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1.
Frontiers in medicine ; 9, 2022.
Article in English | EuropePMC | ID: covidwho-1738251

ABSTRACT

Apha-1-adrenergic receptor antagonists (α1-blockers) can suppress pro-inflammatory cytokines, thereby potentially improving outcomes among patients with COVID-19. Accordingly, we evaluated the association between α1-blocker exposure (before or during hospitalization) and COVID-19 in-hospital mortality. We identified 2,627 men aged 45 or older who were admitted to Mount Sinai hospitals with COVID-19 between February 24 and May 31, 2020, in New York. Men exposed to α1-blockers (N = 436) were older (median age 73 vs. 64 years, P < 0.001) and more likely to have comorbidities than unexposed men (N = 2,191). Overall, 777 (29.6%) patients died in hospital, and 1,850 (70.4%) were discharged. Notably, we found that α1-blocker exposure was independently associated with improved in-hospital mortality in a multivariable logistic analysis (OR 0.699;95% CI, 0.498-0.982;P = 0.039) after adjusting for patient demographics, comorbidities, and baseline vitals and labs. The protective effect of α1-blockers was stronger among patients with documented inpatient exposure to α1-blockers (OR 0.624;95% CI 0.431-0.903;P = 0.012). Finally, age-stratified analyses suggested variable benefit from inpatient α1-blocker across age groups: Age 45-65 OR 0.483, 95% CI 0.216-1.081 (P = 0.077);Age 55-75 OR 0.535, 95% CI 0.323-0.885 (P = 0.015);Age 65-89 OR 0.727, 95% CI 0.484-1.092 (P = 0.124). Taken together, clinical trials to assess the therapeutic value of α1-blockers for COVID-19 complications are warranted.

2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-322248

ABSTRACT

Epidemiological studies suggest that men exhibit a higher mortality rate to COVID-19 than women, yet the underlying biology is largely unknown. Here, we seek to delineate sex differences in the gene expression of viral entry proteins ACE2 and TMPRSS2, and host transcriptional responses to SARS-CoV-2 through large-scale analysis of genomic and clinical data. We first compiled 220,000 human gene expression profiles from three databases and completed the meta-information through machine learning and manual annotation. Large scale analysis of these profiles indicated that male samples show higher expression levels of ACE2 and TMPRSS2 than female samples, especially in the older group (>60 years) and in the kidney. Subsequent analysis of 6,031 COVID-19 patients at Mount Sinai Health System revealed that men have significantly higher creatinine levels, an indicator of impaired kidney function. Further analysis of 782 COVID-19 patient gene expression profiles taken from upper airway and blood suggested men and women present distinct expression changes. Computational deconvolution analysis of these profiles revealed male COVID-19 patients have enriched kidney-specific mesangial cells in blood compared to healthy patients. Together, this study suggests biological differences in the kidney between sexes may contribute to sex disparity in COVID-19.

3.
J Clin Invest ; 131(19)2021 10 01.
Article in English | MEDLINE | ID: covidwho-1448084

ABSTRACT

BACKGROUNDThe angiotensin-converting enzyme (ACE) D allele is more prevalent among African Americans compared with other races and ethnicities and has previously been associated with severe coronavirus disease 2019 (COVID-19) pathogenesis through excessive ACE1 activity. ACE inhibitors/angiotensin receptor blockers (ACE-I/ARB) may counteract this mechanism, but their association with COVID-19 outcomes has not been specifically tested in the African American population.METHODSWe identified 6218 patients who were admitted into Mount Sinai hospitals with COVID-19 between February 24 and May 31, 2020, in New York City. We evaluated whether the outpatient and in-hospital use of ACE-I/ARB is associated with COVID-19 in-hospital mortality in an African American compared with non-African American population.RESULTSOf the 6218 patients with COVID-19, 1138 (18.3%) were ACE-I/ARB users. In a multivariate logistic regression model, ACE-I/ARB use was independently associated with a reduced risk of in-hospital mortality in the entire population (OR, 0.655; 95% CI, 0.505-0.850; P = 0.001), African American population (OR, 0.44; 95% CI, 0.249-0.779; P = 0.005), and non-African American population (OR, 0.748, 95% CI, 0.553-1.012, P = 0.06). In the African American population, in-hospital use of ACE-I/ARB was associated with improved mortality (OR, 0.378; 95% CI, 0.188-0.766; P = 0.006), whereas outpatient use was not (OR, 0.889; 95% CI, 0.375-2.158; P = 0.812). When analyzing each medication class separately, ARB in-hospital use was significantly associated with reduced in-hospital mortality in the African American population (OR, 0.196; 95% CI, 0.074-0.516; P = 0.001), whereas ACE-I use was not associated with impact on mortality in any population.CONCLUSIONIn-hospital use of ARB was associated with a significant reduction in in-hospital mortality among COVID-19-positive African American patients.FUNDINGNone.


Subject(s)
African Americans , Angiotensin Receptor Antagonists/administration & dosage , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , COVID-19 , Hospital Mortality/ethnology , SARS-CoV-2/metabolism , Aged , COVID-19/drug therapy , COVID-19/ethnology , COVID-19/metabolism , COVID-19/mortality , Disease-Free Survival , Female , Humans , Male , Middle Aged , Peptidyl-Dipeptidase A/metabolism , Retrospective Studies , Survival Rate
4.
BMJ Open Respir Res ; 8(1)2021 04.
Article in English | MEDLINE | ID: covidwho-1166518

ABSTRACT

BACKGROUND: Corticosteroids are a potential therapeutic agent for patients with COVID-19 pneumonia. The RECOVERY (Randomised Trials in COVID-19 Therapy) trial provided data on the mortality benefits of corticosteroids. The study aimed to determine the association between corticosteroid use on mortality and infection rates and to define subgroups who may benefit from corticosteroids in a real-world setting. METHODS: Clinical data were extracted that included demographic, laboratory data and details of the therapy, including the administration of corticosteroids, azithromycin, hydroxychloroquine, tocilizumab and anticoagulation. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) admission and invasive mechanical ventilation. Outcomes were compared in patients who did and did not receive corticosteroids using the multivariate Cox regression model. RESULTS: 4313 patients were hospitalised with COVID-19 during the study period, of whom 1270 died (29.4%). When administered within the first 7 days after admission, corticosteroids were associated with reduced mortality (OR 0.73, 95% CI 0.55 to 0.97, p=0.03) and decreased transfers to the ICU (OR 0.72, 95% CI 0.47 to 1.11, p=0.02). This mortality benefit was particularly impressive in younger patients (<65 years of age), females and those with elevated inflammatory markers, defined as C reactive protein ≥150 mg/L (p≤0.05), interleukin-6 ≥20 pg/mL (p≤0.05) or D-dimer ≥2.0 µg/L (p≤0.05). Therapy was safe with similar rates of bacteraemia and fungaemia in corticosteroid-treated and non-corticosteroid-treated patients. CONCLUSION: In patients hospitalised with COVID-19 pneumonia, corticosteroid use within the first 7 days of admission decreased mortality and ICU admissions with no associated increase in bacteraemia or fungaemia.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , COVID-19/drug therapy , Hospitalization , Adult , Aged , Aged, 80 and over , Anti-Inflammatory Agents/therapeutic use , COVID-19/complications , COVID-19/mortality , Cohort Studies , Female , Hospital Mortality , Humans , Male , Middle Aged , New York City , Survival Rate
5.
SciFinder; 2020.
Preprint | SciFinder | ID: ppcovidwho-4400

ABSTRACT

A review. "One Health", referring to "the collaborative efforts of multiple disciplines working locally, nationally, and globally, to attain optimal health for people, animals, and our environment", is an effective perspective for emerging infectious disease (EID) events prevention as well as control. Since the first case was diagnosed on Dec. 8, 2019, in Wuhan, Hubei province of China, the novel coronavirus pneumonia is spreading throughout the country and even worldwide unprecedentedly. As of Feb. 7, 2020, the number of confirmed cases of this epidemic reached 34 546, far exceeding the number of SARS cases in 2003. At present, the source of 2019-nCoV is still unclear and there is no approved specific drug nor vaccine on market, while only remdesivir has already been tested in phase-three of the clin. trials. Under the perspective of "one health", multiple functional departments formed an ensemble prevention and control mechanism which will play an important role on tracing source of virus, studying vaccines and drugs, and controlling the spread of the outbreak

6.
Res Sq ; 2020 Nov 04.
Article in English | MEDLINE | ID: covidwho-918844

ABSTRACT

Epidemiological studies suggest that men exhibit a higher mortality rate to COVID-19 than women, yet the underlying biology is largely unknown. Here, we seek to delineate sex differences in the expression of entry genes ACE2 and TMPRSS2 , host responses to SARS-CoV-2, and in vitro responses to sex steroid hormone treatment. Using over 220,000 human gene expression profiles covering a wide range of age, tissues, and diseases, we found that male samples show higher expression levels of ACE2 and TMPRSS2 , especially in the older group (>60 years) and in the kidney. Analysis of 6,031 COVID-19 patients at Mount Sinai Health System revealed that men have significantly higher creatinine levels, an indicator of impaired kidney function. Further analysis of 782 COVID-19 patient gene expression profiles taken from upper airway and blood suggested men and women present profound expression differences in responses to SARS-CoV-2. Computational deconvolution analysis of these profiles revealed male COVID-19 patients have enriched kidney-specific mesangial cells in blood compared to healthy patients. Finally, we observed selective estrogen receptor modulators, but not other hormone drugs (agonists/antagonists of estrogen, androgen, and progesterone), could reduce SARS-CoV-2 infection in vitro.

7.
BMJ Open ; 10(10): e040441, 2020 10 26.
Article in English | MEDLINE | ID: covidwho-894876

ABSTRACT

OBJECTIVE: To assess association of clinical features on COVID-19 patient outcomes. DESIGN: Retrospective observational study using electronic medical record data. SETTING: Five member hospitals from the Mount Sinai Health System in New York City (NYC). PARTICIPANTS: 28 336 patients tested for SARS-CoV-2 from 24 February 2020 to 15 April 2020, including 6158 laboratory-confirmed COVID-19 cases. MAIN OUTCOMES AND MEASURES: Positive test rates and in-hospital mortality were assessed for different racial groups. Among positive cases admitted to the hospital (N=3273), we estimated HR for both discharge and death across various explanatory variables, including patient demographics, hospital site and unit, smoking status, vital signs, lab results and comorbidities. RESULTS: Hispanics (29%) and African Americans (25%) had disproportionately high positive case rates relative to their representation in the overall NYC population (p<0.05); however, no differences in mortality rates were observed in hospitalised patients based on race. Outcomes differed significantly between hospitals (Gray's T=248.9; p<0.05), reflecting differences in average baseline age and underlying comorbidities. Significant risk factors for mortality included age (HR 1.05, 95% CI 1.04 to 1.06; p=1.15e-32), oxygen saturation (HR 0.985, 95% CI 0.982 to 0.988; p=1.57e-17), care in intensive care unit areas (HR 1.58, 95% CI 1.29 to 1.92; p=7.81e-6) and elevated creatinine (HR 1.75, 95% CI 1.47 to 2.10; p=7.48e-10), white cell count (HR 1.02, 95% CI 1.01 to 1.04; p=8.4e-3) and body mass index (BMI) (HR 1.02, 95% CI 1.00 to 1.03; p=1.09e-2). Deceased patients were more likely to have elevated markers of inflammation. CONCLUSIONS: While race was associated with higher risk of infection, we did not find racial disparities in inpatient mortality suggesting that outcomes in a single tertiary care health system are comparable across races. In addition, we identified key clinical features associated with reduced mortality and discharge. These findings could help to identify which COVID-19 patients are at greatest risk of a severe infection response and predict survival.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Hospitalization/statistics & numerical data , Intensive Care Units/statistics & numerical data , Pandemics , Pneumonia, Viral , Age Factors , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/statistics & numerical data , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Electronic Health Records/statistics & numerical data , Female , Hospital Mortality , Humans , Male , Middle Aged , Mortality , New York City/epidemiology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Retrospective Studies , Risk Factors , SARS-CoV-2
8.
Sustainability ; 12(18):7459, 2020.
Article | MDPI | ID: covidwho-762695

ABSTRACT

In the context of the global economic downturn caused by COVID-19, e-commerce has become the first choice for people to shop. Many merchants choose to launch promotion activities through some social media platforms. Price discounts can dramatically increase sales volume in social e-commerce due to the interaction of online consumers. It is urgent for e-commerce merchants to learn rules about discount information dissemination in social media, so as to formulate reasonable discount strategies and achieve sustainable business. This paper constructs an evolutionary game model for e-commerce platforms and merchants when they implement promotion strategies through social media, investigates discount information dissemination among consumers under multiple situations by introducing price discount parameters, and further discusses the influence mechanism of discount size and platform reputation on consumers"purchase behavior. Results show that in low-reputation e-commerce platforms, the price discount is the main motivation to purchase. Consumers"preference for the high discount is weakened by the increase in platforms"reputation. Discounts should be set according to the different reputations. Businesses in a high-reputation environment are relatively more profitable. E-commerce businesses should work together, apply reasonable pricing, and improve their quality to create a green and healthy shopping environment, in order to get benefits and sustainable development.

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