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1.
Dis Markers ; 2021: 6304189, 2021.
Article in English | MEDLINE | ID: covidwho-1553755

ABSTRACT

Background: Early identification of patients with severe coronavirus disease (COVID-19) at an increased risk of progression may promote more individualized treatment schemes and optimize the use of medical resources. This study is aimed at investigating the utility of the C-reactive protein to albumin (CRP/Alb) ratio for early risk stratification of patients. Methods: We retrospectively reviewed 557 patients with COVID-19 with confirmed outcomes (discharged or deceased) admitted to the West Court of Union Hospital, Wuhan, China, between January 29, 2020 and April 8, 2020. Patients with severe COVID-19 (n = 465) were divided into stable (n = 409) and progressive (n = 56) groups according to whether they progressed to critical illness or death during hospitalization. To predict disease progression, the CRP/Alb ratio was evaluated on admission. Results: The levels of new biomarkers, including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, CRP/Alb ratio, and systemic immune-inflammation index, were higher in patients with progressive disease than in those with stable disease. Correlation analysis showed that the CRP/Alb ratio had the strongest positive correlation with the sequential organ failure assessment score and length of hospital stay in survivors. Multivariate logistic regression analysis showed that percutaneous oxygen saturation (SpO2), D-dimer levels, and the CRP/Alb ratio were risk factors for disease progression. To predict clinical progression, the areas under the receiver operating characteristic curves of Alb, CRP, CRP/Alb ratio, SpO2, and D-dimer were 0.769, 0.838, 0.866, 0.107, and 0.748, respectively. Moreover, patients with a high CRP/Alb ratio (≥1.843) had a markedly higher rate of clinical deterioration (log - rank p < 0.001). A higher CRP/Alb ratio (≥1.843) was also closely associated with higher rates of hospital mortality, ICU admission, invasive mechanical ventilation, and a longer hospital stay. Conclusion: The CRP/Alb ratio can predict the risk of progression to critical disease or death early, providing a promising prognostic biomarker for risk stratification and clinical management of patients with severe COVID-19.


Subject(s)
C-Reactive Protein/metabolism , COVID-19/diagnosis , Coronary Disease/diagnosis , Hypertension/diagnosis , Pulmonary Disease, Chronic Obstructive/diagnosis , SARS-CoV-2/pathogenicity , Serum Albumin, Human/metabolism , Aged , Area Under Curve , Biomarkers/blood , Blood Platelets/pathology , Blood Platelets/virology , COVID-19/epidemiology , COVID-19/mortality , COVID-19/virology , China/epidemiology , Comorbidity , Coronary Disease/epidemiology , Coronary Disease/mortality , Coronary Disease/virology , Disease Progression , Early Diagnosis , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Hypertension/epidemiology , Hypertension/mortality , Hypertension/virology , Length of Stay/statistics & numerical data , Lymphocytes/pathology , Lymphocytes/virology , Male , Middle Aged , Neutrophils/pathology , Neutrophils/virology , Prognosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/mortality , Pulmonary Disease, Chronic Obstructive/virology , ROC Curve , Retrospective Studies , SARS-CoV-2/growth & development , Severity of Illness Index , Survival Analysis
2.
PLoS One ; 16(10): e0258914, 2021.
Article in English | MEDLINE | ID: covidwho-1480460

ABSTRACT

BACKGROUND: Risk factors of severe COVID-19 have mainly been investigated in the hospital setting. We investigated pre-defined risk factors for testing positive for SARS-CoV-2 infection and cardiovascular or pulmonary complications in the outpatient setting. METHODS: The present cohort study makes use of ambulatory claims data of statutory health insurance physicians in Bavaria, Germany, with polymerase chain reaction (PCR) test confirmed or excluded SARS-CoV-2 infection in first three quarters of 2020. Statistical modelling and machine learning were used for effect estimation and for hypothesis testing of risk factors, and for prognostic modelling of cardiovascular or pulmonary complications. RESULTS: A cohort of 99 811 participants with PCR test was identified. In a fully adjusted multivariable regression model, dementia (odds ratio (OR) = 1.36), type 2 diabetes (OR = 1.14) and obesity (OR = 1.08) were identified as significantly associated with a positive PCR test result. Significant risk factors for cardiovascular or pulmonary complications were coronary heart disease (CHD) (OR = 2.58), hypertension (OR = 1.65), tobacco consumption (OR = 1.56), chronic obstructive pulmonary disease (COPD) (OR = 1.53), previous pneumonia (OR = 1.53), chronic kidney disease (CKD) (OR = 1.25) and type 2 diabetes (OR = 1.23). Three simple decision rules derived from prognostic modelling based on age, hypertension, CKD, COPD and CHD were able to identify high risk patients with a sensitivity of 74.8% and a specificity of 80.0%. CONCLUSIONS: The decision rules achieved a high prognostic accuracy non-inferior to complex machine learning methods. They might help to identify patients at risk, who should receive special attention and intensified protection in ambulatory care.


Subject(s)
Ambulatory Care , COVID-19 , Coronary Disease , Hypertension , Renal Insufficiency, Chronic , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , Coronary Disease/epidemiology , Coronary Disease/therapy , Dementia/epidemiology , Dementia/therapy , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Female , Germany , Humans , Hypertension/epidemiology , Hypertension/therapy , Male , Middle Aged , Obesity/epidemiology , Obesity/therapy , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/therapy , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/therapy , Risk Assessment , Risk Factors
3.
Glob Heart ; 16(1): 14, 2021 02 12.
Article in English | MEDLINE | ID: covidwho-1143732

ABSTRACT

Background: Infection caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) exhibits a strong infectivity but less virulence compared to severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). In terms of cardiovascular morbidity, susceptible population include elderly and patients with certain cardiovascular conditions. This infection has been associated with cardiac injury, cardiovascular complications and higher mortality. Objectives: The main objective of the CARDIO COVID 19-20 Registry is to determine the presence of cardiovascular comorbidities and cardiovascular complications in COVID-19 infected patients that required in-hospital treatment in different Latin American institutions. Methods: The CARDIO COVID 19-20 Registry is an observational, multicenter, ambispective, and hospital-based registry of patients with confirmed COVID-19 infection who required in-hospital treatment in Latin America. Enrollment of patients started on May 01, 2020 and was initially planned to last three months; based on the progression of pandemic in Latin America, enrollment was extended until December 2020, and could be extended once again based on the pandemic course in our continent at that moment. Conclusions: The CARDIO COVID 19-20 Registry will characterize the in-hospital population diagnosed with COVID-19 in Latin America in order to identify risk factors for worsening of cardiovascular comorbidities or for the appearance of cardiovascular complications during hospitalization and during the 30-day follow up period.


Subject(s)
COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Registries , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/physiopathology , COVID-19/complications , COVID-19/physiopathology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/physiopathology , Comorbidity , Coronary Disease/epidemiology , Coronary Disease/etiology , Coronary Disease/physiopathology , Heart Failure/epidemiology , Heart Failure/etiology , Heart Failure/physiopathology , Humans , Latin America , Myocarditis/epidemiology , Myocarditis/etiology , Myocarditis/physiopathology , SARS-CoV-2 , Thrombosis/epidemiology , Thrombosis/etiology , Thrombosis/physiopathology
4.
Curr Med Sci ; 41(1): 69-76, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1083894

ABSTRACT

The infectious coronavirus disease 2019 (COVID-19) has spread all over the world and been persistently evolving so far. The number of deaths in the whole world has been rising rapidly. However, the early warning factors for mortality have not been well ascertained. In this retrospective, single-centre cohort study, we included some adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Renmin Hospital of Wuhan University who had been discharged or had died by Apr. 8, 2020. Demographic, clinical and laboratory data at admission were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable analysis, Cox proportional hazard model analysis and receiver operating characteristic (ROC) curve to explore the early warning factors associated with in-hospital death. A total of 159 patients were included in this study, of whom 86 were discharged and 73 died in hospital. Hypertension (52.1% vs. 29.1%, P=0.003) and coronary heart disease (28.8% vs. 12.8%, P=0.012) were more frequent among non-survived patients than among survived patients. The proportions of patients with dyspnoea (67.1% vs. 25.6%, P<0.001), chest distress (58.9% vs. 26.7%, P<0.001) and fatigue (64.4% vs. 25.6%, P<0.001) were significantly higher in the non-survived group than in the survived group. Regression analysis with the Cox proportional hazards mode revealed that increasing odds of in-hospital death were associated with higher IL-6 (odds ratio 10.87, 95% CI 1.41-83.59; P=0.022), lactate (3.59, 1.71-7.54; P=0.001), older age (1.86, 1.03-3.38; P=0.041) and lower lymphopenia (5.44, 2.71-10.93; P<0.001) at admission. The areas under the ROC curve (AUCs) of IL-6, lymphocyte, age and lactate were 0.933, 0.928, 0.786 and 0.753 respectively. The AUC of IL-6 was significantly higher than that of age (z=3.332, P=0.0009) and lactate (z=4.441, P<0.0001) for outcome prediction. There was no significant difference between the AUCs of IL-6 and lymphocyte for outcome prediction (z=0.372, P=0.7101). It was concluded that the potential risk factors of higher IL-6, lactate, older age and lower lymphopenia at admission could help clinicians to identify patients with poor prognosis at an early stage.


Subject(s)
COVID-19/mortality , Coronary Disease/epidemiology , Hypertension/epidemiology , Female , Hospital Mortality , Humans , Male , Prognosis , Retrospective Studies , Risk Factors
5.
Med Intensiva (Engl Ed) ; 45(1): 14-26, 2021.
Article in English, Spanish | MEDLINE | ID: covidwho-1065470

ABSTRACT

OBJECTIVE: To describe and compare the demographic characteristics and comorbidities of patients with COVID-19 who died in Spanish hospitals during the 2020 pandemic based on whether they were or were not admitted to an intensive care unit (ICU) prior to death. METHODS: We performed a secondary analysis of COVID-19 patients who died during hospitalization included by 62 Spanish emergency departments in the SIESTA cohort. We collected the demographic characteristics and comorbidities, determined both individually and estimated globally by the Charlson index (ChI). Independent factors related to ICU admission were identified and different analyses of sensitivity were performed to contrast the consistency of the findings of the principal analysis. RESULTS: We included the 338 patients from the SIESTA cohort that died during hospitalization. Of these, 77 (22.8%) were admitted to an ICU before dying. After multivariate adjustment, 3 out of the 20 basal characteristics analyzed in the present study were independently associated with ICU admission: dementia (no patients with dementia who died were admitted to the ICU: OR = 0, 95%CI = not calculable), active cancer (OR = 0.07; 95%CI = 0.02-0.21) and age (< 70 years: OR = 1, reference; 70-74 years: OR = 0.21; 95%CI = 0.08-0.54; 75-79 years: OR = 0.21; 95%CI = 0.08-0.54; ≥ 80 years: OR = 0.02; 95%CI = 0.01-0.05). The probability of ICU admission significantly increased in parallel to the ChI, even after adjustment for age (ChI 0 points: OR = 0, reference; ChI 1 point: OR = 0.36; 95%CI = 0.16-0.83; ChI 2 points: OR = 0.36; 95%CI = 0.16-0.83; ChI >2 points: OR = 0.09; 95%CI = 0.04-0.23). The sensitivity analyses showed no gross differences compared to the principal analysis. CONCLUSIONS: The profile of COVID-19 patients who died without ICU admission is similar to that observed in the usual medical practice before the pandemic. The basal characteristics limiting their admission were age and global burden due to comorbidity, especially dementia and active cancer.


Subject(s)
COVID-19/mortality , Hospital Mortality , Intensive Care Units/statistics & numerical data , Pandemics/statistics & numerical data , SARS-CoV-2 , Age Distribution , Aged , Aged, 80 and over , Analysis of Variance , Asthma/epidemiology , COVID-19/epidemiology , Cohort Studies , Comorbidity , Confidence Intervals , Coronary Disease/epidemiology , Dementia/epidemiology , Diabetes Mellitus/epidemiology , Dyslipidemias/epidemiology , Female , Humans , Hypertension/epidemiology , Male , Neoplasms/epidemiology , Odds Ratio , Sex Distribution , Spain/epidemiology , Time Factors
6.
Med Clin (Barc) ; 156(11): 547-554, 2021 06 11.
Article in English, Spanish | MEDLINE | ID: covidwho-1051846

ABSTRACT

OBJECTIVE: Since the World Health Organization (WHO) announced coronavirus disease 2019 (COVID-19) had become a global pandemic on March 11, 2020, the number of infections has been increasing. The purpose of this meta-analysis was to investigate the prognosis of COVID-19 in patients with coronary heart disease. METHOD: Pubmed, Embase, and Cochrane Library databases were searched to collect the literature concerning coronary heart disease and COVID-19. The retrieval time was from inception to Nov 20, 2020, using Stata version 14.0 for meta-analysis. RESULTS: A total of 22,148 patients from 40 studies were included. The meta-analysis revealed that coronary heart disease was associated with poor prognosis of COVID-19 (OR=3.42, 95%CI [2.83, 4.13], P<0.001). After subgroup analysis, coronary heart disease was found to be related to mortality (OR=3.75, 95%CI [2.91, 4.82], P<0.001), severe/critical COVID-19 (OR=3.23, 95%CI [2.19, 4.77], P<0.001), ICU admission (OR=2.25, 95%CI [1.34, 3.79], P=0.002), disease progression (OR=3.01, 95%CI [1.46, 6.22], P=0.003); Meta-regression showed that the association between coronary heart disease and poor prognosis of COVID-19 was affected by hypertension (P=0.004), and subgroup analysis showed that compared with the proportion of hypertension >30% (OR=2.85, 95%CI [2.33, 3.49]), the proportion of hypertension <30% (OR=4.78, 95%CI [3.50, 6.51]) had a higher risk of poor prognosis. CONCLUSION: Coronary heart disease is a risk factor for poor prognosis in patients with COVID-19.


Subject(s)
COVID-19 , Coronary Disease , Coronary Disease/diagnosis , Coronary Disease/epidemiology , Hospitalization , Humans , Pandemics , SARS-CoV-2
7.
Public Health ; 192: 33-36, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1039535

ABSTRACT

OBJECTIVES: Multimorbidity, defined as the co-occurrence of at least two chronic diseases, is a common occurrence with ageing and a recognised public health concern, especially during the COVID-19 pandemic. The multimorbidity population is more susceptible to the virus, its complications, and death. The study aimed to explore the multimorbidity characteristics and their associations at a population level for the first time in Malta. Such data enables adequate priority and policy planning due to COVID-19's predilection for this population. STUDY AND METHODS: Baseline data was collected from 3,947 adults recruited between 2014-2016 through a cross-sectional study. A single-stage sampling strategy was implemented and stratified by age (18 -70 years), sex and locality. Participants were invited to attend a health examination survey consisting of a questionnaire, anthropometric and biological measurements. Descriptive (chi-square) and analytic (regression modelling) statistics were used to determine the characteristics and associations of the multimorbidity population. The chronic diseases considered for multimorbidity were type 2 diabetes, obesity, hypertension, myocardial infraction, coronary heart disease and dyslipidaemia. RESULTS: Multimorbidity was present in 33% (95% confidence interval 31.54-34.47) of the study population, with a male predominance. Hypertension and myocardial infarction were the commonest multimorbidity combination from a young age group (20-30 years). Low socio-economic status and residing on the island of Gozo were positively associated with multimorbidity. CONCLUSION: Multimorbidity in Malta was evident from a young age, with the highest occurrence among the low socio-economic status and residents of Gozo, bringing forward the need for preventive action. An adaptive healthcare system and policies are recommended to prevent, support, and manage multimorbidity non-communicable diseases while bracing for the current COVID-19 pandemic.


Subject(s)
Aging , COVID-19/epidemiology , Chronic Disease/epidemiology , Adolescent , Adult , Aged , Coronary Disease/epidemiology , Cross-Sectional Studies , Diabetes Mellitus, Type 2/epidemiology , Dyslipidemias/epidemiology , Female , Health Surveys , Humans , Hypertension/epidemiology , Male , Malta/epidemiology , Middle Aged , Multimorbidity , Myocardial Infarction/epidemiology , Noncommunicable Diseases/epidemiology , Obesity/epidemiology , Pandemics , Population Health , Risk Factors , SARS-CoV-2 , Social Class , Young Adult
8.
Am J Respir Crit Care Med ; 201(11): 1372-1379, 2020 06 01.
Article in English | MEDLINE | ID: covidwho-975792

ABSTRACT

Rationale: The global death toll from coronavirus disease (COVID-19) virus as of May 12, 2020, exceeds 286,000. The risk factors for death were attributed to advanced age and comorbidities but have not been accurately defined.Objectives: To report the clinical features of 85 fatal cases of COVID-19 in two hospitals in Wuhan.Methods: Medical records were collected of 85 fatal cases of COVID-19 between January 9, 2020, and February 15, 2020. Information recorded included medical history, exposure history, comorbidities, symptoms, signs, laboratory findings, computed tomographic scans, and clinical management.Measurements and Main Results: The median age of the patients was 65.8 years, and 72.9% were male. Common symptoms were fever (78 [91.8%]), shortness of breath (50 [58.8%]), fatigue (50 [58.8%]), and dyspnea (60 [70.6%]). Hypertension, diabetes, and coronary heart disease were the most common comorbidities. Notably, 81.2% of patients had very low eosinophil counts on admission. Complications included respiratory failure (80 [94.1%]), shock (69 [81.2%]), acute respiratory distress syndrome (63 [74.1%]), and arrhythmia (51 [60%]), among others. Most patients received antibiotic (77 [90.6%]), antiviral (78 [91.8%]), and glucocorticoid (65 [76.5%]) treatments. A total of 38 (44.7%) and 33 (38.8%) patients received intravenous immunoglobulin and IFN-α2b, respectively.Conclusions: In this depictive study of 85 fatal cases of COVID-19, most cases were males aged over 50 years with noncommunicable chronic diseases. The majority of the patients died of multiple organ failure. Early onset of shortness of breath may be used as an observational symptom for COVID-19 exacerbations. Eosinophilopenia may indicate a poor prognosis. A combination of antimicrobial drugs did not offer considerable benefit to the outcome of this group of patients.


Subject(s)
Coronavirus Infections/mortality , Pneumonia, Viral/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , China/epidemiology , Comorbidity , Coronary Disease/epidemiology , Diabetes Mellitus/epidemiology , Female , Humans , Hypertension/epidemiology , Male , Middle Aged , Multiple Organ Failure/virology , Pandemics , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed , Young Adult
9.
Aging (Albany NY) ; 12(22): 23409-23421, 2020 11 16.
Article in English | MEDLINE | ID: covidwho-927827

ABSTRACT

We examined the effects of coronary heart disease (CHD), hypertension and diabetes on the development of severe COVID-19. We performed a comprehensive, systematic literature search for studies published between December 2019 and July 5, 2020 in five databases. The prevalence of severe COVID-19 in patients with CHD, hypertension and diabetes was evaluated through a meta-analysis. Thirty-five articles with 8,170 patients were included, and all the available studies were case series. The pooled odds ratio for the development of severe COVID-19 was 3.21 for patients with CHD (fixed-effects model, 95% CI: 2.58-3.99), 2.27 for patients with hypertension (random-effects model, 95% CI: 1.79-2.90) and 2.34 for patients with diabetes (random-effects model, 95% CI: 1.79-3.05). The heterogeneity of the studies was moderate for the effect of CHD on COVID-19 severity, but was high for the effects of diabetes and hypertension. Funnel plots and Egger's tests revealed no publication bias in the CHD and hypertension analyses, but suggested publication bias in the diabetes analysis. This bias was corrected using the trim-and-fill method, and was ultimately found to have no effect on the results. Our findings suggest patients with CHD, hypertension and diabetes are at greater risk for developing severe COVID-19 than those without these conditions.


Subject(s)
COVID-19/diagnosis , Coronary Disease/epidemiology , Diabetes Mellitus/epidemiology , Hypertension/epidemiology , COVID-19/epidemiology , COVID-19/virology , Humans , Pandemics , Risk Factors , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity , Severity of Illness Index
12.
Diabetes Obes Metab ; 23(1): 258-262, 2021 01.
Article in English | MEDLINE | ID: covidwho-793166

ABSTRACT

Obesity is associated with severe COVID-19 outcomes, yet, it is unclear whether the risk of COVID-19 mortality associated with obesity is similar between the sexes. We used data from the UK Biobank to assess the risk of COVID-19 mortality associated with various anthropometric measures in women and men. To put these results in context, we also compared these estimates with those for mortality from influenza/pneumonia and coronary heart disease (CHD). The analyses included 502 493 individuals (54% women), of whom 410 (36% women) died from COVID-19, 549 (36% women) died from influenza/pneumonia and 3355 (19% women) died from CHD. A higher body mass index (BMI), waist circumference, waist-to-hip ratio and waist-to-height ratio were each associated with a greater risk of death from COVID-19, influenza/pneumonia and CHD in both sexes, with the exception of the association between higher BMI and the risk of influenza/pneumonia death in men. A higher BMI was associated with a stronger risk of COVID-19 mortality in women than men; the women-to-men ratio of hazard ratios was 1.20 (95% confidence interval 1.00; 1.43). This study demonstrates the role of obesity in COVID-19 mortality and shows that the relative effects of a higher BMI on COVID-19 mortality may be stronger in women than men.


Subject(s)
COVID-19 , Coronary Disease , Influenza, Human , Obesity , Adult , Aged , Body Mass Index , COVID-19/complications , COVID-19/epidemiology , COVID-19/mortality , Cohort Studies , Coronary Disease/complications , Coronary Disease/epidemiology , Databases, Factual , Female , Humans , Influenza, Human/complications , Influenza, Human/epidemiology , Male , Middle Aged , Obesity/complications , Obesity/epidemiology , Pandemics , Risk Factors , SARS-CoV-2 , United Kingdom
13.
BMJ Open ; 10(9): e038976, 2020 09 17.
Article in English | MEDLINE | ID: covidwho-781179

ABSTRACT

OBJECTIVE: Evaluate the risk of pre-existing comorbidities on COVID-19 mortality, and provide clinical suggestions accordingly. SETTING: A nested case-control design using confirmed case reports released from the news or the national/provincial/municipal health commissions of China between 18 December 2019 and 8 March 2020. PARTICIPANTS: Patients with confirmed SARS-CoV-2 infection, excluding asymptomatic patients, in mainland China outside of Hubei Province. OUTCOME MEASURES: Patient demographics, survival time and status, and history of comorbidities. METHOD: A total of 94 publicly reported deaths in locations outside of Hubei Province, mainland China, were included as cases. Each case was matched with up to three controls, based on gender and age ±1 year old (94 cases and 181 controls). The inverse probability-weighted Cox proportional hazard model was performed, controlling for age, gender and the early period of the outbreak. RESULTS: Of the 94 cases, the median age was 72.5 years old (IQR=16), and 59.6% were men, while in the control group the median age was 67 years old (IQR=22), and 64.6% were men. Adjusting for age, gender and the early period of the outbreak, poor health conditions were associated with a higher risk of COVID-19 mortality (HR of comorbidity score, 1.31 [95% CI 1.11 to 1.54]; p=0.001). The estimated mortality risk in patients with pre-existing coronary heart disease (CHD) was three times that of those without CHD (p<0.001). The estimated 30-day survival probability for a profile patient with pre-existing CHD (65-year-old woman with no other comorbidities) was 0.53 (95% CI 0.34 to 0.82), while it was 0.85 (95% CI 0.79 to 0.91) for those without CHD. Older age was also associated with increased mortality risk: every 1-year increase in age was associated with a 4% increased risk of mortality (p<0.001). CONCLUSION: Extra care and early medical interventions are needed for patients with pre-existing comorbidities, especially CHD.


Subject(s)
Coronary Disease/epidemiology , Coronavirus Infections/mortality , Pneumonia, Viral/mortality , Adult , Age Factors , Aged , Aged, 80 and over , Betacoronavirus , Bronchitis, Chronic/epidemiology , COVID-19 , Case-Control Studies , Cerebral Infarction/epidemiology , China/epidemiology , Comorbidity , Diabetes Mellitus/epidemiology , Female , Heart Failure/epidemiology , Humans , Liver Failure/epidemiology , Male , Middle Aged , Pandemics , Proportional Hazards Models , Pulmonary Disease, Chronic Obstructive/epidemiology , Renal Insufficiency/epidemiology , SARS-CoV-2 , Young Adult
14.
Int J Antimicrob Agents ; 56(4): 106093, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-730600

ABSTRACT

This study was conducted to assess the spread of SARS-CoV-2 in Russia and the adaptation of the population to the virus in March to June 2020. Two groups were investigated: 1) 12 082 individuals already proven positive for SARS-CoV-2 (clinical information was studied); 2) 7864+4458 individuals with suspected respiratory infections (polymerase chain reaction [PCR] tests and clinical information were studied). In the latter, SARS-CoV-2-positive individuals comprised 5.37% in March and 11.42% in June 2020. Several viral co-infections were observed for SARS-CoV-2. Rhinoviruses accounted for the largest proportion of co-infections (7.91% of samples were SARS-CoV-2-positive); followed by respiratory syncytial virus (7.03%); adenoviruses (4.84%); metapneumoviruses (3.29%); parainfluenza viruses (2.42%); enterovirus D68 (1.10%) and other viruses (entero-, echo-, parecho-) (<1%). Average SARS-CoV-2 case fatality rate in the group of 12 537 individuals was determined to be 0.6% (in contrast to official Russian government statistics of 1.5% mortality). This rate is within the range of mortality caused by other common seasonal respiratory viruses (0.01-2.21% in Russia in 2012 to 2020). Most fatalities occurred in individuals with comorbidities, as for other respiratory viruses. The proportion of SARS-CoV-2 asymptomatic carriers was 56.68% in March and 70.67% in June 2020. This new pathogen presents a substantial risk to human beings as it was not contained at the start of its outbreak in Wuhan and spread worldwide. However, surveillance, prevention and treatment must be strictly evidence-based and not dictated by fear.


Subject(s)
Betacoronavirus/pathogenicity , Cardiovascular Diseases/epidemiology , Coronary Disease/epidemiology , Coronavirus Infections/epidemiology , Diabetes Mellitus/epidemiology , Obesity/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Respiratory Tract Infections/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Asymptomatic Diseases , COVID-19 , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/mortality , Child , Child, Preschool , Comorbidity , Coronary Disease/diagnosis , Coronary Disease/mortality , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/transmission , Diabetes Mellitus/diagnosis , Diabetes Mellitus/mortality , Fear/psychology , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Obesity/diagnosis , Obesity/mortality , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pneumonia, Viral/transmission , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/mortality , Respiratory Tract Infections/transmission , Retrospective Studies , Russia/epidemiology , SARS-CoV-2 , Severity of Illness Index , Survival Analysis
15.
Biosci Rep ; 40(8)2020 08 28.
Article in English | MEDLINE | ID: covidwho-690426

ABSTRACT

The new 2019 coronavirus disease (COVID-19), according to the World Health Organization (WHO), has been characterized as a pandemic. As more is being discovered about this virus, we aim to report findings of the complete blood count (CBC) of COVID-19 patients. This would serve in providing physicians with important knowledge on the changes that can be expected from the CBC of mild and normal COVID-19 patients. A total of 208 mild and common patients were admitted at the Dongnan Hospital located in the city of Xiaogan, Hubei, China. The CBCs of these patients, following a confirmed diagnosis of COVID-19, were retrospectively analyzed and a significant P<0.05 was found after a full statistical analysis was conducted using the Statistical Package for the Social Sciences (IBM SPSS). CBC analysis revealed changes in the levels of red blood cells (RBCs), hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), and C-reactive protein (CRP). Clinicians should expect similar findings when dealing with the new COVID-19.


Subject(s)
Betacoronavirus/pathogenicity , Coronary Disease/diagnosis , Coronavirus Infections/diagnosis , Diabetes Mellitus/diagnosis , Hypertension/diagnosis , Pneumonia, Viral/diagnosis , Respiratory Insufficiency/diagnosis , Adult , Aged , Asymptomatic Diseases , Blood Cell Count , C-Reactive Protein/metabolism , COVID-19 , China/epidemiology , Comorbidity , Coronary Disease/blood , Coronary Disease/epidemiology , Coronary Disease/physiopathology , Coronavirus Infections/blood , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Diabetes Mellitus/physiopathology , Erythrocyte Indices , Erythrocytes/pathology , Erythrocytes/virology , Female , Hematocrit , Hemoglobins/metabolism , Humans , Hypertension/blood , Hypertension/epidemiology , Hypertension/physiopathology , Male , Middle Aged , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Respiratory Insufficiency/blood , Respiratory Insufficiency/epidemiology , Respiratory Insufficiency/physiopathology , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index
16.
Eur J Clin Microbiol Infect Dis ; 39(12): 2309-2315, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-656200

ABSTRACT

During the COVID-19 outbreak, the mobile cabin hospital has effectively isolated and treated patients diagnosed as mild-moderate disease. However, a detailed clinical course has not been well described. We included 483 patients who were isolated and treated from Feb 6, 2020, to Feb 15, 2020, including definite outcome (discharge or deterioration). Sixty-two patients were transferred to severe cases, of whom were trasfered to designated hospital for intensive care. By March 9, 2020, all patients were discharged without dead. The mobile cabin hospital provides feasible strategy of isolation of mild-moderate cases and timely intervention during the virus outbreak.


Subject(s)
Coronary Disease/diagnosis , Coronavirus Infections/diagnosis , Lung Diseases/diagnosis , Pandemics , Patient Discharge/statistics & numerical data , Patient Isolation/methods , Pneumonia, Viral/diagnosis , Aged , Betacoronavirus/pathogenicity , Body Mass Index , COVID-19 , COVID-19 Testing , China/epidemiology , Clinical Laboratory Techniques , Comorbidity , Coronary Disease/epidemiology , Coronary Disease/physiopathology , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Female , Hospitalization/statistics & numerical data , Humans , Lung Diseases/epidemiology , Lung Diseases/physiopathology , Male , Middle Aged , Mobile Health Units , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index
17.
Clin Immunol ; 217: 108509, 2020 08.
Article in English | MEDLINE | ID: covidwho-597932

ABSTRACT

BACKGROUND: National health-system hospitals of Lombardy faced a heavy burden of admissions for acute respiratory distress syndromes associated with coronavirus disease (COVID-19). Data on patients of European origin affected by COVID-19 are limited. METHODS: All consecutive patients aged ≥18 years, coming from North-East of Milan's province and admitted at San Raffaele Hospital with COVID-19, between February 25th and March 24th, were reported, all patients were followed for at least one month. Clinical and radiological features at admission and predictors of clinical outcomes were evaluated. RESULTS: Of the 500 patients admitted to the Emergency Unit, 410 patients were hospitalized and analyzed: median age was 65 (IQR 56-75) years, and the majority of patients were males (72.9%). Median (IQR) days from COVID-19 symptoms onset was 8 (5-11) days. At hospital admission, fever (≥ 37.5 °C) was present in 67.5% of patients. Median oxygen saturation (SpO2) was 93% (range 60-99), with median PaO2/FiO2 ratio, 267 (IQR 184-314). Median Radiographic Assessment of Lung Edema (RALE) score was 9 (IQR 4-16). More than half of the patients (56.3%) had comorbidities, with hypertension, coronary heart disease, diabetes and chronic kidney failure being the most common. The probability of overall survival at day 28 was 66%. Multivariable analysis showed older age, coronary artery disease, cancer, low lymphocyte count and high RALE score as factors independently associated with an increased risk of mortality. CONCLUSION: In a large cohort of COVID-19 patients of European origin, main risk factors for mortality were older age, comorbidities, low lymphocyte count and high RALE.


Subject(s)
Coronary Disease/diagnosis , Coronavirus Infections/diagnosis , Diabetes Mellitus/diagnosis , Hypertension/diagnosis , Kidney Failure, Chronic/diagnosis , Pneumonia, Viral/diagnosis , Pulmonary Edema/diagnosis , Severe Acute Respiratory Syndrome/diagnosis , Age Factors , Aged , Betacoronavirus/immunology , Betacoronavirus/pathogenicity , COVID-19 , Comorbidity , Coronary Disease/epidemiology , Coronary Disease/immunology , Coronary Disease/mortality , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Coronavirus Infections/mortality , Diabetes Mellitus/epidemiology , Diabetes Mellitus/immunology , Diabetes Mellitus/mortality , Female , Hospitalization , Humans , Hypertension/epidemiology , Hypertension/immunology , Hypertension/mortality , Infectious Disease Incubation Period , Italy/epidemiology , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/immunology , Kidney Failure, Chronic/mortality , Lymphocyte Count , Lymphocytes/immunology , Lymphocytes/pathology , Lymphocytes/virology , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , Pneumonia, Viral/mortality , Pulmonary Edema/epidemiology , Pulmonary Edema/immunology , Pulmonary Edema/mortality , Risk Factors , SARS-CoV-2 , Severe Acute Respiratory Syndrome/epidemiology , Severe Acute Respiratory Syndrome/immunology , Severe Acute Respiratory Syndrome/mortality , Severity of Illness Index , Survival Analysis
18.
J Mol Cell Cardiol ; 145: 25-29, 2020 08.
Article in English | MEDLINE | ID: covidwho-596957

ABSTRACT

As the coronavirus disease 2019 (COVID-19) epidemic worsens, this global pandemic is impacting more than 200 countries/regions and more than 4,500,000 confirmed cases worldwide. COVID-19 is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which might attack not only the respiratory system, but also the other important organs, including the heart. It was reported that COVID-19 patients with a past history of cardiovascular diseases would have a higher mortality. Meanwhile, elevated troponin levels were frequently observed in COVID-19 cases. Besides the comprehensive treatments for COVID-19, as a cardiologist, we should also remain vigilant about the cardiac injuries, especially those with severe emergent cardiovascular symptoms.


Subject(s)
Betacoronavirus , Coronary Disease/epidemiology , Coronavirus Infections/epidemiology , Myocarditis/epidemiology , Pneumonia, Viral/epidemiology , Adult , Biomarkers/blood , COVID-19 , Comorbidity , Coronary Disease/virology , Coronavirus Infections/immunology , Coronavirus Infections/mortality , Coronavirus Infections/virology , Humans , Interleukin-6/blood , Male , Myocarditis/drug therapy , Myocarditis/immunology , Myocarditis/virology , Natriuretic Peptide, Brain/blood , Pandemics , Peptide Fragments/blood , Pneumonia, Viral/immunology , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Risk Factors , SARS-CoV-2 , Treatment Outcome , Troponin I/blood
19.
Am J Infect Control ; 49(1): 82-89, 2021 01.
Article in English | MEDLINE | ID: covidwho-597653

ABSTRACT

OBJECTIVE: We aimed to investigate the relationship between clinical characteristics, outcomes and the severity of severe acute respiratory syndrome coronavirus 2 pneumonia. METHODS: We performed a systematic review and meta-analysis using PubMed, Embase, and Cochrane Library databases to assess the clinical characteristics and outcomes of confirmed COVID-19 cases and compared severe (ICU) and nonsevere (non-ICU) groups. RESULTS: We included 12 cohort studies including 2,445 patients with COVID-19. Compared with nonsevere (non-ICU) patients, severe (ICU) disease was associated with a smoking history (P = .003) and comorbidities including chronic obstructive pulmonary disease (OR = 5.08, P < .001), diabetes (OR = 3.17, P < .001), hypertension (OR = 2.40, P < .001), coronary heart disease (OR = 2.66, P < .001), cerebrovascular diseases (OR = 2.68, P = .008), and malignancy (OR=2.21, P = .040). We found significant differences between the 2 groups for fever, dyspnea, decreased lymphocyte and platelet counts, and increased leukocyte count, C-creative protein, procalcitonin, lactose dehydrogenase, aspartate aminotransferase, alanine aminotransferase, creatinine kinase, and creatinine levels (P < .05). Significant differences were also observed for multiple treatments (P < .05). Patients in the severe (ICU) group were more likely to have complications and had a much higher mortality rate and lower discharge rate than those with nonsevere (non-ICU) disease (P < .05). CONCLUSIONS: Investigation of clinical characteristics and outcomes of severe cases of COVID-19 will contribute to early prediction, accurate diagnosis, and treatment to improve the prognosis of patients with severe illness.


Subject(s)
COVID-19/physiopathology , Dyspnea/physiopathology , Fever/physiopathology , Leukocytosis/physiopathology , Lymphopenia/physiopathology , Thrombocytopenia/physiopathology , Alanine Transaminase/blood , Aspartate Aminotransferases/blood , C-Reactive Protein/metabolism , COVID-19/blood , COVID-19/mortality , Cerebrovascular Disorders/epidemiology , Comorbidity , Coronary Disease/epidemiology , Creatine Kinase/blood , Creatinine/blood , Diabetes Mellitus/epidemiology , Humans , Hypertension/epidemiology , Intensive Care Units , L-Lactate Dehydrogenase/blood , Leukocytosis/blood , Lymphopenia/blood , Procalcitonin/blood , Pulmonary Disease, Chronic Obstructive/epidemiology , SARS-CoV-2 , Severity of Illness Index , Smoking/epidemiology , Thrombocytopenia/blood
20.
J Infect Dis ; 222(4): 556-563, 2020 07 23.
Article in English | MEDLINE | ID: covidwho-593365

ABSTRACT

Patients who died from COVID-19 often had comorbidities, such as hypertension, diabetes, and chronic obstructive lung disease. Although angiotensin-converting enzyme 2 (ACE2) is crucial for SARS-CoV-2 to bind and enter host cells, no study has systematically assessed the ACE2 expression in the lungs of patients with these diseases. Here, we analyzed over 700 lung transcriptome samples from patients with comorbidities associated with severe COVID-19 and found that ACE2 was highly expressed in these patients compared to control individuals. This finding suggests that patients with such comorbidities may have higher chances of developing severe COVID-19. Correlation and network analyses revealed many potential regulators of ACE2 in the human lung, including genes related to histone modifications, such as HAT1, HDAC2, and KDM5B. Our systems biology approach offers a possible explanation for increased COVID-19 severity in patients with certain comorbidities.


Subject(s)
Coronavirus Infections/epidemiology , Lung/enzymology , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/epidemiology , Angiotensin-Converting Enzyme 2 , COVID-19 , Case-Control Studies , Cerebrovascular Disorders/epidemiology , Cerebrovascular Disorders/genetics , Comorbidity , Coronary Disease/epidemiology , Coronary Disease/genetics , Coronavirus Infections/enzymology , Coronavirus Infections/genetics , Diabetes Complications/epidemiology , Diabetes Complications/genetics , Epigenomics , Female , Humans , Hypertension/epidemiology , Hypertension/genetics , Male , Pandemics , Peptidyl-Dipeptidase A/genetics , Pneumonia, Viral/enzymology , Pneumonia, Viral/genetics , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/genetics , Severity of Illness Index , Systems Biology , Transcriptome
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