosis , Asthma/epidemiology , COVID-19 Testing , Humans , Phenotype , Retrospective Studies , SARS-CoV-2
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