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1.
Mol Divers ; 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2094713

ABSTRACT

IL(interleukin)-6 is a multifunctional cytokine crucial for immunological, hematopoiesis, inflammation, and bone metabolism. Strikingly, IL-6 has been shown to significantly contribute to the initiation of cytokine storm-an acute systemic inflammatory syndrome in Covid-19 patients. Recent study has showed that blocking the IL-6 signaling pathway with an anti-IL-6 receptor monoclonal antibody (mAb) can reduce the severity of COVID-19 symptoms and enhance patient survival. However, the mAb has several drawbacks, such as high cost, potential immunogenicity, and invasive administration due to the large-molecule protein product. Instead, these issues could be mitigated using small molecule IL-6 inhibitors, but none are currently available. This study aimed to discover IL-6 inhibitors based on the PPI with a novel camelid Fab fragment, namely 68F2, in a crystal protein complex structure (PDB ID: 4ZS7). The pharmacophore models and molecular docking were used to screen compounds from DrugBank databases. The oral bioavailability of the top 24 ligands from the screening was predicted by the SwissAMDE tool. Subsequently, the selected molecules from docking and MD simulation illustrated a promising binding affinity in the formation of stable complexes at the active binding pocket of IL-6. Binding energies using the MM-PBSA technique were applied to the top 4 hit compounds. The result indicated that DB08402 and DB12903 could form strong interactions and build stable protein-ligand complexes with IL-6. These potential compounds may serve as a basis for further developing small molecule IL-6 inhibitors in the future.

2.
Int J Mol Sci ; 23(19)2022 Sep 30.
Article in English | MEDLINE | ID: covidwho-2066131

ABSTRACT

The World Health Organization declared monkeypox a global public health emergency on 23 July 2022. This disease was caused by the monkeypox virus (MPXV), which was first identified in 1958 in Denmark. The MPXV is a member of the Poxviridae family, the Chordopoxvirinae subfamily, and the genus Orthopoxvirus, which share high similarities with the vaccinia virus (the virus used to produce the smallpox vaccine). For the initial stage of infection, the MPXV needs to attach to the human cell surface glycosaminoglycan (GAG) adhesion molecules using its E8 protein. However, up until now, neither a structure for the MPXV E8 protein nor a specific cure for the MPXV exists. This study aimed to search for small molecules that inhibit the MPXV E8 protein, using computational approaches. In this study, a high-quality three-dimensional structure of the MPXV E8 protein was retrieved by homology modeling using the AlphaFold deep learning server. Subsequent molecular docking and molecular dynamics simulations (MDs) for a cumulative duration of 2.1 microseconds revealed that ZINC003977803 (Diosmin) and ZINC008215434 (Flavin adenine dinucleotide-FAD) could be potential inhibitors against the E8 protein with the MM/GBSA binding free energies of -38.19 ± 9.69 and -35.59 ± 7.65 kcal·mol-1, respectively.


Subject(s)
Diosmin , Monkeypox , Smallpox Vaccine , Flavin-Adenine Dinucleotide , Glycosaminoglycans , Humans , Molecular Docking Simulation , Monkeypox/prevention & control , Monkeypox virus , Viral Proteins
3.
Struct Chem ; 33(5): 1707-1725, 2022.
Article in English | MEDLINE | ID: covidwho-2014349

ABSTRACT

The main protease 3CLpro is one of the potential targets against coronavirus. Inhibiting this enzyme leads to the interruption of viral replication. Chalcone and its derivatives were reported to possess the ability to bind to 3CLpro protease in the binding pocket. This study explored an in-house database of 269 chalcones as 3CLpro inhibitors using in silico screening models, including molecular docking, molecular dynamics simulation, binding free energy calculation, and ADME prediction. C264 and C235 stand out as the two most potential structures. The top hit compound C264 was with the Jamda score of -2.8329 and the MM/GBSA binding energy mean value of -28.23 ± 3.53 kcal/mol, which was lower than the reference ligand. Despite the lower mean binding energy (-22.07 ± 3.39 kcal/mol), in-depth analysis of binding interaction suggested C235 could be another potential candidate. Further, in vitro and in vivo experiments are required to confirm the inhibitory ability. Supplementary Information: The online version contains supplementary material available at 10.1007/s11224-022-02000-3.

4.
Eur J Epidemiol ; 37(9): 901-913, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2014244

ABSTRACT

Concerns have been raised about early vs. later impacts of the COVID-19 pandemic on suicidal behavior. However, data remain sparse to date. We investigated all calls for intentional drug or other toxic ingestions to the eight Poison Control Centers in France between 1st January 2018 and 31st May 2022. Data were extracted from the French National Database of Poisonings. Calls during the study period were analyzed using time trends and time series analyses with SARIMA models (based on the first two years). Breakpoints were determined using Chow test. These analyses were performed together with examination of age groups (≤ 11, 12-24, 25-64, ≥ 65 years) and gender effects when possible. Over the studied period, 66,589 calls for suicide attempts were received. Overall, there was a downward trend from 2018, which slowed down in October 2019 and was followed by an increase from November 2020. Number of calls observed during the COVID period were above what was expected. However, important differences were found according to age and gender. The increase in calls from mid-2020 was particularly observed in young females, while middle-aged adults showed a persisting decrease. An increase in older-aged people was observed from mid-2019 and persisted during the pandemic. The pandemic may therefore have exacerbated a pre-existing fragile situation in adolescents and old-aged people. This study emphasizes the rapidly evolving situation regarding suicidal behaviour during the pandemic, the possibility of age and gender differences in impact, and the value of having access to real-time information to monitor suicidal acts.


Subject(s)
COVID-19 , Poison Control Centers , Adolescent , Adult , Aged , COVID-19/epidemiology , Databases, Factual , Female , Humans , Middle Aged , Pandemics , Suicide, Attempted
5.
Nat Commun ; 13(1): 1812, 2022 04 05.
Article in English | MEDLINE | ID: covidwho-1778602

ABSTRACT

About 10% of people infected by severe acute respiratory syndrome coronavirus 2 experience post COVID-19 disease. We analysed data from 968 adult patients (5350 person-months) with a confirmed infection enroled in the ComPaRe long COVID cohort, a disease prevalent prospective e-cohort of such patients in France. Day-by-day prevalence of post COVID-19 symptoms was determined from patients' responses to the Long COVID Symptom Tool, a validated self-reported questionnaire assessing 53 symptoms. Among patients symptomatic after 2 months, 85% still reported symptoms one year after their symptom onset. Evolution of symptoms showed a decreasing prevalence over time for 27/53 symptoms (e.g., loss of taste/smell); a stable prevalence over time for 18/53 symptoms (e.g., dyspnoea), and an increasing prevalence over time for 8/53 symptoms (e.g., paraesthesia). The disease impact on patients' lives began increasing 6 months after onset. Our results are of importance to understand the natural history of post COVID-19 disease.


Subject(s)
COVID-19 , Adult , COVID-19/complications , Humans , Prospective Studies , SARS-CoV-2 , Taste Disorders/epidemiology
6.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-322898

ABSTRACT

About 10% of the people infected by the severe acute respiratory syndrome coronavirus 2 are reported to experience “long COVID,” that is, persistence of symptoms several weeks after infection. Day-by-day prevalence of long COVID symptoms was determined from responses to the Long COVID Symptom Tool by 837 patients (3075 person-months) with a confirmed infection and enrolled in the ComPaRe long COVID cohort, a prospective cohort of such patients in France. Nine months after disease onset, 88.7% patients reported persistent symptoms and 70% reported a high burden of disease. Over time, the prevalence progressively decreased for 19/53 symptoms (e.g., loss of taste/smell) and was stable for 29/53 symptoms (e.g., fatigue). For 5/53 symptoms (e.g., memory problems), prevalence increased rapidly over the first two months and then reached a plateau. These findings are important for understanding the underlying etiologies and mechanisms of long COVID.

7.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-319866

ABSTRACT

The Covid-19 outbreak threatens to saturate healthcare systems in most Western countries. We describe how digital technologies may be used to automatically and remotely monitor patients at home. Patients answer simple self-reported questionnaires and their data is transmitted, in real time, to a Command Centre in the nearest reference hospital. Patient reported data are automatically filtered by algorithms to identify those with early warning signs. Open-source code of all software components required to deploy the remote digital monitoring platform and Command Centres is available.

8.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-317920

ABSTRACT

Social distancing plays a pivotal role in preventing the spread of viral diseases illnesses such as COVID-19. By minimizing the close physical contact among people, we can reduce the chances of catching the virus and spreading it across the community. This paper aims to provide a comprehensive survey on how emerging technologies, e.g., wireless and networking, artificial intelligence (AI) can enable, encourage, and even enforce social distancing practice. To that end, we first provide a comprehensive background of social distancing including basic concepts, measurements, models, and propose various practical social distancing scenarios. We then discuss enabling wireless technologies which are especially effective and can be widely adopted in practice to keep distance, encourage, and enforce social distancing in general. After that, other emerging and related technologies such as machine learning, computer vision, thermal, ultrasound, etc., are introduced. These technologies open many new solutions and directions to deal with problems in social distancing, e.g., symptom prediction, detection and monitoring quarantined people, and contact tracing. Finally, we provide important open issues and challenges (e.g., privacy-preserving, scheduling, and incentive mechanisms) in implementing social distancing in practice. As an example, instead of reacting with ad-hoc responses to COVID-19-like pandemics in the future, smart infrastructures (e.g., next-generation wireless systems like 6G, smart home/building, smart city, intelligent transportation systems) should incorporate a pandemic mode in its standard architecture/design.

9.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-308851

ABSTRACT

Objectives: To determine recommendations for the use of personal protective equipment (PPE) based on transmission risk for paediatric procedures in the Emergency Department during the COVID-19 pandemic. MethodsTwo survey rounds were conducted in April-May 2020. The survey presented a number of emergency medicine procedures relevant to the care of children, and asked respondents to provide PPE recommendations according to levels of community transmission, and whether or not the child had symptoms of acute respiratory illness. ResultsParticipants were recruited by approaching relevant professional groups, with 15 from the PREDICT network and 12 from the Australasian Society of Infectious Diseases (ASID) Paediatric Infectious Diseases (ANZPID) Group. Airborne PPE is recommended for resuscitative procedures and various respiratory procedures in most situations There were differences in opinion between emergency and paediatric infectious disease specialists with regards to most appropriate PPE for children without symptoms of COVID-19 in a setting of low community transmission, and for procedures involving the head, neck or airway. In general, emergency physicians were more likely to favour airborne PPE than infectious disease specialists. In the setting of high community transmission, there was a stronger tendency to recommend at least droplet precautions for most procedures – regardless of whether or not the child had symptoms. ConclusionsDifferences in PPE recommendations for various paediatric procedures between infectious disease specialists and emergency physicians were identified. Further research is urgently needed to clarify and quantify risks for many common interventions and determine strategies for multidisciplinary consensus regarding future recommendations.

10.
Clin Infect Dis ; 74(2): 278-287, 2022 01 29.
Article in English | MEDLINE | ID: covidwho-1662112

ABSTRACT

BACKGROUND: To develop and validate patient-reported instruments, based on patients' lived experiences, for monitoring the symptoms and impact of long coronavirus disease (covid). METHODS: The long covid Symptom and Impact Tools (ST and IT) were constructed from the answers to a survey with open-ended questions to 492 patients with long COVID. Validation of the tools involved adult patients with suspected or confirmed coronavirus disease 2019 (COVID-19) and symptoms extending over 3 weeks after onset. Construct validity was assessed by examining the relations of the ST and IT scores with health-related quality of life (EQ-5D-5L), function (PCFS, post-COVID functional scale), and perceived health (MYMOP2, Measure yourself medical outcome profile 2). Reliability was determined by a test-retest. The "patient acceptable symptomatic state" (PASS) was determined by the percentile method. RESULTS: Validation involved 1022 participants (55% with confirmed COVID-19, 79% female, and 12.5% hospitalized for COVID-19). The long COVID ST and IT scores were strongly correlated with the EQ-5D-5L (rs = -0.45 and rs = -0.59, respectively), the PCFS (rs = -0.39 and rs = -0.55), and the MYMOP2 (rs = -0.40 and rs = -0.59). Reproducibility was excellent with an interclass correlation coefficient of 0.83 (95% confidence interval .80 to .86) for the ST score and 0.84 (.80 to .87) for the IT score. In total, 793 (77.5%) patients reported an unacceptable symptomatic state, thereby setting the PASS for the long covid IT score at 30 (28 to 33). CONCLUSIONS: The long covid ST and IT tools, constructed from patients' lived experiences, provide the first validated and reliable instruments for monitoring the symptoms and impact of long covid.


Subject(s)
COVID-19 , Adult , COVID-19/complications , Female , Humans , Male , Patient Reported Outcome Measures , Psychometrics , Quality of Life , Reproducibility of Results , SARS-CoV-2 , Surveys and Questionnaires
11.
JAMA Netw Open ; 4(12): e2141233, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1596574

ABSTRACT

Importance: The COVID-19 pandemic led to the implementation of alternative care modalities (eg, teleconsultations and task shifting) that will continue to be implemented in parallel to traditional care after the pandemic. An ideal balance between alternative and traditional care modalities is unknown. Objectives: To quantify the ideal postpandemic balance between alternative and traditional care modalities among patients with chronic illness and to qualify the circumstances in which patients consider it appropriate to replace traditional care with alternative care. Design, Setting, and Participants: This survey study invited 5999 adults with chronic illness in ComPaRe, a French nationwide e-cohort of adults with chronic conditions who volunteer their time to participate in research projects, to participate in this study, which was performed from January 27 to February 23, 2021. Main Outcomes and Measures: Participants rated the ideal proportion at which they would use 3 alternative care modalities instead of the traditional care equivalent on a 0% to 100% scale (with 0% indicating using alternative care modalities for none of one's future care and 100% indicating using alternative care modalities for all of one's future care) of their overall future care: (1) teleconsultations, (2) online symptom-checkers to react to new symptoms, and (3) remote monitoring to adapt treatment outside consultations. The median ideal proportion of alternative care use was calculated. Perceived appropriate circumstances in which each alternative modality could replace traditional care were collected with open-ended questions. Analyses were performed on a weighted data set representative of patients with chronic illness in France. Results: Of the 5999 invited individuals, 1529 (mean [SD] age, 50.3 [14.7] years; 1072 [70.1%] female) agreed to participate (participation rate, 25.5%). Participants would choose teleconsultations for 50.0% of their future consultations (IQR, 11.0%-52.0%), online symptom-checkers over contacting their physician for 22.0% of new symptoms (IQR, 2.0%-50.0%), and remote monitoring instead of consultations for 52.3% of their treatment adaptations (IQR, 25.4%-85.4%). Participants reported 67 circumstances for which replacing traditional with alternative care modalities was considered appropriate, including 31 care activities (eg, prescription renewal and addressing acute or minor complaints), 25 patient characteristics (eg, stable chronic condition and established patient-physician relationship), and 11 required characteristics of the alternative care modalities (eg, quality assurance). Conclusions and Relevance: Results of this survey study suggest that after the pandemic, patients would choose alternative over traditional care for 22% to 52% of the time across different care needs. Participants proposed 67 criteria to guide clinicians in replacing traditional care with alternative care. These findings provide a guide for redesigning care in collaboration with patients after the pandemic.


Subject(s)
COVID-19 , Chronic Disease/therapy , Delivery of Health Care/methods , Pandemics , Patient Acceptance of Health Care , Patient Preference , Adult , Female , France , Humans , Male , Middle Aged , SARS-CoV-2 , Surveys and Questionnaires , Telemedicine
12.
IEEE Access ; 8: 153479-153507, 2020.
Article in English | MEDLINE | ID: covidwho-1528283

ABSTRACT

Social distancing plays a pivotal role in preventing the spread of viral diseases illnesses such as COVID-19. By minimizing the close physical contact among people, we can reduce the chances of catching the virus and spreading it across the community. This two-part paper aims to provide a comprehensive survey on how emerging technologies, e.g., wireless and networking, artificial intelligence (AI) can enable, encourage, and even enforce social distancing practice. In this Part I, we provide a comprehensive background of social distancing including basic concepts, measurements, models, and propose various practical social distancing scenarios. We then discuss enabling wireless technologies which are especially effect- in social distancing, e.g., symptom prediction, detection and monitoring quarantined people, and contact tracing. The companion paper Part II surveys other emerging and related technologies, such as machine learning, computer vision, thermal, ultrasound, etc., and discusses open issues and challenges (e.g., privacy-preserving, scheduling, and incentive mechanisms) in implementing social distancing in practice.

13.
IEEE Access ; 8: 154209-154236, 2020.
Article in English | MEDLINE | ID: covidwho-1528282

ABSTRACT

This two-part paper aims to provide a comprehensive survey on how emerging technologies, e.g., wireless and networking, artificial intelligence (AI) can enable, encourage, and even enforce social distancing practice. In Part I, an extensive background of social distancing is provided, and enabling wireless technologies are thoroughly surveyed. In this Part II, emerging technologies such as machine learning, computer vision, thermal, ultrasound, etc., are introduced. These technologies open many new solutions and directions to deal with problems in social distancing, e.g., symptom prediction, detection and monitoring quarantined people, and contact tracing. Finally, we discuss open issues and challenges (e.g., privacy-preserving, scheduling, and incentive mechanisms) in implementing social distancing in practice. As an example, instead of reacting with ad-hoc responses to COVID-19-like pandemics in the future, smart infrastructures (e.g., next-generation wireless systems like 6G, smart home/building, smart city, intelligent transportation systems) should incorporate a pandemic mode in their standard architectures/designs.

14.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-292721

ABSTRACT

About 10% of people infected by severe acute respiratory syndrome coronavirus 2 experience post COVID-19 disease. We analysed data from 968 adult patients (5350 person-months) with a confirmed infection enrolled in the ComPaRe long COVID cohort, a disease prevalent prospective e-cohort of such patients in France. Day-by-day prevalence of post COVID-19 symptoms was determined from patients’ responses to the Long COVID Symptom Tool, an online validated self-reported questionnaire assessing 53 post COVID-19 disease symptoms. One year after symptom onset, 84.9% patients still reported their persistence, with a progressively lower prevalence of 27/53 symptoms (e.g., loss of taste/smell);18/53 symptoms (e.g., dyspnoea) were stable, while the prevalence of 8/53 symptoms (e.g., paraesthesia) had increased. The disease impact on patients’ lives began increasing 6 months after onset, as patients realized they had a chronic disease. Our results should be useful for researchers seeking the potential pathophysiological mechanisms underlying post COVID-19 disease.

17.
BMC Med Inform Decis Mak ; 21(1): 228, 2021 07 31.
Article in English | MEDLINE | ID: covidwho-1331942

ABSTRACT

OBJECTIVES: In France, about 30% of the population refuses COVID-19 vaccination outright, and 9 to 40% are hesitant. We developed and evaluated an interactive web tool providing transparent and reliable information on the benefits and risks of COVID-19 vaccination. METHODS: The most recent scientific data at the time of the study were implemented into an interactive web tool offering individualized information on the risks of COVID-19 infection-related events versus vaccination-related serious adverse events. The tool was evaluated during a before-and-after impact study nested in ComPaRe, a French e-cohort of adult patients with chronic conditions. Primary outcome was the proportion of patients intending to receive vaccination after using the tool, among those not intending to receive it at baseline. RESULTS: Between January 8 and 14, 2021, we enrolled 3152 patients in the study [mean age 55.2 (SD: 16.9), 52.9% women and 63% with ≥ 2 chronic conditions]. Before consulting the tool, 961 (30.5%) refused to be vaccinated until further data on efficacy/safety was obtained and 239 (7.5%) outright refused vaccination. Among these 1200 patients, 96 (8.0%, number needed to treat: 12.5) changed their mind after consulting the tool and would subsequently accept vaccination. CONCLUSIONS: Our interactive web tool represents a scalable method to help increase the intent to receive COVID-19 vaccination among patients with chronic conditions and address vaccine hesitancy. Since April 2021, our tool has been embedded on the official webpage of the French Government for COVID-19 information.


Subject(s)
COVID-19 Vaccines , COVID-19 , Adult , Female , France , Humans , Intention , Male , Middle Aged , SARS-CoV-2 , Vaccination
18.
Emerg Med Australas ; 33(5): 911-921, 2021 10.
Article in English | MEDLINE | ID: covidwho-1324954

ABSTRACT

OBJECTIVE: The aim of the present study was to describe the characteristics and outcomes of patients presenting to Australian EDs with suspected and confirmed COVID-19 during 2020, and to determine the predictors of in-hospital death for SARS-CoV-2 positive patients. METHODS: This analysis from the COVED Project presents data from 12 sites across four Australian states for the period from 1 April to 30 November 2020. All adult patients who met local criteria for suspected COVID-19 and underwent testing for SARS-CoV-2 in the ED were eligible for inclusion. Study outcomes were mechanical ventilation and in-hospital mortality. RESULTS: Among 24 405 eligible ED presentations over the whole study period, 423 tested positive for SARS-CoV-2. During the 'second wave' from 1 July to 30 September 2020, 26 (6%) of 406 SARS-CoV-2 patients received invasive mechanical ventilation, compared to 175 (2%) of the 9024 SARS-CoV-2 negative patients (odds ratio [OR] 3.5; 95% confidence interval [CI] 2.3-5.2, P < 0.001), and 41 (10%) SARS-CoV-2 positive patients died in hospital compared to 312 (3%) SARS-CoV-2 negative patients (OR 3.2; 95% CI 2.2-4.4, P = 0.001). For SARS-CoV-2 positive patients, the strongest independent predictors of hospital death were age (OR 1.1; 95% CI 1.1-1.1, P < 0.001), higher triage category (OR 3.5; 95% CI 1.3-9.4, P = 0.012), obesity (OR 4.2; 95% CI 1.2-14.3, P = 0.024) and receiving immunosuppressive treatment (OR 8.2; 95% CI 1.8-36.7, P = 0.006). CONCLUSIONS: ED patients who tested positive for SARS-CoV-2 had higher odds of mechanical ventilation and death in hospital. The strongest predictors of death were age, a higher triage category, obesity and receiving immunosuppressive treatment.


Subject(s)
COVID-19 , Adult , Australia/epidemiology , Emergency Service, Hospital , Hospital Mortality , Humans , SARS-CoV-2
19.
J Asthma ; 59(8): 1491-1500, 2022 08.
Article in English | MEDLINE | ID: covidwho-1263578

ABSTRACT

BACKGROUND: Asthma patients are under-represented among patients with COVID-19. Their behavior during lockdown and associated restrictions is unknown, as well as whether it was influenced by coexistent cardiovascular conditions. METHODS: We conducted a cross-sectional survey in May 2020, in France, nested in ComPaRe, an e-cohort of adults with chronic diseases. A self-administered questionnaire was mailed to 10,859 people; 3701 fully completed questionnaires. The prevalence of self-reported asthma was 7%. Patients were classified in 4 categories: asthma with (n = 106) or without (n = 149) cardiovascular disease and other diseases with (n = 1186) or without (n = 2260) cardiovascular disease. RESULT: Adherence to movement restrictions during the lockdown was very strong: 89% of participants reported a frequency of outings of "less than once per week" and "once or twice per week" for errands and no family-related outings during the lockdown. This proportion and frequency of outings were similar whatever the chronic disease (p = 0.122). Most patients (96%) reported a high feeling of security during the lockdown, but 95% felt anxious or depressed, with no difference by disease. As compared with patients with controlled asthma, those with uncontrolled asthma more frequently reported complaints related to deteriorated medical follow-up, waived care, anxiety or depression. CONCLUSIONS: Behaviors during the lockdown in France among the asthma population did not differ from patients with other chronic diseases in this cohort, which strengthens hypotheses for specific disease-related susceptibility to explain the low representation of asthmatics among COVID-19 cases. Special attention should be paid to the subgroup of patients with uncontrolled asthma during lockdowns.


Subject(s)
Asthma , COVID-19 , Cardiovascular Diseases , Adult , Asthma/epidemiology , Chronic Disease , Communicable Disease Control , Cross-Sectional Studies , France/epidemiology , Humans
20.
Clin Microbiol Infect ; 27(8): 1145-1150, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1258353

ABSTRACT

OBJECTIVE: To assess the effectiveness of corticosteroids among older adults with coronavirus disease 2019 (COVID-19) pneumonia requiring oxygen. METHODS: We used routine care data from 36 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids with at least 0.4 mg/kg/day equivalent prednisone (treatment group) versus standard of care (control group). Participants were adults aged 80 years or older with PCR-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or CT scan images typical of COVID-19 pneumonia, requiring oxygen ≥3 L/min, and with an inflammatory syndrome (C-reactive protein ≥40 mg/L). The primary outcome was overall survival at day 14. In our main analysis, characteristics of patients at baseline (i.e. time when patients met all inclusion criteria) were balanced by using propensity-score inverse probability of treatment weighting. RESULTS: Among the 267 patients included in the analysis, 98 were assigned to the treatment group. Their median age was 86 years (interquartile range 83-90 years) and 95% had a SARS-CoV-2 PCR-confirmed diagnosis. In total, 43/98 (43.9%) patients in the treatment group and 84/166 (50.6%) in the control group died before day 14 (weighted hazard ratio 0.67, 95% CI 0.46-0.99). The treatment and control groups did not differ significantly for the proportion of patients discharged to home/rehabilitation at day 14 (weighted relative risk 1.12, 95% CI 0.68-1.82). Twenty-two (16.7%) patients receiving corticosteroids developed adverse events, but only 11 (6.4%) from the control group. CONCLUSIONS: Corticosteroids were associated with a significant increase in the overall survival at day 14 of patients aged 80 years and older hospitalized for severe COVID-19.


Subject(s)
Adrenal Cortex Hormones/administration & dosage , COVID-19/epidemiology , Prednisone/administration & dosage , SARS-CoV-2/physiology , Aged, 80 and over , COVID-19/drug therapy , COVID-19/virology , Cohort Studies , France/epidemiology , Humans , Luxembourg/epidemiology , Survival Analysis , Treatment Outcome
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