Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 9 de 9
Filter
1.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-307676

ABSTRACT

Background: The possibility that vitamin D deficiency might favor a poorer outcome of Coronavirus disease-19 (COVID-19) is debated. We aimed to assess the association between 25-hydroxyvitamin-D (25OHD) levels and COVID-19 severity and mortality. Methods: We prospectively studied 103 in-patients admitted to a Northern-Italian hospital (age 66.1±14.1 years, 70 males) for moderately-to-severely-symptomatic COVID-19. Fifty-two subjects with SARS-CoV-2 infection but mild COVID-19 symptoms (mildly-symptomatic COVID-19 patients) and 206 matched subjects without SARS-CoV-2 infection were controls. We measured 25OHD and IL-6 levels at admission and focused on respiratory outcome during hospitalization.Findings: Moderately-to-severely-symptomatic COVID-19 patients had lower 25OHD levels (45.5±28.5 nmol/L) than mildly-symptomatic COVID-19 patients and non SARS-CoV-2 infected controls (75.8±21.3 nmol/L and 63.5±23.5 nmol/L, respectively, p<0.0001 for both comparisons). 25OHD and IL-6 levels were respectively lower and higher in moderately-to-severely-symptomatic COVID-19 patients admitted to intensive care Unit [(ICU), 36.0±21.5 nmol/L and 43.0 [19.0-56.0] pg/mL, respectively], than in those not requiring ICU admission (56.0±31.8 nmol/L, p=0.0001 and 16.0[8.0-32.0] pg/mL, p=0.0002, respectively). Similar differences were found when comparing COVID-19 patients who died in hospital (33.0±16.0 ng/mL and 45.0 [28.0-99.0] pg/mL) with survivors (48.3±30 nmol/L, p=0.035 and 21.0 [10.5-45.9] pg/mL, p=0.018, respectively). 25OHD levels inversely correlated with IL-6 levels (ρ -0.284, p=0.004) and with the subsequent need of the ICU admission [relative risk, RR 0.99, 95% confidence interval (95%CI) 0.98-1.00, p=0.011] and mortality (RR 0.97, 95%CI, 0.95-0.99, p=0.011) regardless of confounding factors.Interpretation: Vitamin D levels were positively correlated with higher IL-6 levels and negatively associated to COVID-19 severity and mortality.Funding: None.Declaration of Interests: All authors declare no support from any organization for the submitted work, no financial relationships with any organizations that might have an interest in the submitted work in the previous three years and no other relationships or activities that could appear to have influenced the submitted work.Ethics Approval Statement: The study was approved by the ethics committee of our Institution (Ethical Committee, Istituto Auxologico Italiano). The participants or their familiar, when needed as in the case of ICU admitted patients, gave written informed consent before taking part in the study.

2.
Intern Emerg Med ; 2022 Jan 28.
Article in English | MEDLINE | ID: covidwho-1653743

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a newly recognized infectious disease which can lead to acute respiratory distress syndrome requiring ventilatory support and intensive care unit admission. The aim of our study is to evaluate the performance of two non-invasive respiratory function indices (the ROX index and the SatO2/FiO2 ratio), as compared to the traditional PaO2/FiO2 ratio, in predicting a clinically relevant composite outcome (death or intubation) in hospitalized patients for COVID-19 pneumonia. Four hospital centers in Northern Italy conducted an observational retrospective cohort study during the first wave of COVID-19 pandemic. Four hundred and fifty-six patients with COVID-19 pneumonia admitted to medical or sub-intensive wards were enrolled. Clinical, laboratory, and respiratory parameters, for the calculation of different indices, were measured at hospital admission. In medical wards (Verona and Padua) the PaO2/FiO2 ratio, ROX index and SatO2/FiO2 ratio were able to predict intubation or death with good accuracy (AUROC for the PaO2/FiO2 ratio, ROX index and SatO2/FiO2 ratio of 75%, 75% and 74%, respectively). Regarding sub-intensive wards (Milan and Mantua), none of the three respiratory function indices was significantly associated with the composite outcome. In patients admitted to medical wards for COVID-19 pneumonia, the ROX index and the SatO2/FiO2 ratio demonstrated not only good performance in predicting intubation or death, but their accuracy was comparable to that of the PaO2/FiO2 ratio. In this setting, where repeated arterial blood gas tests are not always feasible, they could be considered a reliable alternative to the invasive PaO2/FiO2 ratio.

3.
Int J Environ Res Public Health ; 18(23)2021 11 26.
Article in English | MEDLINE | ID: covidwho-1561773

ABSTRACT

This article describes a user-centred approach taken by a group of five procurers to set specifications for the procurement of value-based research and development services for IT-supported integrated hypertension management. The approach considered the unmet needs of patients and health systems of the involved regions. The procurers established a framework for requirements and a solution design consisting of nine building blocks, divided into three domains: service delivery, devices and integration, and health care organisation. The approach included the development of questionnaires, capturing patients' and professionals' views on possible system functionalities, and a template collecting information about the organisation of healthcare, professionals involved and existing IT systems at the procurers' premises. A total of 28 patients diagnosed with hypertension and 26 professionals were interviewed. The interviewees identified 98 functional requirements, grouped in the nine building blocks. A total of nine use cases and their corresponding process models were defined by the procurers' working group. As result, a digitally enabled integrated approach to hypertension has been designed to allow citizens to learn how to prevent the development of hypertension and lead a healthy lifestyle, and to receive comprehensive, individualised treatment in close collaboration with healthcare professionals.


Subject(s)
Health Services , Hypertension , Delivery of Health Care , Health Personnel , Humans , Hypertension/prevention & control
4.
BMC Infect Dis ; 21(1): 566, 2021 Jun 14.
Article in English | MEDLINE | ID: covidwho-1269873

ABSTRACT

BACKGROUND: Vitamin D deficiency has been suggested to favor a poorer outcome of Coronavirus disease-19 (COVID-19). We aimed to assess if 25-hydroxyvitamin-D (25OHD) levels are associated with interleukin 6 (IL-6) levels and with disease severity and mortality in COVID-19. METHODS: We prospectively studied 103 in-patients admitted to a Northern-Italian hospital (age 66.1 ± 14.1 years, 70 males) for severely-symptomatic COVID-19. Fifty-two subjects with SARS-CoV-2 infection but mild COVID-19 symptoms (mildly-symptomatic COVID-19 patients) and 206 subjects without SARS-CoV-2 infection were controls. We measured 25OHD and IL-6 levels at admission and focused on respiratory outcome during hospitalization. RESULTS: Severely-symptomatic COVID-19 patients had lower 25OHD levels (18.2 ± 11.4 ng/mL) than mildly-symptomatic COVID-19 patients and non-SARS-CoV-2-infected controls (30.3 ± 8.5 ng/mL and 25.4 ± 9.4 ng/mL, respectively, p < 0.0001 for both comparisons). 25OHD and IL-6 levels were respectively lower and higher in severely-symptomatic COVID-19 patients admitted to intensive care Unit [(ICU), 14.4 ± 8.6 ng/mL and 43.0 (19.0-56.0) pg/mL, respectively], than in those not requiring ICU admission [22.4 ± 1.4 ng/mL, p = 0.0001 and 16.0 (8.0-32.0) pg/mL, p = 0.0002, respectively]. Similar differences were found when comparing COVID-19 patients who died in hospital [13.2 ± 6.4 ng/mL and 45.0 (28.0-99.0) pg/mL] with survivors [19.3 ± 12.0 ng/mL, p = 0.035 and 21.0 (10.5-45.9) pg/mL, p = 0.018, respectively). 25OHD levels inversely correlated with: i) IL-6 levels (ρ - 0.284, p = 0.004); ii) the subsequent need of the ICU admission [relative risk, RR 0.99, 95% confidence interval (95%CI) 0.98-1.00, p = 0.011] regardless of age, gender, presence of at least 1 comorbidity among obesity, diabetes, arterial hypertension, creatinine, IL-6 and lactate dehydrogenase levels, neutrophil cells, lymphocytes and platelets count; iii) mortality (RR 0.97, 95%CI, 0.95-0.99, p = 0.011) regardless of age, gender, presence of diabetes, IL-6 and C-reactive protein and lactate dehydrogenase levels, neutrophil cells, lymphocytes and platelets count. CONCLUSION: In our COVID-19 patients, low 25OHD levels were inversely correlated with high IL-6 levels and were independent predictors of COVID-19 severity and mortality.


Subject(s)
COVID-19/blood , COVID-19/mortality , SARS-CoV-2/genetics , Severity of Illness Index , Vitamin D/analogs & derivatives , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/epidemiology , Calcifediol/administration & dosage , Comorbidity , Diabetes Mellitus/epidemiology , Female , Humans , Hypertension/epidemiology , Intensive Care Units , Interleukin-6/blood , Italy/epidemiology , Male , Middle Aged , Obesity/epidemiology , Patient Admission , Prospective Studies , Reverse Transcriptase Polymerase Chain Reaction , Vitamin D/blood , Vitamin D Deficiency/complications , Vitamins/administration & dosage
7.
JACC Basic Transl Sci ; 6(3): 202-218, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1101317

ABSTRACT

The authors hypothesized that the cytokine storm described in COVID-19 patients may lead to consistent cell-based tissue factor (TF)-mediated activation of coagulation, procoagulant microvesicles (MVs) release, and massive platelet activation. COVID-19 patients have higher levels of TF+ platelets, TF+ granulocytes, and TF+ MVs than healthy subjects and coronary artery disease patients. Plasma MV-associated thrombin generation is present in prophylactic anticoagulated patients. A sustained platelet activation in terms of P-selectin expression and platelet-leukocyte aggregate formation, and altered nitric oxide/prostacyclin synthesis are also observed. COVID-19 plasma, added to the blood of healthy subjects, induces platelet activation similar to that observed in vivo. This effect was blunted by pre-incubation with tocilizumab, aspirin, or a P2Y12 inhibitor.

9.
Front Immunol ; 11: 584241, 2020.
Article in English | MEDLINE | ID: covidwho-908875

ABSTRACT

Background: Critically ill patients with coronavirus disease 2019 (COVID-19) have a profound hypercoagulable state and often develop coagulopathy which leads to organ failure and death. Because of a prolonged activated partial-thromboplastin time (aPTT), a relationship with anti-phospholipid antibodies (aPLs) has been proposed, but results are controversial. Functional assays for aPL (i.e., lupus anticoagulant) can be influenced by concomitant anticoagulation and/or high levels of C reactive protein. The presence of anti-cardiolipin (aCL), anti-beta2-glycoprotein I (anti-ß2GPI), and anti-phosphatidylserine/prothrombin (aPS/PT) antibodies was not investigated systematically. Epitope specificity of anti-ß2GPI antibodies was not reported. Objective: To evaluate the prevalence and the clinical association of aPL in a large cohort of COVID-19 patients, and to characterize the epitope specificity of anti-ß2GPI antibodies. Methods: ELISA and chemiluminescence assays were used to test 122 sera of patients suffering from severe COVID-19. Of them, 16 displayed major thrombotic events. Results: Anti-ß2GPI IgG/IgA/IgM was the most frequent in 15.6/6.6/9.0% of patients, while aCL IgG/IgM was detected in 5.7/6.6% by ELISA. Comparable values were found by chemiluminescence. aPS/PT IgG/IgM were detectable in 2.5 and 9.8% by ELISA. No association between thrombosis and aPL was found. Reactivity against domain 1 and 4-5 of ß2GPI was limited to 3/58 (5.2%) tested sera for each domain and did not correlate with aCL/anti-ß2GPI nor with thrombosis. Conclusions: aPL show a low prevalence in COVID-19 patients and are not associated with major thrombotic events. aPL in COVID-19 patients are mainly directed against ß2GPI but display an epitope specificity different from antibodies in antiphospholipid syndrome.


Subject(s)
Antibodies, Anticardiolipin/immunology , Antiphospholipid Syndrome/immunology , COVID-19/immunology , SARS-CoV-2 , Aged , Aged, 80 and over , Antibodies, Anticardiolipin/blood , Antiphospholipid Syndrome/blood , COVID-19/blood , COVID-19/virology , Critical Illness , Enzyme-Linked Immunosorbent Assay , Epitopes/immunology , Female , Humans , Immunoglobulin A/blood , Immunoglobulin A/immunology , Immunoglobulin G/blood , Immunoglobulin G/immunology , Immunoglobulin M/blood , Immunoglobulin M/immunology , Luminescent Measurements , Male , Middle Aged , Phosphatidylserines/immunology , Prothrombin/immunology , Thrombosis/immunology , beta 2-Glycoprotein I/immunology
SELECTION OF CITATIONS
SEARCH DETAIL