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1.
Lancet ; 398(10301): 685-697, 2021 08 21.
Article in English | MEDLINE | ID: covidwho-1815297

ABSTRACT

BACKGROUND: Associations between high and low temperatures and increases in mortality and morbidity have been previously reported, yet no comprehensive assessment of disease burden has been done. Therefore, we aimed to estimate the global and regional burden due to non-optimal temperature exposure. METHODS: In part 1 of this study, we linked deaths to daily temperature estimates from the ERA5 reanalysis dataset. We modelled the cause-specific relative risks for 176 individual causes of death along daily temperature and 23 mean temperature zones using a two-dimensional spline within a Bayesian meta-regression framework. We then calculated the cause-specific and total temperature-attributable burden for the countries for which daily mortality data were available. In part 2, we applied cause-specific relative risks from part 1 to all locations globally. We combined exposure-response curves with daily gridded temperature and calculated the cause-specific burden based on the underlying burden of disease from the Global Burden of Diseases, Injuries, and Risk Factors Study, for the years 1990-2019. Uncertainty from all components of the modelling chain, including risks, temperature exposure, and theoretical minimum risk exposure levels, defined as the temperature of minimum mortality across all included causes, was propagated using posterior simulation of 1000 draws. FINDINGS: We included 64·9 million individual International Classification of Diseases-coded deaths from nine different countries, occurring between Jan 1, 1980, and Dec 31, 2016. 17 causes of death met the inclusion criteria. Ischaemic heart disease, stroke, cardiomyopathy and myocarditis, hypertensive heart disease, diabetes, chronic kidney disease, lower respiratory infection, and chronic obstructive pulmonary disease showed J-shaped relationships with daily temperature, whereas the risk of external causes (eg, homicide, suicide, drowning, and related to disasters, mechanical, transport, and other unintentional injuries) increased monotonically with temperature. The theoretical minimum risk exposure levels varied by location and year as a function of the underlying cause of death composition. Estimates for non-optimal temperature ranged from 7·98 deaths (95% uncertainty interval 7·10-8·85) per 100 000 and a population attributable fraction (PAF) of 1·2% (1·1-1·4) in Brazil to 35·1 deaths (29·9-40·3) per 100 000 and a PAF of 4·7% (4·3-5·1) in China. In 2019, the average cold-attributable mortality exceeded heat-attributable mortality in all countries for which data were available. Cold effects were most pronounced in China with PAFs of 4·3% (3·9-4·7) and attributable rates of 32·0 deaths (27·2-36·8) per 100 000 and in New Zealand with 3·4% (2·9-3·9) and 26·4 deaths (22·1-30·2). Heat effects were most pronounced in China with PAFs of 0·4% (0·3-0·6) and attributable rates of 3·25 deaths (2·39-4·24) per 100 000 and in Brazil with 0·4% (0·3-0·5) and 2·71 deaths (2·15-3·37). When applying our framework to all countries globally, we estimated that 1·69 million (1·52-1·83) deaths were attributable to non-optimal temperature globally in 2019. The highest heat-attributable burdens were observed in south and southeast Asia, sub-Saharan Africa, and North Africa and the Middle East, and the highest cold-attributable burdens in eastern and central Europe, and central Asia. INTERPRETATION: Acute heat and cold exposure can increase or decrease the risk of mortality for a diverse set of causes of death. Although in most regions cold effects dominate, locations with high prevailing temperatures can exhibit substantial heat effects far exceeding cold-attributable burden. Particularly, a high burden of external causes of death contributed to strong heat impacts, but cardiorespiratory diseases and metabolic diseases could also be substantial contributors. Changes in both exposures and the composition of causes of death drove changes in risk over time. Steady increases in exposure to the risk of high temperature are of increasing concern for health. FUNDING: Bill & Melinda Gates Foundation.


Subject(s)
Cause of Death/trends , Cold Temperature/adverse effects , Global Burden of Disease/statistics & numerical data , Global Health/statistics & numerical data , Hot Temperature/adverse effects , Mortality/trends , Bayes Theorem , Heart Diseases/epidemiology , Humans , Metabolic Diseases/epidemiology
2.
Orphanet J Rare Dis ; 17(1): 109, 2022 03 04.
Article in English | MEDLINE | ID: covidwho-1724516

ABSTRACT

BACKGROUND: Since the beginning of the COVID-19 pandemic, MetabERN has been monitoring the SARS-CoV-2 infection rates within its metabolic community. To gather data on the total number of cases and the severity of symptoms among IMD patients one year into the pandemic, an online survey was distributed among all MetabERN healthcare providers (HCP). Epidemiological analysis was performed by integrating the survey's data with the MetabERN database. RESULTS: Survey's respondents reported a total of 452 cases of COVID-19 among their IMD patients (213 paediatric and 239 adults). Considering the total number of patients followed by the respondents (n = 26,347), the registered prevalence of COVID-19 in the IMD population was of 1716 × 100,000. Italy emerged as the most affected country (25.4% of cases), followed by the United Kingdom (14.2% of cases). Most of the paediatric cases of COVID-19 displayed no or mild symptoms during the disease: 34% of HCP reported having asymptomatic patients in 75-100% of cases, while 37.5% reported mild symptoms in about a quarter of their patients. Similarly to paediatric cases, most adult IMD patients with COVID-19 were asymptomatic or had mild symptoms: about one third of respondents reported 75-100% asymptomatic patients and about 65% of HCP had between 0 and 50% of patients with mild symptoms. The majority of the respondents reported no deaths due to COVID-19 in adult and paediatric patients with IMDs. CONCLUSIONS: Most of MetabERN's IMD patients who got COVID-19 during the first year of the pandemic had mild symptoms and a positive outcome of the disease. However, fatal events were recorded in paediatric patients; this, together with the lack of information on the long-term effects of COVID-19 in IMDs, call for caution in the metabolic population.


Subject(s)
COVID-19 , Metabolic Diseases , Adult , Child , Health Personnel , Humans , Metabolic Diseases/epidemiology , Pandemics , SARS-CoV-2
3.
Cardiovasc Diabetol ; 21(1): 24, 2022 02 14.
Article in English | MEDLINE | ID: covidwho-1686015

ABSTRACT

BACKGROUND: Pre-existing cardiometabolic comorbidities place SARS-CoV-2 positive patients at a greater risk for poorer clinical course and mortality than those without it. We aimed to analyze real-world registry data focused primarily on participants with cardiometabolic diseases (CMD), which were remotely obtained via a digital platform. METHODS: Participants were divided into two groups: CMD or no cardiometabolic disease (non-CMD). They were evaluated based on their medical history, current medications/supplements, COVID-19 status, demographics, and baseline characteristics. The frequency of medications/supplements for CMD were compared using relative risks and 95% confidence intervals. The WHO (Five) Well-Being Index (WHO-5) were collected monthly for 6 months to assess psychological well-being which included cheerfulness, calmness, vigor, rest, and engagement with daily activities of interest. RESULTS: The 791 enrollees represented 49 U.S. states. The CMD group had significantly higher (p < 0.0001) BMI (mean + 3.04 kg/m2) and age (mean + 9.15 years) compared to non-CMD group. In the CMD group, participants who tested positive for COVID-19 had lower (p < 0.0001) well-being scores than those without COVID-19. For the 274 participants on CMD medications/supplements, there was no statistical difference in risk of COVID-19 contracture based on medication/supplement type; however, all six participants who were not being treated for CMD were COVID-19 positive (RR ~ 104). For 89 participants who were on treatment for diabetes or insulin resistance, there was a 90% reduced risk of COVID-19 incidence (p = 0.0187). CONCLUSION: The well-being score of the CMD group was dependent on whether they tested positive for COVID-19. Type of CMD treatment did not impact COVID-19 status, but absence of treatment significantly increased COVID-19 incidence. With respect to SARS-CoV-2, our analysis supports continued use of the statins, ACE-I, ARBs, and diabetes medications in CMD patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04348942.


Subject(s)
COVID-19/epidemiology , Heart Diseases/epidemiology , Metabolic Diseases/epidemiology , Adult , COVID-19/diagnosis , Cardiometabolic Risk Factors , Comorbidity , Female , Heart Diseases/diagnosis , Heart Diseases/therapy , Humans , Incidence , Longitudinal Studies , Male , Metabolic Diseases/diagnosis , Metabolic Diseases/therapy , Middle Aged , Prognosis , Prospective Studies , Registries , Risk Assessment , Time Factors , United States/epidemiology
7.
Lancet Diabetes Endocrinol ; 9(11): 786-798, 2021 11.
Article in English | MEDLINE | ID: covidwho-1586178

ABSTRACT

Up to 50% of the people who have died from COVID-19 had metabolic and vascular disorders. Notably, there are many direct links between COVID-19 and the metabolic and endocrine systems. Thus, not only are patients with metabolic dysfunction (eg, obesity, hypertension, non-alcoholic fatty liver disease, and diabetes) at an increased risk of developing severe COVID-19 but also infection with SARS-CoV-2 might lead to new-onset diabetes or aggravation of pre-existing metabolic disorders. In this Review, we provide an update on the mechanisms of how metabolic and endocrine disorders might predispose patients to develop severe COVID-19. Additionally, we update the practical recommendations and management of patients with COVID-19 and post-pandemic. Furthermore, we summarise new treatment options for patients with both COVID-19 and diabetes, and highlight current challenges in clinical management.


Subject(s)
COVID-19/epidemiology , COVID-19/metabolism , Disease Management , Metabolic Diseases/epidemiology , Metabolic Diseases/metabolism , Angiotensin-Converting Enzyme 2/metabolism , COVID-19/therapy , Diabetes Mellitus/epidemiology , Diabetes Mellitus/metabolism , Diabetes Mellitus/therapy , Humans , Hypertension/epidemiology , Hypertension/metabolism , Hypertension/therapy , Metabolic Diseases/therapy , Non-alcoholic Fatty Liver Disease/epidemiology , Non-alcoholic Fatty Liver Disease/metabolism , Non-alcoholic Fatty Liver Disease/therapy , Obesity/epidemiology , Obesity/metabolism , Obesity/therapy
9.
Nutrients ; 13(8)2021 Aug 18.
Article in English | MEDLINE | ID: covidwho-1360798

ABSTRACT

Throughout the 20th and 21st centuries, the incidence of non-communicable diseases (NCDs), also known as chronic diseases, has been increasing worldwide. Changes in dietary and physical activity patterns, along with genetic conditions, are the main factors that modulate the metabolism of individuals, leading to the development of NCDs. Obesity, diabetes, metabolic associated fatty liver disease (MAFLD), and cardiovascular diseases (CVDs) are classified in this group of chronic diseases. Therefore, understanding the underlying molecular mechanisms of these diseases leads us to develop more accurate and effective treatments to reduce or mitigate their prevalence in the population. Given the global relevance of NCDs and ongoing research progress, this article reviews the current understanding about NCDs and their related risk factors, with a focus on obesity, diabetes, MAFLD, and CVDs, summarizing the knowledge about their pathophysiology and highlighting the currently available and emerging therapeutic strategies, especially pharmacological interventions. All of these diseases play an important role in the contamination by the SARS-CoV-2 virus, as well as in the progression and severity of the symptoms of the coronavirus disease 2019 (COVID-19). Therefore, we briefly explore the relationship between NCDs and COVID-19.


Subject(s)
COVID-19/therapy , Metabolic Diseases/therapy , Animals , COVID-19/epidemiology , COVID-19/metabolism , COVID-19/physiopathology , Chronic Disease , Humans , Metabolic Diseases/epidemiology , Metabolic Diseases/physiopathology , Noncommunicable Diseases/epidemiology , Noncommunicable Diseases/therapy , Prevalence , Risk Factors , SARS-CoV-2/isolation & purification , Severity of Illness Index
10.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(4): 628-632, 2021 Apr 20.
Article in Chinese | MEDLINE | ID: covidwho-1219329

ABSTRACT

The high comorbidity between cardiovascular and metabolic diseases (CVMD) and coronavirus disease 2019 (COVID-19) and the consequent high mortality and the potential risk of cardiovascular damage have brought great challenges to the clinical diagnosis and treatment of the condition. The latest studies found that advanced age, immune function defects, inflammatory factor storms and oxidative stress damage all potentially contribute to the high comorbidity of the two. Direct virus invasion, myocardial oxygen supply and demand imbalance and vascular endothelial and coagulation dysfunction may be important mechanisms for cardiovascular injury in COVID-19 patients. In addition, the expression level of ACE2 (the cell membrane receptor of SARS-CoV-2) in various organs and the peripheral blood not only mediates the direct invasion and damage of the organs, but also participates in regulation of the balance of systematic inflammation and oxidative stress, thus affecting the susceptibility and outcomes of the patients. Herein we review the recent research progress in the comorbidity between COVID-19 and CVMD and explore the mechanisms of cardiovascular damage caused by SARS-CoV-2, thus to provide a theoretical basis for the clinical diagnosis and treatment of COVID-19 with underlying CVMD.


Subject(s)
COVID-19 , Cardiovascular Diseases , Metabolic Diseases , Cardiovascular Diseases/epidemiology , Comorbidity , Humans , Metabolic Diseases/complications , Metabolic Diseases/epidemiology , SARS-CoV-2
11.
Circulation ; 143(19): 1831-1834, 2021 05 11.
Article in English | MEDLINE | ID: covidwho-1169909

ABSTRACT

During the past year, clinicians and the public have been focused on the coronavirus disease 2019 (COVID-19) pandemic and its associated societal and economic effects. However, once the acute phase of this crisis has passed, we will face an enormous wave of death and disability as a result of common chronic diseases (CCDs), with cardiometabolic diseases at the crest (Figure). A tsunami results when an earthquake on the ocean floor creates huge waves that can wreak devastation far distant from the original upheaval, especially when warnings are ignored. Similarly, underlying global and national demographic and risk factor profiles have for some time presaged an overwhelming burden of CCDs. However, although the pandemic has created additional impetus that unless heeded will amplify the consequences of this burden, the rapid adaptations and innovations in care and research prompted by the urgent response to it may also offer us the means to stem this flood.


Subject(s)
COVID-19 , Cardiovascular Diseases , Metabolic Diseases , Pandemics , SARS-CoV-2 , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/therapy , Chronic Disease , Humans , Metabolic Diseases/epidemiology , Metabolic Diseases/etiology , Metabolic Diseases/therapy , Risk Factors
12.
Cell Metab ; 33(3): 473-478, 2021 03 02.
Article in English | MEDLINE | ID: covidwho-1074686

ABSTRACT

Chronic metabolic disorders such as diabetes and obesity are major public health issues in the United States. However, significant disparities in their prevalence and incidence place a greater burden on US racial and ethnic minority groups, contributing to worse COVID-19 outcomes in many. Improving treatment and prevention of diabetes and obesity is critical to the NIDDK. In this Perspective, we will review the burden of metabolic diseases in the United States, the observed disparities for metabolic diseases in relation to COVID-19, and research opportunities to address underlying causes of metabolic diseases, their associated health disparities, and COVID-19.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Healthcare Disparities/statistics & numerical data , Metabolic Diseases/epidemiology , Obesity/epidemiology , /statistics & numerical data , Humans , Minority Groups/statistics & numerical data , Research , SARS-CoV-2 , United States/epidemiology
13.
Diabetes Metab Syndr ; 15(1): 55-62, 2021.
Article in English | MEDLINE | ID: covidwho-1065018

ABSTRACT

BACKGROUND AND AIMS: The ongoing pandemic of coronavirus disease 2019 (COVID-19) is rapidly evolving, thereby posing a profound challenge to the global healthcare system. Cardiometabolic disorders are associated with poor clinical outcomes in persons with COVID-19. Healthcare challenges during the COVID-19 pandemic are linked to resource constraints including shortage of Personal Protective Equipment's (PPE), laboratory tests and medication. In this context, a group of clinical experts discussed the endocrine and cardiology vigilance required in times of COVID-19. Further, the group proposed certain resource husbandry recommendations to be followed during the pandemic to overcome the constraints. METHOD: The clinical experts discussed and provided their inputs virtually. The expert panel included clinical experts comprising endocrinologists, Consultant Physicians and cardiologists from India. The panel thoroughly reviewed existing literature on the subject and proposed expert opinion. RESULTS: The expert panel put forward clinical practice-based opinion for the management of cardiometabolic conditions including diabetes mellitus and hypertension. As these conditions are associated with poor clinical outcomes, the expert panel recommends that these persons be extra-cautious and take necessary precautions during the ongoing pandemic. Further, experts also provided appropriate, affordable, available and accessible solution to the resource constraint situations in times of COVID-19 pandemic. CONCLUSION: The clinical expert opinion put forward in this article will serve as a reference for clinicians treating diabetes and cardiovascular disease during the COVID-19 pandemic.


Subject(s)
COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Expert Testimony/trends , Health Resources/trends , Metabolic Diseases/epidemiology , Blood Glucose/drug effects , Blood Glucose/metabolism , COVID-19/diagnosis , COVID-19/prevention & control , Cardiotonic Agents/therapeutic use , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/drug therapy , Humans , Hypertension/diagnosis , Hypertension/drug therapy , Hypertension/epidemiology , Hypoglycemic Agents/pharmacology , Hypoglycemic Agents/therapeutic use , India/epidemiology , Metabolic Diseases/diagnosis , Metabolic Diseases/drug therapy
16.
Med Hypotheses ; 146: 110416, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-970166

ABSTRACT

The COVID-19 pandemic has placed significant restrictions on people's daily activities and even change their eating habits, yet it has inadvertently allowed people to benefit potentially from this restriction for certain diseases. The COVID-19 outbreak has had the positive effect of changing the nutritional status of some populations. From this point of view, the COVID-19 pandemic is cleverly beneficial.


Subject(s)
COVID-19/epidemiology , Life Style , Metabolic Diseases/prevention & control , Pandemics , SARS-CoV-2 , COVID-19/psychology , China/epidemiology , Exercise , Feeding Behavior , Humans , Incidence , Metabolic Diseases/epidemiology , Nutritional Status , Risk Factors
17.
JCI Insight ; 5(20)2020 10 15.
Article in English | MEDLINE | ID: covidwho-877604

ABSTRACT

BACKGROUNDPatients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) differ in the severity of disease. We hypothesized that characteristics of SARS-CoV-2-specific immunity correlate with disease severity.METHODSIn this study, SARS-CoV-2-specific T cells and antibodies were characterized in uninfected controls and patients with different coronavirus disease 2019 (COVID-19) disease severity. SARS-CoV-2-specific T cells were flow cytometrically quantified after stimulation with SARS-CoV-2 peptide pools and analyzed for expression of cytokines (IFN-γ, IL-2, and TNF-α) and markers for activation, proliferation, and functional anergy. SARS-CoV-2-specific IgG and IgA antibodies were quantified using ELISA. Moreover, global characteristics of lymphocyte subpopulations were compared between patient groups and uninfected controls.RESULTSDespite severe lymphopenia affecting all major lymphocyte subpopulations, patients with severe disease mounted significantly higher levels of SARS-CoV-2-specific T cells as compared with convalescent individuals. SARS-CoV-2-specific CD4+ T cells dominated over CD8+ T cells and closely correlated with the number of plasmablasts and SARS-CoV-2-specific IgA and IgG levels. Unlike in convalescent patients, SARS-CoV-2-specific T cells in patients with severe disease showed marked alterations in phenotypical and functional properties, which also extended to CD4+ and CD8+ T cells in general.CONCLUSIONGiven the strong induction of specific immunity to control viral replication in patients with severe disease, the functionally altered characteristics may result from the need for contraction of specific and general immunity to counteract excessive immunopathology in the lung.FUNDINGThe study was supported by institutional funds to MS and in part by grants of Saarland University, the State of Saarland, and the Rolf M. Schwiete Stiftung.


Subject(s)
Antibodies, Viral , Betacoronavirus , Coronavirus Infections , Cytokines/blood , Leukocyte Count , Pandemics , Pneumonia, Viral , T-Lymphocytes , Adult , Antibodies, Viral/blood , Antibodies, Viral/classification , Betacoronavirus/immunology , Betacoronavirus/isolation & purification , COVID-19 , Cardiovascular Diseases/epidemiology , Comorbidity , Coronavirus Infections/blood , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/virology , Correlation of Data , Critical Care/methods , Critical Care/statistics & numerical data , Critical Illness/therapy , Female , Germany/epidemiology , Humans , Leukocyte Count/methods , Leukocyte Count/statistics & numerical data , Lymphocyte Subsets/classification , Male , Metabolic Diseases/epidemiology , Middle Aged , Pneumonia, Viral/blood , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/virology , SARS-CoV-2 , Severity of Illness Index , T-Lymphocytes/classification , T-Lymphocytes/virology
18.
Am J Med Genet A ; 185(1): 68-72, 2021 01.
Article in English | MEDLINE | ID: covidwho-855991

ABSTRACT

The national importance of telemedicine for safe and effective patient care has been highlighted by the current COVID-19 pandemic. Prior to the 2020 pandemic the Division of Genetics and Metabolism piloted a telemedicine program focused on initial and follow-up visits in the patients' home. The goals were to increase access to care, decrease missed work, improve scheduling, and avoid the transport and exposure of medically fragile patients. Visits were conducted by physician medical geneticists, genetic counselors, and biochemical dietitians, together and separately. This allowed the program to develop detailed standard operating procedures. At the onset of the COVID-19 pandemic, this pilot-program was deployed by the full team of 22 providers in one business day. Two physicians remained on-site for patients requiring in-person evaluations. This model optimized patient safety and workforce preservation while providing full access to patients during a pandemic. We provide initial data on visit numbers, types of diagnoses, and no-show rates. Experience in this implementation before and during the pandemic has confirmed the effectiveness and value of telemedicine for a highly complex medical population. This program is a model that can and will be continued well-beyond the current crisis.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/organization & administration , Endocrinology/organization & administration , Genetics, Medical/organization & administration , Models, Organizational , Pandemics , Telemedicine/organization & administration , Adolescent , Adult , Child , Child, Preschool , Delivery of Health Care/methods , Delivery of Health Care/standards , Endocrinology/education , Female , Genetic Counseling/methods , Genetic Counseling/organization & administration , Genetic Counseling/standards , Genetic Diseases, Inborn/epidemiology , Genetic Diseases, Inborn/therapy , Genetic Testing/methods , Genetic Testing/standards , Genetics, Medical/education , Humans , Implementation Science , Infant , Infant, Newborn , Internship and Residency/methods , Internship and Residency/organization & administration , Internship and Residency/standards , Male , Metabolic Diseases/epidemiology , Metabolic Diseases/therapy , Middle Aged , Patient Safety , Pilot Projects , Program Evaluation , Telemedicine/methods , Young Adult
19.
Cardiovasc Diabetol ; 19(1): 164, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-810407

ABSTRACT

BACKGROUND: Cardiometabolic disorders may worsen Covid-19 outcomes. We investigated features and Covid-19 outcomes for patients with or without diabetes, and with or without cardiometabolic multimorbidity. METHODS: We collected and compared data retrospectively from patients hospitalized for Covid-19 with and without diabetes, and with and without cardiometabolic multimorbidity (defined as ≥ two of three risk factors of diabetes, hypertension or dyslipidaemia). Multivariate logistic regression was used to assess the risk of the primary composite outcome (any of mechanical ventilation, admission to an intensive care unit [ICU] or death) in patients with diabetes and in those with cardiometabolic multimorbidity, adjusting for confounders. RESULTS: Of 354 patients enrolled, those with diabetes (n = 81), compared with those without diabetes (n = 273), had characteristics associated with the primary composite outcome that included older age, higher prevalence of hypertension and chronic obstructive pulmonary disease (COPD), higher levels of inflammatory markers and a lower PaO2/FIO2 ratio. The risk of the primary composite outcome in the 277 patients who completed the study as of May 15th, 2020, was higher in those with diabetes (Adjusted Odds Ratio (adjOR) 2.04, 95%CI 1.12-3.73, p = 0.020), hypertension (adjOR 2.31, 95%CI: 1.37-3.92, p = 0.002) and COPD (adjOR 2.67, 95%CI 1.23-5.80, p = 0.013). Patients with cardiometabolic multimorbidity were at higher risk compared to patients with no cardiometabolic conditions (adjOR 3.19 95%CI 1.61-6.34, p = 0.001). The risk for patients with a single cardiometabolic risk factor did not differ with that for patients with no cardiometabolic risk factors (adjOR 1.66, 0.90-3.06, adjp = 0.10). CONCLUSIONS: Patients with diabetes hospitalized for Covid-19 present with high-risk features. They are at increased risk of adverse outcomes, likely because diabetes clusters with other cardiometabolic conditions.


Subject(s)
Betacoronavirus , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Aged , Aged, 80 and over , COVID-19 , Cardiovascular Diseases/metabolism , Coronavirus Infections/metabolism , Diabetes Mellitus/metabolism , Female , Follow-Up Studies , Humans , Male , Metabolic Diseases/diagnosis , Metabolic Diseases/epidemiology , Metabolic Diseases/metabolism , Middle Aged , Multimorbidity/trends , Pandemics , Pneumonia, Viral/metabolism , Prognosis , Retrospective Studies , Risk Factors , SARS-CoV-2
20.
Cytokine Growth Factor Rev ; 58: 102-110, 2021 04.
Article in English | MEDLINE | ID: covidwho-778706

ABSTRACT

The severe form of COVID-19 is marked by an abnormal and exacerbated immunological host response favoring to a poor outcome in a significant number of patients, especially those with obesity, diabetes, hypertension, and atherosclerosis. The chronic inflammatory process found in these cardiometabolic comorbidities is marked by the overexpression of pro-inflammatory cytokines such as interleukin-6 (IL-6) and tumoral necrosis factor-alpha (TNF-α), which are products of the Toll-Like receptors 4 (TLR4) pathway. The SARS-CoV-2 initially infects cells in the upper respiratory tract and, in some patients, spread very quickly, needing respiratory support and systemically, causing collateral damage in tissues. We hypothesize that this happens because the SARS-CoV-2 spike protein interacts strongly with TLR4, causing an intensely exacerbated immune response in the host's lungs, culminating with the cytokine storm, accumulating secretions and hindering blood oxygenation, along with the immune system attacks the body, leading to multiple organ failure.


Subject(s)
COVID-19/complications , Cardiovascular Diseases/etiology , Metabolic Diseases/etiology , SARS-CoV-2/pathogenicity , Toll-Like Receptor 4/physiology , COVID-19/epidemiology , COVID-19/pathology , Cardiometabolic Risk Factors , Cardiovascular Diseases/epidemiology , Comorbidity , Cytokine Release Syndrome/epidemiology , Cytokine Release Syndrome/etiology , Humans , Metabolic Diseases/epidemiology , Multiple Organ Failure/epidemiology , Multiple Organ Failure/etiology , Severity of Illness Index
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