Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 7 de 7
Filter
1.
PLoS One ; 17(2): e0263922, 2022.
Article in English | MEDLINE | ID: covidwho-1686110

ABSTRACT

IMPORTANCE: When hospitals are at capacity, accurate deterioration indices could help identify low-risk patients as potential candidates for home care programs and alleviate hospital strain. To date, many existing deterioration indices are based entirely on structured data from the electronic health record (EHR) and ignore potentially useful information from other sources. OBJECTIVE: To improve the accuracy of existing deterioration indices by incorporating unstructured imaging data from chest radiographs. DESIGN, SETTING, AND PARTICIPANTS: Machine learning models were trained to predict deterioration of patients hospitalized with acute dyspnea using existing deterioration index scores and chest radiographs. Models were trained on hospitalized patients without coronavirus disease 2019 (COVID-19) and then subsequently tested on patients with COVID-19 between January 2020 and December 2020 at a single tertiary care center who had at least one radiograph taken within 48 hours of hospital admission. MAIN OUTCOMES AND MEASURES: Patient deterioration was defined as the need for invasive or non-invasive mechanical ventilation, heated high flow nasal cannula, IV vasopressor administration or in-hospital mortality at any time following admission. The EPIC deterioration index was augmented with unstructured data from chest radiographs to predict risk of deterioration. We compared discriminative performance of the models with and without incorporating chest radiographs using area under the receiver operating curve (AUROC), focusing on comparing the fraction and total patients identified as low risk at different negative predictive values (NPV). RESULTS: Data from 6278 hospitalizations were analyzed, including 5562 hospitalizations without COVID-19 (training cohort) and 716 with COVID-19 (216 in validation, 500 in held-out test cohort). At a NPV of 0.95, the best-performing image-augmented deterioration index identified 49 more (9.8%) individuals as low-risk compared to the deterioration index based on clinical data alone in the first 48 hours of admission. At a NPV of 0.9, the EPIC image-augmented deterioration index identified 26 more individuals (5.2%) as low-risk compared to the deterioration index based on clinical data alone in the first 48 hours of admission. CONCLUSION AND RELEVANCE: Augmenting existing deterioration indices with chest radiographs results in better identification of low-risk patients. The model augmentation strategy could be used in the future to incorporate other forms of unstructured data into existing disease models.


Subject(s)
Clinical Deterioration , Thorax/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/pathology , COVID-19/virology , Dyspnea/pathology , Female , Hospitalization , Humans , Machine Learning , Male , Middle Aged , ROC Curve , Respiration, Artificial , Retrospective Studies , Risk Factors , SARS-CoV-2/isolation & purification , Young Adult
2.
Rev Med Virol ; 31(6): e2288, 2021 11.
Article in English | MEDLINE | ID: covidwho-1384306

ABSTRACT

SARS Coronavirus-2 is one of the most widespread viruses globally during the 21st century, whose severity and ability to cause severe pneumonia and death vary. We performed a comprehensive systematic review of all studies that met our standardised criteria and then extracted data on the age, symptoms, and different treatments of Covid-19 patients and the prognosis of this disease during follow-up. Cases in this study were divided according to severity and death status and meta-analysed separately using raw mean and single proportion methods. We included 171 complete studies including 62,909 confirmed cases of Covid-19, of which 148 studies were meta-analysed. Symptoms clearly emerged in an escalating manner from mild-moderate symptoms, pneumonia, severe-critical to the group of non-survivors. Hypertension (Pooled proportion (PP): 0.48 [95% Confident interval (CI): 0.35-0.61]), diabetes (PP: 0.23 [95% CI: 0.16-0.33]) and smoking (PP: 0.12 [95% CI: 0.03-0.38]) were highest regarding pre-infection comorbidities in the non-survivor group. While acute respiratory distress syndrome (PP: 0.49 [95% CI: 0.29-0.78]), (PP: 0.63 [95% CI: 0.34-0.97]) remained one of the most common complications in the severe and death group respectively. Bilateral ground-glass opacification (PP: 0.68 [95% CI: 0.59-0.75]) was the most visible radiological image. The mortality rates estimated (PP: 0.11 [95% CI: 0.06-0.19]), (PP: 0.03 [95% CI: 0.01-0.05]), and (PP: 0.01 [95% CI: 0-0.3]) in severe-critical, pneumonia and mild-moderate groups respectively. This study can serve as a high evidence guideline for different clinical presentations of Covid-19, graded from mild to severe, and for special forms like pneumonia and death groups.


Subject(s)
COVID-19/pathology , Cough/pathology , Dyspnea/pathology , Fatigue/pathology , Fever/pathology , SARS-CoV-2/pathogenicity , Antiviral Agents/therapeutic use , COVID-19/drug therapy , COVID-19/mortality , COVID-19/virology , Comorbidity , Cough/drug therapy , Cough/mortality , Cough/virology , Diabetes Mellitus/diagnosis , Diabetes Mellitus/physiopathology , Dyspnea/drug therapy , Dyspnea/mortality , Dyspnea/virology , Fatigue/drug therapy , Fatigue/mortality , Fatigue/virology , Fever/drug therapy , Fever/mortality , Fever/virology , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Immunologic Factors/therapeutic use , Prognosis , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/physiopathology , Severity of Illness Index , Smoking/physiopathology , Survival Analysis
3.
PLoS One ; 16(7): e0255141, 2021.
Article in English | MEDLINE | ID: covidwho-1323020

ABSTRACT

The natural history of COVID-19 and predictors of mortality in older adults need to be investigated to inform clinical operations and healthcare policy planning. A retrospective study took place in 80 long-term nursing homes in Catalonia, Spain collecting data from March 1st to May 31st, 2020. Demographic and clinical data from 2,092 RT-PCR confirmed cases of SARS-CoV-2 infection were registered, including structural characteristics of the facilities. Descriptive statistics to describe the demographic, clinical, and molecular characteristics of our sample were prepared, both overall and by their symptomatology was performed and an analysis of statistically significant bivariate differences and constructions of a logistic regression model were carried out to assess the relationship between variables. The incidence of the infection was 28%. 71% of the residents showed symptoms. Five major symptoms included: fever, dyspnea, dry cough, asthenia and diarrhea. Fever and dyspnea were by far the most frequent (50% and 28%, respectively). The presentation was predominantly acute and symptomatology persisted from days to weeks (mean 9.1 days, SD = 10,9). 16% of residents had confirmed pneumonia and 22% required hospitalization. The accumulated mortality rate was 21.75% (86% concentrated during the first 28 days at onset). A multivariate logistic regression analysis showed a positive predictive value for mortality for some variables such as age, pneumonia, fever, dyspnea, stupor refusal to oral intake and dementia (p<0.01 for all variables). Results suggest that density in the nursing homes did not account for differences in the incidence of the infection within the facilities. This study provides insights into the natural history of the disease in older adults with high dependency living in long-term nursing homes during the first pandemic wave of March-May 2020 in the region of Catalonia, and suggests that some comorbidities and symptoms have a strong predictive value for mortality.


Subject(s)
COVID-19 , Dyspnea , Fever , Nursing Homes , SARS-CoV-2 , Aged , Aged, 80 and over , COVID-19/mortality , COVID-19/pathology , COVID-19/physiopathology , Comorbidity , Dyspnea/mortality , Dyspnea/pathology , Dyspnea/physiopathology , Female , Fever/mortality , Fever/pathology , Fever/physiopathology , Humans , Incidence , Male , Retrospective Studies , Spain/epidemiology
4.
J Enzyme Inhib Med Chem ; 36(1): 1230-1235, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1254219

ABSTRACT

The ongoing Covid-19 is a contagious disease, and it is characterised by different symptoms such as fever, cough, and shortness of breath. Rising concerns about Covid-19 have severely affected the healthcare system in all countries as the Covid-19 outbreak has developed at a rapid rate all around the globe. Intriguing, a clinically used drug, acetazolamide (a specific inhibitor of carbonic anhydrase, CA, EC 4.2.1.1), is used to treat high-altitude pulmonary oedema (HAPE), showing a high degree of clinical similarities with the pulmonary disease caused by Covid-19. In this context, this preliminary study aims to provide insights into some factors affecting the Covid-19 patients, such as hypoxaemia, hypoxia as well as the blood CA activity. We hypothesise that patients with Covid-19 problems could show a dysregulated acid-base status influenced by CA activity. These preliminary results suggest that the use of CA inhibitors as a pharmacological treatment for Covid-19 may be beneficial.


Subject(s)
Acetazolamide/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Carbonic Anhydrase Inhibitors/therapeutic use , Carbonic Anhydrases/blood , Acid-Base Equilibrium/drug effects , Altitude Sickness/blood , Altitude Sickness/drug therapy , Anticonvulsants/therapeutic use , Bicarbonates/blood , COVID-19/blood , COVID-19/diagnostic imaging , COVID-19/virology , Carbon Dioxide/blood , Cough/blood , Cough/drug therapy , Cough/pathology , Cough/virology , Drug Repositioning , Dyspnea/blood , Dyspnea/drug therapy , Dyspnea/pathology , Dyspnea/virology , Fever/blood , Fever/drug therapy , Fever/pathology , Fever/virology , Humans , Hydrogen-Ion Concentration , Hypertension, Pulmonary/blood , Hypertension, Pulmonary/drug therapy , Hypoxia/blood , Hypoxia/drug therapy , Hypoxia/pathology , Hypoxia/virology , Oximetry , Research Design , SARS-CoV-2/pathogenicity , SARS-CoV-2/physiology , Severity of Illness Index , Tomography, X-Ray Computed
5.
J Med Virol ; 93(3): 1761-1765, 2021 03.
Article in English | MEDLINE | ID: covidwho-1196476

ABSTRACT

To determine the distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) respiratory viral loads (VL) during the acute phase of infection and their correlation with clinical presentation and inflammation-related biomarkers. Nasopharyngeal swabs from 453 adult SARS-CoV-2-infected patients from the Department of Infectious Diseases, Besançon, France, were collected at the time of admission or consultation for reverse transcriptase polymerase chain reaction (RT-PCR) analysis. Clinical information and concentrations of biological parameters (C-reactive protein [CRP], fibrinogen, lactate dehydrogenase [LDH], prealbumin) were noticed. Mean respiratory VL homogeneously decreased from 7.2 log10 copies/ml (95% confidence interval [CI]: 6.6-7.8) on the first day of symptoms until 4.6 log10 copies/ml (95% CI: 3.8-5.4) at day 10 (slope = -0.24; R2 = .95). VL were poorly correlated with COVID-19 symptoms and outcome, excepted for dyspnea and anosmia, which were significantly associated with lower VL (p < .05). CRP, fibrinogen, and LDH concentrations significantly increased over the first 10 days (median CRP concentrations from 36.8 mg/L at days 0-1 to 99.5 mg/L at days 8-10; p < .01), whereas prealbumin concentrations tended to decrease. Since SARS-CoV-2 respiratory VL regularly decrease in the acute phase of infection, determining the level of VL may help predicting the onset of virus shedding in a specific patient. However, the role of SARS-CoV-2 VL as a biomarker of severity is limited.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , COVID-19/epidemiology , Viral Load/methods , Adult , Aged , Aged, 80 and over , Anosmia/pathology , C-Reactive Protein/analysis , Dyspnea/pathology , Female , Fibrinogen/analysis , France/epidemiology , Humans , L-Lactate Dehydrogenase/blood , Male , Middle Aged , Nasopharynx/virology , Prealbumin/analysis , RNA, Viral/analysis , SARS-CoV-2 , Treatment Outcome , Virus Shedding , Young Adult
6.
Infection ; 49(1): 153-157, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-680113

ABSTRACT

PURPOSE: The aim of our study was to assess respiratory function at the time of clinical recovery and 6 weeks after discharge in patients surviving to COVID-19 pneumonia. METHODS: Our case series consisted of 13 patients with COVID-19 pneumonia. RESULTS: At the time of clinical recovery, FEV1 (2.07 ± 0.72 L) and FVC (2.25 ± 0.86 L) were lower compared to lower limit of normality (LLN) values (2.56 ± 0.53 L, p = 0.004, and 3.31 ± 0.65 L, p < 0.001, respectively), while FEV1/FVC (0.94 ± 0.07) was higher compared to upper limit of normality (ULN) values (0.89 ± 0.01, p = 0.029). After 6 weeks pulmonary function improved but FVC was still lower than ULN (2.87 ± 0.81, p = 0.014). CONCLUSION: These findings suggest that COVID-19 pneumonia may result in clinically relevant alterations in pulmonary function tests, with a mainly restrictive pattern.


Subject(s)
COVID-19/physiopathology , Cough/physiopathology , Dyspnea/physiopathology , Fever/physiopathology , Lung/physiopathology , SARS-CoV-2/pathogenicity , Adult , Aged , COVID-19/diagnosis , COVID-19/pathology , COVID-19/virology , Cough/diagnosis , Cough/pathology , Cough/virology , Dyspnea/diagnosis , Dyspnea/pathology , Dyspnea/virology , Female , Fever/diagnosis , Fever/pathology , Fever/virology , Humans , Lung/diagnostic imaging , Lung/pathology , Lung/virology , Male , Middle Aged , Respiratory Function Tests , Spirometry , Tomography, X-Ray Computed
7.
Encephale ; 46(3): 169-172, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-322038

ABSTRACT

OBJECTIVES: The ongoing COVID-19 pandemic has caused approximately 2,350,000 infections worldwide and killed more than 160,000 individuals. In Sainte-Anne Hospital (GHU PARIS Psychiatrie & Neuroscience, Paris, France) we have observed a lower incidence of symptomatic forms of COVID-19 among patients than among our clinical staff. This observation led us to hypothesize that psychotropic drugs could have a prophylactic action against SARS-CoV-2 and protect patients from the symptomatic and virulent forms of this infection, since several of these psychotropic drugs have documented antiviral properties. Chlorpromazine (CPZ), a phenothiazine derivative, is also known for its antiviral activity via the inhibition of clathrin-mediated endocytosis. Recentin vitro studies have reported that CPZ exhibits anti-MERS-CoV and anti-SARS-CoV-1 activity. METHODS: In this context, the ReCoVery study aims to repurpose CPZ, a molecule with an excellent tolerance profile and a very high biodistribution in the saliva, lungs and brain. We hypothesize that CPZ could reduce the unfavorable course of COVID-19 infection among patients requiring respiratory support without the need for ICU care, and that it could also reduce the contagiousness of SARS-CoV-2. For this purpose, we plan a pilot, multicenter, randomized, single blind, controlled, phase III therapeutic trial (standard treatment vs. CPZ+standard treatment). CONCLUSION: This repurposing of CPZ for its anti-SARS-CoV-2 activity could offer an alternative, rapid strategy to alleviate infection severity. This repurposing strategy also avoids numerous developmental and experimental steps, and could save precious time to rapidly establish an anti-COVID-19 therapy with well-known, limited and easily managed side effects.


Subject(s)
Chlorpromazine/therapeutic use , Coronavirus Infections/drug therapy , Drug Repositioning , Pneumonia, Viral/drug therapy , Antiviral Agents/therapeutic use , Anxiety/complications , Anxiety/drug therapy , Anxiety/epidemiology , Anxiety/pathology , Betacoronavirus/pathogenicity , Blood-Brain Barrier/drug effects , COVID-19 , Clathrin-Coated Vesicles/drug effects , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/pathology , Disease Progression , Dyspnea/drug therapy , Dyspnea/epidemiology , Dyspnea/pathology , Dyspnea/psychology , Endocytosis/drug effects , France/epidemiology , Humans , Length of Stay , Mortality , Pandemics , Patient Outcome Assessment , Pilot Projects , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/pathology , Recovery of Function , SARS-CoV-2 , Single-Blind Method , Time-to-Treatment , Treatment Outcome
SELECTION OF CITATIONS
SEARCH DETAIL