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1.
Eur Heart J Qual Care Clin Outcomes ; 7(5): 438-446, 2021 09 16.
Article in English | MEDLINE | ID: covidwho-1377964

ABSTRACT

AIMS: To evaluate the acute and chronic patterns of myocardial injury among patients with coronavirus disease-2019 (COVID-19), and their mid-term outcomes. METHODS AND RESULTS: Patients with laboratory-confirmed COVID-19 who had a hospital encounter within the Mount Sinai Health System (New York City) between 27 February 2020 and 15 October 2020 were evaluated for inclusion. Troponin levels assessed between 72 h before and 48 h after the COVID-19 diagnosis were used to stratify the study population by the presence of acute and chronic myocardial injury, as defined by the Fourth Universal Definition of Myocardial Infarction. Among 4695 patients, those with chronic myocardial injury (n = 319, 6.8%) had more comorbidities, including chronic kidney disease and heart failure, while acute myocardial injury (n = 1168, 24.9%) was more associated with increased levels of inflammatory markers. Both types of myocardial injury were strongly associated with impaired survival at 6 months [chronic: hazard ratio (HR) 4.17, 95% confidence interval (CI) 3.44-5.06; acute: HR 4.72, 95% CI 4.14-5.36], even after excluding events occurring in the first 30 days (chronic: HR 3.97, 95% CI 2.15-7.33; acute: HR 4.13, 95% CI 2.75-6.21). The mortality risk was not significantly different in patients with acute as compared with chronic myocardial injury (HR 1.13, 95% CI 0.94-1.36), except for a worse prognostic impact of acute myocardial injury in patients <65 years of age (P-interaction = 0.043) and in those without coronary artery disease (P-interaction = 0.041). CONCLUSION: Chronic and acute myocardial injury represent two distinctive patterns of cardiac involvement among COVID-19 patients. While both types of myocardial injury are associated with impaired survival at 6 months, mortality rates peak in the early phase of the infection but remain elevated even beyond 30 days during the convalescent phase.


Subject(s)
COVID-19/complications , Myocardial Infarction/blood , Myocardial Infarction/etiology , Troponin/analysis , Acute Disease/epidemiology , Acute Disease/mortality , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Chronic Disease/epidemiology , Chronic Disease/mortality , Comorbidity , Coronary Artery Disease/epidemiology , Coronary Artery Disease/mortality , Female , Heart Failure/epidemiology , Humans , Male , Middle Aged , Mortality/trends , Myocardial Infarction/epidemiology , Myocardial Infarction/mortality , New York City/epidemiology , Outcome Assessment, Health Care , Prognosis , Renal Insufficiency, Chronic/epidemiology , Retrospective Studies , SARS-CoV-2/genetics
2.
Curr Atheroscler Rep ; 23(9): 49, 2021 07 06.
Article in English | MEDLINE | ID: covidwho-1323961

ABSTRACT

PURPOSE OF REVIEW: The syndrome of myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) is not uncommon and has multiple potential coronary etiologies. With the use of more sensitive cardiac biomarkers and advanced cardiovascular imaging, MINOCA presentations have gain increasing attention among researchers and cardiologists. Despite the presence of a myocardial infarction and elevated future risk, many patients are sent home with little or no cardio-protective treatment and no explanation for their symptoms. In this review, we emphasized the importance of MINOCA treatment based on the underlying etiology. RECENT FINDINGS: As there are multiple pathophysiological mechanisms potentially involved in MINOCA, it should be considered a working diagnosis until there is a better understanding regarding the underlying cause. It is critical to use multimodality imaging when treating patients with MINOCA to help determine the underlying etiology and rule out mimics of MINOCA, so that therapies appropriate to the etiology can be provided. A more systematic approach to managing patients with MINOCA should result in better treatment and an improved prognosis for these patients.


Subject(s)
Coronary Artery Disease , Myocardial Infarction , Coronary Angiography , Coronary Artery Disease/diagnosis , Coronary Artery Disease/epidemiology , Coronary Vessels , Humans , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Risk Factors
3.
BMJ Open Respir Res ; 8(1)2021 07.
Article in English | MEDLINE | ID: covidwho-1315812

ABSTRACT

BACKGROUND: Although several studies have reported an association between atherosclerosis-related diseases and COVID-19, the relationship between COVID-19 severity and atherosclerosis progression remains unclear. The aim of this study is to determine the coronary artery calcium score (CACS) prognostic value in patients with COVID-19 using indices such as deterioration in oxygenation and CT images of the chest. METHODS: This was a single-centre retrospective study of 53 consecutive patients with COVID-19 in Narita who were admitted to our hospital between March 2020 and August 2020. CACS was calculated based on non-gated CT scans of the chest performed on admission day. The patients were divided into the following two groups based on CACS: group 1 (CACS ≥180, n=11) and group 2 (CACS <180, n=42). Following univariate analysis of the main variables, multivariate analysis of variables that may be associated with COVID-19 progression was performed. RESULTS: Multivariable logistic regression analysis of age, sex, smoking history, diabetes, hypertension, dyslipidaemia, number of days from symptom onset to hospitalisation and CACS of ≥180 was performed. It revealed that unlike CACS of <180, CACS of ≥180 is associated with exacerbation of oxygenation or CT images of the chest during hospitalisation (OR: 12.879, 95% CI: 1.399 to 380.401). Furthermore, this model of eight variables showed good calibration (Hosmer-Lemeshow p=0.119). CONCLUSION: CACS may be a prognosis marker of COVID-19 severity. Although coronary artery calcification is not typically assessed in pneumonia cases, it may provide a valuable clinical indicator for predicting severe COVID-19 outcomes.


Subject(s)
COVID-19/physiopathology , Coronary Artery Disease/diagnostic imaging , Vascular Calcification/diagnostic imaging , Aged , Aged, 80 and over , COVID-19/epidemiology , Coronary Artery Disease/epidemiology , Diabetes Mellitus/epidemiology , Disease Progression , Dyslipidemias/epidemiology , Female , Hospitalization , Humans , Hypertension/epidemiology , Length of Stay/statistics & numerical data , Logistic Models , Male , Middle Aged , Multivariate Analysis , Prognosis , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Sex Factors , Smoking/epidemiology , Time Factors , Tomography, X-Ray Computed , Vascular Calcification/epidemiology
4.
Intern Emerg Med ; 16(5): 1231-1237, 2021 08.
Article in English | MEDLINE | ID: covidwho-1293431

ABSTRACT

BACKGROUND: Patients with coronavirus disease 2019 (Covid-19) may experience venous thrombosis while data regarding arterial thrombosis are sparse. METHODS: Prospective multicenter study in 5 hospitals including 373 patients with Covid-19-related pneumonia. Demographic data, laboratory findings including coagulation tests and comorbidities were reported. During the follow-up any arterial or venous thrombotic events and death were registered. RESULTS: Among 373 patients, 75 (20%) had a thrombotic event and 75 (20%) died. Thrombotic events included 41 venous thromboembolism and 34 arterial thrombosis. Age, cardiovascular disease, intensive care unit treatment, white blood cells, D-dimer, albumin and troponin blood levels were associated with thrombotic events. In a multivariable regression logistic model, intensive care unit treatment (Odds Ratio [OR]: 6.0; 95% Confidence Interval [CI] 2.8-12.6; p < 0.001); coronary artery disease (OR: 2.4; 95% CI 1.4-5.0; p = 0.022); and albumin levels (OR: 0.49; 95% CI 0.28-0.87; p = 0.014) were associated with ischemic events. Age, sex, chronic obstructive pulmonary disease, diabetes, heart failure, coronary heart disease, intensive care unit treatment, in-hospital thrombotic events, D-dimer, C-reactive protein, troponin, and albumin levels were associated with mortality. A multivariable Cox regression analysis showed that in-hospital thrombotic events (hazard ratio [HR]: 2.72; 95% CI 1.59-4.65; p < 0.001), age (HR: 1.035; 95% CI 1.014-1.057; p = 0.001), and albumin (HR: 0.447; 95% CI 0.277-0.723; p = 0.001) predicted morality. CONCLUSIONS: Covid-19 patients experience an equipollent rate of venous and arterial thrombotic events, that are associated with poor survival. Early identification and appropriate treatment of Covid-19 patients at risk of thrombosis may improve prognosis.


Subject(s)
COVID-19/complications , Coronary Artery Disease/etiology , Mortality/trends , Thromboembolism/etiology , Aged , Aged, 80 and over , C-Reactive Protein/analysis , COVID-19/epidemiology , Coronary Artery Disease/epidemiology , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Kaplan-Meier Estimate , Logistic Models , Male , Middle Aged , Odds Ratio , Proportional Hazards Models , Prospective Studies , Thromboembolism/epidemiology
5.
Turk Kardiyol Dern Ars ; 49(4): 286-292, 2021 06.
Article in English | MEDLINE | ID: covidwho-1262654

ABSTRACT

OBJECTIVE: To compare the prevalence of hypertension and pre-existing use of renin-angiotensin-aldosterone system blockers in patients with coronavirus disease (COVID-19) and non-COVID-19 viral pneumonias. METHODS: Real-time polymerase chain reaction confirmed COVID-19 and non-COVID-19 pneumonia patients were retrospectively analyzed. The presence of hypertension, coronary artery disease (CAD), and pre-existing use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) were compared between the groups. RESULTS: A total of 103 COVID-19 and 91 non-COVID-19 hospitalized viral pneumonia patients were enrolled. Hypertension and CAD were more common in patients with non-COVID-19 viral pneumonia than in patients with COVID-19 (39.6% vs 22.3%, respectively, p=0.012 and 24.2% vs 4.9%, respectively, p<0.001). In our study, 2.9% and 6.8% of patients with COVID-19 were on ACEIs and ARBs, respectively, whereas 13.2% and 19.8% of patients with non-COVID-19 viral pneumonia were on ACEIs and ARBs, respectively (p=0.009 and p=0.013). Neutrophil-to-lymphocyte ratio (p<0.001) was prominent in patients with non-COVID-19 viral pneumonia compared with patients with COVID-19. CONCLUSION: Our study results indicate that hypertension and CAD are more common among patients with non-COVID-19 viral pneumonia than patients with COVID-19. The prevalence of ACEIs and ARBs use was not higher in patients with COVID-19. Our results support that the use of ACEIs and ARBs do not play a specific role in patients with COVID-19.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19 , Hypertension , Adult , COVID-19/complications , COVID-19/epidemiology , Coronary Artery Disease/complications , Coronary Artery Disease/epidemiology , Female , Humans , Hypertension/complications , Hypertension/drug therapy , Hypertension/epidemiology , Male , Middle Aged , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Prevalence , Retrospective Studies
6.
Crit Care ; 25(1): 158, 2021 04 26.
Article in English | MEDLINE | ID: covidwho-1204102

ABSTRACT

BACKGROUND: COVID-19 has resulted in high mortality worldwide. Information regarding cardiac markers for precise risk-stratification is limited. We aim to discover sensitive and reliable early-warning biomarkers for optimizing management and improving the prognosis of COVID-19 patients. METHODS: A total of 2954 consecutive COVID-19 patients who were receiving treatment from the Wuhan Huoshenshan Hospital in China from February 4 to April 10 were included in this retrospective cohort. Serum levels of cardiac markers were collected after admission. Coronary artery disease diagnosis and survival status were recorded. Single-cell RNA-sequencing and bulk RNA-sequencing from different cohorts of non-COVID-19 were performed to analyze SARS-CoV-2 receptor expression. RESULTS: Among 2954 COVID-19 patients in the analysis, the median age was 60 years (50-68 years), 1461 (49.5%) were female, and 1515 (51.3%) were severe/critical. Compared to mild/moderate (1439, 48.7%) patients, severe/critical patients showed significantly higher levels of cardiac markers within the first week after admission. In severe/critical COVID-19 patients, those with abnormal serum levels of BNP (42 [24.6%] vs 7 [1.1%]), hs-TNI (38 [48.1%] vs 6 [1.0%]), α- HBDH (55 [10.4%] vs 2 [0.2%]), CK-MB (45 [36.3%] vs 12 [0.9%]), and LDH (56 [12.5%] vs 1 [0.1%]) had a significantly higher mortality rate compared to patients with normal levels. The same trend was observed in the ICU admission rate. Severe/critical COVID-19 patients with pre-existing coronary artery disease (165/1,155 [10.9%]) had more cases of BNP (52 [46.5%] vs 119 [16.5%]), hs-TNI (24 [26.7%] vs 9.6 [%], α- HBDH (86 [55.5%] vs 443 [34.4%]), CK-MB (27 [17.4%] vs 97 [7.5%]), and LDH (65 [41.9%] vs 382 [29.7%]), when compared with those without coronary artery disease. There was enhanced SARS-CoV-2 receptor expression in coronary artery disease compared with healthy controls. From regression analysis, patients with five elevated cardiac markers were at a higher risk of death (hazards ratio 3.4 [95% CI 2.4-4.8]). CONCLUSIONS: COVID-19 patients with pre-existing coronary artery disease represented a higher abnormal percentage of cardiac markers, accompanied by high mortality and ICU admission rate. BNP together with hs-TNI, α- HBDH, CK-MB and LDH act as a prognostic biomarker in COVID-19 patients with or without pre-existing coronary artery disease.


Subject(s)
Biomarkers/blood , COVID-19/blood , COVID-19/therapy , Coronary Artery Disease/blood , Aged , COVID-19/epidemiology , China/epidemiology , Coronary Artery Disease/epidemiology , Female , Hospitalization , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Assessment/methods
8.
Cardiol Rev ; 29(3): 143-149, 2021.
Article in English | MEDLINE | ID: covidwho-1148006

ABSTRACT

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 has affected the health of people across the globe. Cardiovascular diseases (CVDs) have a significant relationship with COVID-19, both as a risk factor and prognostic indicator, and as a complication of the disease itself. In addition to predisposing to CVD complications, the ongoing pandemic has severely affected the delivery of timely and appropriate care for cardiovascular conditions resulting in increased mortality. The etiology behind the cardiac injury associated with severe acute respiratory syndrome coronavirus-2 is likely varied, including coronary artery disease, microvascular thrombosis, myocarditis, and stress cardiomyopathy. Further large-scale investigations are needed to better determine the underlying mechanism of myocardial infarction and other cardiac injury in COVID-19 patients and to determine the incidence of each type of cardiac injury in this patient population. Telemedicine and remote monitoring technologies can play an important role in optimizing outcomes in patients with established CVD. In this article, we summarize the various impacts that COVID-19 has on the cardiovascular system, including myocardial infarction, myocarditis, stress cardiomyopathy, thrombosis, and stroke.


Subject(s)
COVID-19/physiopathology , Cardiovascular Diseases/physiopathology , COVID-19/complications , COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Comorbidity , Coronary Artery Disease/epidemiology , Coronary Artery Disease/etiology , Coronary Artery Disease/physiopathology , Coronary Thrombosis/etiology , Coronary Thrombosis/physiopathology , Heart Disease Risk Factors , Humans , Ischemic Stroke/epidemiology , Ischemic Stroke/etiology , Ischemic Stroke/physiopathology , Microvessels , Myocardial Infarction/epidemiology , Myocardial Infarction/etiology , Myocardial Infarction/physiopathology , Myocarditis/etiology , Myocarditis/physiopathology , SARS-CoV-2 , Stroke/epidemiology , Stroke/etiology , Stroke/physiopathology , Takotsubo Cardiomyopathy/etiology , Takotsubo Cardiomyopathy/physiopathology , Thrombosis/etiology , Thrombosis/physiopathology
9.
PLoS Med ; 18(3): e1003553, 2021 03.
Article in English | MEDLINE | ID: covidwho-1117467

ABSTRACT

BACKGROUND: Epidemiological studies report associations of diverse cardiometabolic conditions including obesity with COVID-19 illness, but causality has not been established. We sought to evaluate the associations of 17 cardiometabolic traits with COVID-19 susceptibility and severity using 2-sample Mendelian randomization (MR) analyses. METHODS AND FINDINGS: We selected genetic variants associated with each exposure, including body mass index (BMI), at p < 5 × 10-8 from genome-wide association studies (GWASs). We then calculated inverse-variance-weighted averages of variant-specific estimates using summary statistics for susceptibility and severity from the COVID-19 Host Genetics Initiative GWAS meta-analyses of population-based cohorts and hospital registries comprising individuals with self-reported or genetically inferred European ancestry. Susceptibility was defined as testing positive for COVID-19 and severity was defined as hospitalization with COVID-19 versus population controls (anyone not a case in contributing cohorts). We repeated the analysis for BMI with effect estimates from the UK Biobank and performed pairwise multivariable MR to estimate the direct effects and indirect effects of BMI through obesity-related cardiometabolic diseases. Using p < 0.05/34 tests = 0.0015 to declare statistical significance, we found a nonsignificant association of genetically higher BMI with testing positive for COVID-19 (14,134 COVID-19 cases/1,284,876 controls, p = 0.002; UK Biobank: odds ratio 1.06 [95% CI 1.02, 1.10] per kg/m2; p = 0.004]) and a statistically significant association with higher risk of COVID-19 hospitalization (6,406 hospitalized COVID-19 cases/902,088 controls, p = 4.3 × 10-5; UK Biobank: odds ratio 1.14 [95% CI 1.07, 1.21] per kg/m2, p = 2.1 × 10-5). The implied direct effect of BMI was abolished upon conditioning on the effect on type 2 diabetes, coronary artery disease, stroke, and chronic kidney disease. No other cardiometabolic exposures tested were associated with a higher risk of poorer COVID-19 outcomes. Small study samples and weak genetic instruments could have limited the detection of modest associations, and pleiotropy may have biased effect estimates away from the null. CONCLUSIONS: In this study, we found genetic evidence to support higher BMI as a causal risk factor for COVID-19 susceptibility and severity. These results raise the possibility that obesity could amplify COVID-19 disease burden independently or through its cardiometabolic consequences and suggest that targeting obesity may be a strategy to reduce the risk of severe COVID-19 outcomes.


Subject(s)
Body Mass Index , COVID-19 , Coronary Artery Disease , Diabetes Mellitus, Type 2 , Disease Susceptibility , Obesity , Renal Insufficiency, Chronic , Stroke , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/genetics , Cardiometabolic Risk Factors , Causality , Coronary Artery Disease/epidemiology , Coronary Artery Disease/genetics , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/genetics , Genetic Variation , Genome-Wide Association Study/statistics & numerical data , Humans , Mendelian Randomization Analysis , Meta-Analysis as Topic , Obesity/diagnosis , Obesity/epidemiology , Obesity/metabolism , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/genetics , SARS-CoV-2 , Severity of Illness Index , Stroke/epidemiology , Stroke/genetics
10.
Medicine (Baltimore) ; 100(9): e25072, 2021 Mar 05.
Article in English | MEDLINE | ID: covidwho-1114904

ABSTRACT

RATIONALE: Northern Italy has been particularly hit by the current Covid-19 pandemic. Italian deceased patients have a mean age of 78.5 years and only 1.2% have no comorbidities. These data started a public debate whether patients die "with" or "from" Covid-19. If on one hand the public opinion has been persuaded to believe that Covid-19 infection has poor outcomes just in elderly and/or fragile subjects, on the other hand, hospitals are admitting an increasing number of healthy young patients needing semi-intensive or intensive care units. PATIENT CONCERNS: At the end of March 2020, a 79-year-old patient (M.G.) was admitted to the emergency department of our hospital with a 5 days history of fever, dyspnea, and cough. He was known for hypertension and coronary artery disease with a previous coronary artery stenting. Both the comorbidities were carried out without complications and the patient was previously asymptomatic and in good health. At admission, he was febrile and showed signs of respiratory failure with hypoxia and hypocapnia at blood gas analysis. DIAGNOSIS: The day after, he was tested for SARS-CoV-2 with a real-time reverse transcriptase-polymerase chain reaction assay of nasopharyngeal swab, which turned positive and a chest CT-Scan was consistent with the diagnosis of interstitial pneumonia. INTERVENTIONS: He was treated with i.v. diuretics, paracetamol, prolonged noninvasive ventilation (CPAP), and empiric antibiotic therapy on top of his chronic treatment. OUTCOMES: A treatment with heparin and corticosteroids was started; however, he developed irreversible respiratory failure. Invasive ventilation was not considered appropriate due to his comorbidities, low chances of recovery, and intensive care unit overcrowding. The patient died 9 days after admission. LESSONS: Health conditions that are most reported as risk factors are common cardiovascular diseases that can be managed in modern clinical practice. Through a brief illustrative clinical case, we would like to underline how Covid-19 can be per se the cause of death in patients that would otherwise have had an acceptable life expectancy.


Subject(s)
COVID-19 , Coronary Artery Disease , Hypertension , Patient Care Management/methods , Pneumonia, Viral , Aged , Blood Gas Analysis/methods , COVID-19/diagnosis , COVID-19/mortality , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing/methods , Clinical Deterioration , Coronary Artery Disease/epidemiology , Coronary Artery Disease/physiopathology , Coronary Artery Disease/therapy , Fatal Outcome , Humans , Hypertension/epidemiology , Hypertension/physiopathology , Hypertension/therapy , Male , Pneumonia, Viral/blood , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Risk Assessment , SARS-CoV-2/isolation & purification , Tomography, X-Ray Computed/methods
11.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Article in English | MEDLINE | ID: covidwho-1059803

ABSTRACT

COVID-19 is a pandemic with over 5 million cases worldwide. The disease has imposed a huge burden on health resources. Evaluation of clinical and epidemiological profiles of such patients can help in understanding and managing the outbreak more efficiently. This study was a prospective observational analysis of 200 diagnosed COVID-19 patients admitted to a tertiary care center from 20th march to 8th May 2020. All these patients were positive for COVID-19 by an oro-nasopharyngeal swab-rtPCR based testing. Analyses of demographic factors, clinical characteristics, comorbidities, laboratory parameters, and the outcomes were performed. The mean age of the population was 40 years with a slight male predominance (116 patients out of 200, 58%). A majority of the patients (147, 73.5 %) were symptomatic, with fever being the most common symptom (109, 54.5%), followed by cough (91, 45.5%). An older age, presence of symptoms and their duration, leukocytosis, a high quick SOFA score, a high modified SOFA score, need for ventilator support, an AST level more than 3 times the upper limit of normal (ULN), and a serum creatinine level of 2 mg/dl or greater were at a significantly higher risk of ICU admission and mortality. Presence of diabetes mellitus, AST > three times ULN, serum creatinine 2 mg/dl or higher, and a qSOFA score of 1 or higher were all associated with significantly greater odds of critical care requirement. Triage and severity assessment helps in deciding the requirement for a hospital stay and ICU admission for COVID-19 which can easily be done using clinical and laboratory parameters. A mild, moderate and severe category approach with defined criteria and treatment guidelines will help in judicious utilization of health-care resources, especially for developing countries like India.   *Other members of the Safdarjung Hospital COVID-19 working group: Balvinder Singh (Microbiology), MK Sen (Pulmonary Medicine), Shibdas Chakrabarti (Pulmonary Medicine), NK Gupta (Pulmonary medicine), AJ Mahendran (Pulmonary Medicine), Ramesh Meena (Medicine), G Usha (Anaesthesiology), Santvana Kohli (Anaesthesiology), Sahil Diwan (Anaesthesiology), Rushika Saksena (Microbiology), Vikramjeet Dutta (Microbiology), Anupam Kr Anveshi (Microbiology).


Subject(s)
Coronavirus Infections/blood , Coronavirus Infections/physiopathology , Pneumonia, Viral/blood , Pneumonia, Viral/physiopathology , Adolescent , Adult , Aged , Aged, 80 and over , Alanine Transaminase/blood , Anemia/blood , Aspartate Aminotransferases/blood , Betacoronavirus , COVID-19 , Child , Child, Preschool , Comorbidity , Coronary Artery Disease/epidemiology , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Cough/physiopathology , Creatinine/blood , Diabetes Mellitus/epidemiology , Female , Fever/physiopathology , Humans , Hypertension/epidemiology , Hypoxia/physiopathology , India/epidemiology , Infant , Infant, Newborn , Intensive Care Units , Length of Stay , Leukocyte Count , Leukocytosis/blood , Lymphopenia/blood , Lymphopenia/physiopathology , Male , Middle Aged , Myalgia/physiopathology , Organ Dysfunction Scores , Pandemics , Pharyngitis/physiopathology , Platelet Count , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Prospective Studies , Respiration, Artificial , SARS-CoV-2 , Tachypnea/physiopathology , Tertiary Care Centers , Time Factors , Tuberculosis/epidemiology , Young Adult
12.
Eur Rev Med Pharmacol Sci ; 24(24): 13089-13097, 2020 12.
Article in English | MEDLINE | ID: covidwho-1000855

ABSTRACT

OBJECTIVE: Recently, two influential articles that reported the association of (hydroxy)chloroquine or angiotensin converting enzyme (ACE) inhibitors and coronavirus disease 2019 (COVID-19) mortality were retracted due to significant methodological issues. Therefore, we aimed to analyze the same clinical issues through an improved research method and to find out the differences from the retracted papers. We systematically reviewed pre-existing literature, and compared the results with those of the retracted papers to gain a novel insight. MATERIALS AND METHODS: We extracted common risk factors identified in two retracted papers, and conducted relevant publication search until June 26, 2020 in PubMed. Then, we analyzed the risk factors for COVID-19 mortality and compared them to those of the retracted papers. RESULTS: Our systematic review demonstrated that most demographic and clinical risk factors for COVID-19 mortality were similar to those of the retracted papers. However, while the retracted paper indicated that both (hydroxy)chloroquine monotherapy and combination therapy with macrolide were associated with higher risk of mortality, our study showed that only combination therapy of hydroxychloroquine and macrolide was associated with higher risk of mortality (odds ratio 2.33; 95% confidence interval 1.63-3.34). In addition, our study demonstrated that use of ACE inhibitors or angiotensin receptor blockers (ARBs) was associated with reduced risk of mortality (0.77; 0.65-0.91). CONCLUSIONS: When analyzing the same clinical issues with the two retracted papers through a systematic review of randomized controlled trials and relevant cohort studies, we found out that (hydroxy)chloroquine monotherapy was not associated with higher risk of mortality, and that the use of ACE inhibitors or ARBs was associated with reduced risk of mortality in COVID-19 patients.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19/mortality , Enzyme Inhibitors/therapeutic use , Hydroxychloroquine/therapeutic use , Retraction of Publication as Topic , Age Factors , /statistics & numerical data , COVID-19/drug therapy , COVID-19/epidemiology , COVID-19/immunology , Coronary Artery Disease/epidemiology , Databases, Factual , Diabetes Mellitus/epidemiology , Drug Therapy, Combination , Heart Failure/epidemiology , Humans , Hypertension/epidemiology , Immunocompromised Host/immunology , Information Dissemination , Macrolides/therapeutic use , Obesity/epidemiology , Organ Dysfunction Scores , Protective Factors , Pulmonary Disease, Chronic Obstructive/epidemiology , Randomized Controlled Trials as Topic , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Sex Factors , Smoking/epidemiology
13.
Turk J Med Sci ; 51(2): 454-463, 2021 04 30.
Article in English | MEDLINE | ID: covidwho-976377

ABSTRACT

Background/aim: We aimed to investigate the factors affecting the mortality of patients aged 65 years or older who were hospitalized with the diagnosis of new coronavirus pneumonia (COVID-19). Materials and methods: This is a retrospective study of patients 65 years old or older with COVID-19 who were hospitalized in Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty Hospital, between March 11 and May 28, 2020. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records. We used univariate and multivariate logistic regression methods to explore the risk factors for in-hospital death. Results: A total of 218 patients (112 men, 106 women) were included, of whom 166 were discharged and 52 died in hospital. With univariate analysis, various clinical features and laboratory variables were found to be significantly different (i.e. P < 0.05). In multivariate logistic regression analysis the following were independently associated with mortality: present malignancy [odds ratio (OR) = 4.817, 95% confidence interval (CI) = 1.107­20.958, P: 0.036]; dyspnea (OR = 4.652, 95% CI = 1.473­14.688, P: 0.009); neutrophil/lymphocyte ratio (NLR; OR = 1.097, 95% CI = 1.012­1.188, P: 0.025); the highest values of C-reactive protein (CRP; OR = 1.006, 95% CI = 1.000­1.012, P: 0.049), lactate dehydrogenase (LDH; OR = 1.002, 95% CI = 1.001­1.004, P: 0.003), and creatinine levels (OR = 1.497, 95% CI = 1.126­1.990, P: 0.006); oxygen saturation (SpO2) values on admission (OR = 0.897, 95% CI = 0.811­0.993, P: 0.036); and azithromycin use (OR = 0.239, 95% CI = 0.065­0.874, P: 0.031). Conclusion: The presence of malignancy; symptoms of dyspnea; high NLR; highest CRP, LDH, and creatinine levels; and low SpO2 on admission predicted mortality. On the other hand, azithromycin use was found to be protective against mortality. Knowing the causes predicting mortality will be important to treat future cases more successfully.


Subject(s)
COVID-19/mortality , Neoplasms/epidemiology , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , C-Reactive Protein/metabolism , COVID-19/epidemiology , COVID-19/metabolism , COVID-19/physiopathology , Comorbidity , Coronary Artery Disease/epidemiology , Creatinine/metabolism , Diabetes Mellitus, Type 2/epidemiology , Dyspnea/physiopathology , Female , Heart Failure/epidemiology , Humans , Hypertension/epidemiology , Hypoxia/physiopathology , L-Lactate Dehydrogenase/metabolism , Leukocyte Count , Lymphocyte Count , Male , Neutrophils , Prognosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Turkey/epidemiology
14.
Eur Heart J Acute Cardiovasc Care ; 9(8): 817-823, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-939994

ABSTRACT

AIMS: To determine the frequency and pattern of cardiac complications in patients hospitalised with coronavirus disease (COVID-19). METHODS AND RESULTS: CAPACITY-COVID is an international patient registry established to determine the role of cardiovascular disease in the COVID-19 pandemic. In this registry, data generated during routine clinical practice are collected in a standardised manner for patients with a (highly suspected) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requiring hospitalisation. For the current analysis, consecutive patients with laboratory confirmed COVID-19 registered between 28 March and 3 July 2020 were included. Patients were followed for the occurrence of cardiac complications and pulmonary embolism from admission to discharge. In total, 3011 patients were included, of which 1890 (62.8%) were men. The median age was 67 years (interquartile range 56-76); 937 (31.0%) patients had a history of cardiac disease, with pre-existent coronary artery disease being most common (n=463, 15.4%). During hospitalisation, 595 (19.8%) patients died, including 16 patients (2.7%) with cardiac causes. Cardiac complications were diagnosed in 349 (11.6%) patients, with atrial fibrillation (n=142, 4.7%) being most common. The incidence of other cardiac complications was 1.8% for heart failure (n=55), 0.5% for acute coronary syndrome (n=15), 0.5% for ventricular arrhythmia (n=14), 0.1% for bacterial endocarditis (n=4) and myocarditis (n=3), respectively, and 0.03% for pericarditis (n=1). Pulmonary embolism was diagnosed in 198 (6.6%) patients. CONCLUSION: This large study among 3011 hospitalised patients with COVID-19 shows that the incidence of cardiac complications during hospital admission is low, despite a frequent history of cardiovascular disease. Long-term cardiac outcomes and the role of pre-existing cardiovascular disease in COVID-19 outcome warrants further investigation.


Subject(s)
COVID-19/complications , Heart Diseases/epidemiology , Hospitalization/trends , SARS-CoV-2/genetics , Acute Coronary Syndrome/epidemiology , Aged , Atrial Fibrillation/epidemiology , COVID-19/epidemiology , COVID-19/virology , Coronary Artery Disease/epidemiology , Endocarditis, Bacterial/epidemiology , Female , Heart Diseases/mortality , Heart Failure/epidemiology , Humans , Incidence , Male , Middle Aged , Myocarditis/epidemiology , Outcome Assessment, Health Care , Pericarditis/epidemiology , Pulmonary Embolism/epidemiology , Registries
15.
Curr Probl Cardiol ; 46(4): 100737, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-898666

ABSTRACT

BACKGROUND: The COVID-19 pandemic's mental health consequences remain unknown. AIM: To assess the mental health status of ambulatory cardiometabolic patients during COVID-19 pandemic lockdown in Spanish speaking Latin American countries. METHODS: Cardiometabolic patients without COVID-19 evidence in 13 Latin American countries answered a survey between June 15th and July 15th, 2020. The Diagnosis Manual of Mental Disorders fifth edition was used to identify the presence of major depressive symptoms. RESULTS: The sample included 4216 patients, 1590 (37.71%; IC95% 36.24-39.19) were considered suffering major depression. Female gender, consuming ≥5 medications day, physical activity <100 minutes weekly, low fruits and vegetables intake, poor treatment adherence, reduced food consumption were independently associated to the presence of major depressive symptoms. CONCLUSIONS: The CorCOVID Latam Psy study showed that one-third of the Latin American Spanish speaking population is suffering from major depressive symptoms during the COVID-19 outbreak.


Subject(s)
COVID-19 , Cardiovascular Diseases/epidemiology , Depression/epidemiology , Depressive Disorder, Major/epidemiology , Diabetes Mellitus/epidemiology , Metabolic Syndrome/epidemiology , Adult , Aged , Cardiovascular Diseases/psychology , Coronary Artery Disease/epidemiology , Coronary Artery Disease/psychology , Depression/psychology , Depressive Disorder, Major/psychology , Diabetes Mellitus/psychology , Diet/statistics & numerical data , Dyslipidemias/epidemiology , Dyslipidemias/psychology , Eating , Exercise/psychology , Female , Fruit , Heart Failure/epidemiology , Heart Failure/psychology , Humans , Hypertension/epidemiology , Hypertension/psychology , Latin America/epidemiology , Male , Mental Health , Metabolic Syndrome/psychology , Middle Aged , SARS-CoV-2 , Sex Factors , Stroke/epidemiology , Stroke/psychology , Surveys and Questionnaires , Treatment Adherence and Compliance/psychology , Treatment Adherence and Compliance/statistics & numerical data , Vegetables
18.
Eur Radiol ; 31(3): 1770-1779, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-777788

ABSTRACT

OBJECTIVE: To evaluate whether the initial chest X-ray (CXR) severity assessed by an AI system may have prognostic utility in patients with COVID-19. METHODS: This retrospective single-center study included adult patients presenting to the emergency department (ED) between February 25 and April 9, 2020, with SARS-CoV-2 infection confirmed on real-time reverse transcriptase polymerase chain reaction (RT-PCR). Initial CXRs obtained on ED presentation were evaluated by a deep learning artificial intelligence (AI) system and compared with the Radiographic Assessment of Lung Edema (RALE) score, calculated by two experienced radiologists. Death and critical COVID-19 (admission to intensive care unit (ICU) or deaths occurring before ICU admission) were identified as clinical outcomes. Independent predictors of adverse outcomes were evaluated by multivariate analyses. RESULTS: Six hundred ninety-seven 697 patients were included in the study: 465 males (66.7%), median age of 62 years (IQR 52-75). Multivariate analyses adjusting for demographics and comorbidities showed that an AI system-based score ≥ 30 on the initial CXR was an independent predictor both for mortality (HR 2.60 (95% CI 1.69 - 3.99; p < 0.001)) and critical COVID-19 (HR 3.40 (95% CI 2.35-4.94; p < 0.001)). Other independent predictors were RALE score, older age, male sex, coronary artery disease, COPD, and neurodegenerative disease. CONCLUSION: AI- and radiologist-assessed disease severity scores on CXRs obtained on ED presentation were independent and comparable predictors of adverse outcomes in patients with COVID-19. TRIAL REGISTRATION: ClinicalTrials.gov NCT04318366 ( https://clinicaltrials.gov/ct2/show/NCT04318366 ). KEY POINTS: • AI system-based score ≥ 30 and a RALE score ≥ 12 at CXRs performed at ED presentation are independent and comparable predictors of death and/or ICU admission in COVID-19 patients. • Other independent predictors are older age, male sex, coronary artery disease, COPD, and neurodegenerative disease. • The comparable performance of the AI system in relation to a radiologist-assessed score in predicting adverse outcomes may represent a game-changer in resource-constrained settings.


Subject(s)
COVID-19/diagnostic imaging , Deep Learning , Intensive Care Units/statistics & numerical data , Radiography, Thoracic , Age Factors , Aged , Artificial Intelligence , COVID-19/epidemiology , COVID-19/mortality , COVID-19/physiopathology , Comorbidity , Coronary Artery Disease/epidemiology , Emergency Service, Hospital , Female , Hospitalization , Humans , Italy/epidemiology , Male , Middle Aged , Mortality , Neurodegenerative Diseases/epidemiology , Prognosis , Proportional Hazards Models , Pulmonary Disease, Chronic Obstructive/epidemiology , Radiography , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Sex Factors , Tomography, X-Ray Computed
19.
Int J Cardiol ; 323: 276-280, 2021 01 15.
Article in English | MEDLINE | ID: covidwho-747491

ABSTRACT

BACKGROUND: Since the body of evidence addressing the coagulation derangements caused by Coronavirus disease (COVID-19) has been constantly growing, we investigated whether pre-hospitalization oral anticoagulation (OAC) or in-hospital heparin treatment could have a protective role among COVID-19 patients. METHOD: In this cohort study, consecutive COVID-19 patients admitted to four different Italian Institutions were enrolled. Baseline demographic, clinical, laboratory, and radiological characteristics, as well as in-hospital treatment and outcomes were evaluated. The primary outcome was mortality. RESULTS: A total of 844 COVID-19 patients were enrolled as study cohort, n = 65 (7.7%) taking OACs prior to hospitalization. Regarding clinical outcomes, OAC patients developed acute hypoxemic respiratory failure (AHRF) more frequently than non-OAC patients as well as presenting a higher mortality rate (44.6% vs 19.8%, p < 0.001). At overall multivariate logistical regression, use of heparin (n = 394, 46.6%) was associated with a better chance of survival to hospital discharge (OR 0.60 [0.38-0.94], p < 0.001), in particular in patients with AHRF, with no association found with the use of OACs. In a sub-analysis, the highest mortality rate was found for AHRF patients when heparin was not administered. CONCLUSION: In our cohort, OACs appeared to be ineffective in reducing mortality rate, while heparin resulted to be a useful treatment when lung disease was sufficiently severe, potentially suggesting a crucial role of microthrombosis in severe COVID-19. Due to the relatively small number of COVID-19 patients treated with OACs included in our analysis and their higher number of comorbidities, larger studies are needed in order to confirm our findings.


Subject(s)
Anticoagulants/therapeutic use , COVID-19/mortality , Heparin/therapeutic use , Respiratory Insufficiency/drug therapy , Respiratory Insufficiency/mortality , Administration, Oral , Age Factors , Aged , COVID-19/drug therapy , COVID-19/virology , Cohort Studies , Coronary Artery Disease/epidemiology , Female , Fibrin Fibrinogen Degradation Products/analysis , Hospitalization , Humans , Italy/epidemiology , Male , Middle Aged , Multivariate Analysis , Oxygen/blood , Sex Factors
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