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1.
PLoS One ; 16(11): e0260169, 2021.
Article in English | MEDLINE | ID: covidwho-1526694

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has affected millions of people worldwide, and several sociodemographic variables, comorbidities and care variables have been associated with complications and mortality. OBJECTIVE: To identify the factors associated with admission to intensive care units (ICUs) and mortality in patients with COVID-19 from 4 clinics in Colombia. METHODS: This was a follow-up study of a cohort of patients diagnosed with COVID-19 between March and August 2020. Sociodemographic, clinical (Charlson comorbidity index and NEWS 2 score) and pharmacological variables were identified. Multivariate analyses were performed to identify variables associated with the risk of admission to the ICU and death (p<0.05). RESULTS: A total of 780 patients were analyzed, with a median age of 57.0 years; 61.2% were male. On admission, 54.9% were classified as severely ill, 65.3% were diagnosed with acute respiratory distress syndrome, 32.4% were admitted to the ICU, and 26.0% died. The factors associated with a greater likelihood of ICU admission were severe pneumonia (OR: 9.86; 95%CI:5.99-16.23), each 1-point increase in the NEWS 2 score (OR:1.09; 95%CI:1.002-1.19), history of ischemic heart disease (OR:3.24; 95%CI:1.16-9.00), and chronic obstructive pulmonary disease (OR:2.07; 95%CI:1.09-3.90). The risk of dying increased in those older than 65 years (OR:3.08; 95%CI:1.66-5.71), in patients with acute renal failure (OR:6.96; 95%CI:4.41-11.78), admitted to the ICU (OR:6.31; 95%CI:3.63-10.95), and for each 1-point increase in the Charlson comorbidity index (OR:1.16; 95%CI:1.002-1.35). CONCLUSIONS: Factors related to increasing the probability of requiring ICU care or dying in patients with COVID-19 were identified, facilitating the development of anticipatory intervention measures that favor comprehensive care and improve patient prognosis.


Subject(s)
COVID-19/epidemiology , Hospital Mortality/trends , Intensive Care Units/statistics & numerical data , Patient Admission/statistics & numerical data , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19/mortality , COVID-19/therapy , Colombia , Comorbidity , Female , Humans , Male , Middle Aged , Myocardial Ischemia/epidemiology , Pulmonary Disease, Chronic Obstructive/epidemiology , Renal Insufficiency/epidemiology , Sex Factors
2.
Prev Med ; 153: 106818, 2021 12.
Article in English | MEDLINE | ID: covidwho-1440419

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has been associated with a declining volume of patients seen in the emergency department. Despite the need for seeking urgent care for conditions such as myocardial infarction, many people may not seek treatment. This study seeks to measure associations between the COVID-19 pandemic and location of death among individuals who died from ischemic heart disease (IHD). Data obtained from death certificates from the Arkansas Department of Health was used to conduct a difference-in-difference analysis to assess whether decedents of IHD were more likely to die at home during the pandemic (March 2020 through September 2020). The analysis compared location of death for decedents of IHD pre and during the pandemic to location of death for decedents from non-natural causes. Before the pandemic, 50.0% of decedents of IHD died at home compared to 57.9% dying at home during (through September 2020) the pandemic study period (p < .001). There was no difference in the proportion of decedents who died at home from non-natural causes before and during the pandemic study period (55.8% vs. 53.5%; p = .21). After controlling for confounders, there was a 48% increase in the odds of dying at home from IHD during the pandemic study period (p < .001) relative to the change in dying at home due to non-natural causes. During the study period, there was an increase in the proportion of decedents who died at home due to IHD. Despite the ongoing pandemic, practitioners should emphasize the need to seek urgent care during an emergency.


Subject(s)
COVID-19 , Myocardial Ischemia , Emergency Service, Hospital , Humans , Myocardial Ischemia/epidemiology , Pandemics , SARS-CoV-2
3.
Am Heart J ; 241: 35-37, 2021 11.
Article in English | MEDLINE | ID: covidwho-1356104

ABSTRACT

Societal lockdowns during the first wave of the coronavirus disease 2019 pandemic were associated with decreased admission rates for acute cardiovascular conditions worldwide. In this nationwide Danish study of the first five weeks of a second pandemic lockdown, incidence of new-onset heart failure and atrial fibrillation remained stable, but there was a significant drop in new-onset ischemic heart disease and ischemic stroke during the fourth week of lockdown, which normalized promptly. The observed drops were lower compared to the first Danish lockdown in March 2020; thus, our data suggest that declines in acute cardiovascular disease admission rates during future lockdowns are avoidable.


Subject(s)
Atrial Fibrillation/epidemiology , COVID-19 , Heart Failure/epidemiology , Hospitalization/statistics & numerical data , Ischemic Stroke/epidemiology , Myocardial Ischemia/epidemiology , Cardiovascular Diseases/epidemiology , Communicable Disease Control , Denmark/epidemiology , Humans , Incidence , Public Policy , SARS-CoV-2
5.
J Intern Med ; 291(1): 101-107, 2022 01.
Article in English | MEDLINE | ID: covidwho-1258958

ABSTRACT

BACKGROUND: Comorbidities including ischemic heart disease (IHD) worsen outcomes after SARS-CoV-2 infections. High lipoprotein(a) [Lp(a)] concentrations are a strong risk factor for IHD and possibly for thromboembolic events. We therefore evaluated whether SARS-CoV-2 infections modify the risk of high Lp(a) concentrations for IHD or thromboembolic events during the first 8.5 months follow-up of the pandemic. METHOD: Cohort study using data from the UK Biobank during the SARS-CoV-2 pandemic. Baseline Lp(a) was compared between SARS-CoV-2 positive patients and the population controls. RESULTS: SARS-CoV-2 positive patients had Lp(a) concentrations similar to the population controls. The risk for IHD increased with higher Lp(a) concentrations in both, the population controls (n = 435,104) and SARS-CoV-2 positive patients (n = 6937). The causality of the findings was supported by a genetic risk score for Lp(a). A SARS-CoV-2 infection modified the association with a steeper increase in risk for infected patients (interaction p-value = 0.03). Although SARS-CoV-2 positive patients had a five-times higher frequency of thromboembolic events compared to the population controls (1.53% vs. 0.31%), the risk was not influenced by Lp(a). CONCLUSIONS: SARS-CoV-2 infections enforce the association between high Lp(a) and IHD but the risk for thromboembolic events is not influenced by Lp(a).


Subject(s)
COVID-19/diagnosis , Lipoprotein(a)/blood , Myocardial Ischemia/epidemiology , Nasopharynx/virology , SARS-CoV-2/isolation & purification , Thromboembolism/epidemiology , Adult , Aged , COVID-19/blood , COVID-19 Nucleic Acid Testing , Case-Control Studies , Cohort Studies , Female , Humans , Intensive Care Units , Male , Middle Aged , Risk Factors , SARS-CoV-2/genetics , Thromboembolism/etiology
6.
Cardiovasc Res ; 117(2): 367-385, 2021 01 21.
Article in English | MEDLINE | ID: covidwho-1254643

ABSTRACT

Ischaemic heart disease (IHD) is a complex disorder and a leading cause of death and morbidity in both men and women. Sex, however, affects several aspects of IHD, including pathophysiology, incidence, clinical presentation, diagnosis as well as treatment and outcome. Several diseases or risk factors frequently associated with IHD can modify cellular signalling cascades, thus affecting ischaemia/reperfusion injury as well as responses to cardioprotective interventions. Importantly, the prevalence and impact of risk factors and several comorbidities differ between males and females, and their effects on IHD development and prognosis might differ according to sex. The cellular and molecular mechanisms underlying these differences are still poorly understood, and their identification might have important translational implications in the prediction or prevention of risk of IHD in men and women. Despite this, most experimental studies on IHD are still undertaken in animal models in the absence of risk factors and comorbidities, and assessment of potential sex-specific differences are largely missing. This ESC WG Position Paper will discuss: (i) the importance of sex as a biological variable in cardiovascular research, (ii) major biological mechanisms underlying sex-related differences relevant to IHD risk factors and comorbidities, (iii) prospects and pitfalls of preclinical models to investigate these associations, and finally (iv) will provide recommendations to guide future research. Although gender differences also affect IHD risk in the clinical setting, they will not be discussed in detail here.


Subject(s)
Health Status Disparities , Myocardial Ischemia/epidemiology , Animals , Comorbidity , Disease Models, Animal , Female , Humans , Male , Myocardial Ischemia/diagnosis , Myocardial Ischemia/physiopathology , Risk Assessment , Risk Factors , Sex Characteristics , Sex Factors , Species Specificity
7.
Cochrane Database Syst Rev ; 3: CD013879, 2021 03 11.
Article in English | MEDLINE | ID: covidwho-1151840

ABSTRACT

BACKGROUND: A small minority of people with coronavirus disease 2019 (COVID-19) develop a severe illness, characterised by inflammation, microvascular damage and coagulopathy, potentially leading to myocardial injury, venous thromboembolism (VTE) and arterial occlusive events. People with risk factors for or pre-existing cardiovascular disease may be at greater risk. OBJECTIVES: To assess the prevalence of pre-existing cardiovascular comorbidities associated with suspected or confirmed cases of COVID-19 in a variety of settings, including the community, care homes and hospitals. We also assessed the nature and rate of subsequent cardiovascular complications and clinical events in people with suspected or confirmed COVID-19. SEARCH METHODS: We conducted an electronic search from December 2019 to 24 July 2020 in the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, covid-19.cochrane.org, ClinicalTrials.gov and EU Clinical Trial Register. SELECTION CRITERIA: We included prospective and retrospective cohort studies, controlled before-and-after, case-control and cross-sectional studies, and randomised controlled trials (RCTs). We analysed controlled trials as cohorts, disregarding treatment allocation. We only included peer-reviewed studies with 100 or more participants, and excluded articles not written in English or only published in pre-print servers. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results and extracted data. Given substantial variation in study designs, reported outcomes and outcome metrics, we undertook a narrative synthesis of data, without conducting a meta-analysis. We critically appraised all included studies using the Joanna Briggs Institute (JBI) checklist for prevalence studies and the JBI checklist for case series. MAIN RESULTS: We included 220 studies. Most of the studies originated from China (47.7%) or the USA (20.9%); 9.5% were from Italy. A large proportion of the studies were retrospective (89.5%), but three (1.4%) were RCTs and 20 (9.1%) were prospective. Using JBI's critical appraisal checklist tool for prevalence studies, 75 studies attained a full score of 9, 57 studies a score of 8, 31 studies a score of 7, 5 studies a score of 6, three studies a score of 5 and one a score of 3; using JBI's checklist tool for case series, 30 studies received a full score of 10, six studies a score of 9, 11 studies a score of 8, and one study a score of 5 We found that hypertension (189 studies, n = 174,414, weighted mean prevalence (WMP): 36.1%), diabetes (197 studies, n = 569,188, WMP: 22.1%) and ischaemic heart disease (94 studies, n = 100,765, WMP: 10.5%)  are highly prevalent in people hospitalised with COVID-19, and are associated with an increased risk of death. In those admitted to hospital, biomarkers of cardiac stress or injury are often abnormal, and the incidence of a wide range of cardiovascular complications is substantial, particularly arrhythmias (22 studies, n = 13,115, weighted mean incidence (WMI) 9.3%), heart failure (20 studies, n = 29,317, WMI: 6.8%) and thrombotic complications (VTE: 16 studies, n = 7700, WMI: 7.4%). AUTHORS' CONCLUSIONS: This systematic literature review indicates that cardiometabolic comorbidities are common in people who are hospitalised with a COVID-19 infection, and cardiovascular complications are frequent. We plan to update this review and to conduct a formal meta-analysis of outcomes based on a more homogeneous selected subsample of high-certainty studies.


Subject(s)
COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Arrhythmias, Cardiac/epidemiology , COVID-19/mortality , Comorbidity , Diabetes Mellitus/epidemiology , Heart Failure/epidemiology , Hospitalization/statistics & numerical data , Humans , Hypertension/epidemiology , Incidence , Myocardial Ischemia/epidemiology , Obesity/epidemiology , Prevalence , Thrombosis/epidemiology
8.
J Neurovirol ; 27(2): 354-358, 2021 04.
Article in English | MEDLINE | ID: covidwho-1111383

ABSTRACT

A 63-year-old Caucasian male, known case of controlled type 2 diabetes, chronic renal failure, and ischemic heart disease, was presented with weakness and loss of movement in lower limbs, an absent sensation from the chest below, constipation, and urinary retention. About 4 days before these symptoms, he experienced a flu-like syndrome. Suspicious for COVID-19, his nasopharyngeal specimen's reverse transcription-polymerase chain reaction (RT-PCR) resulted positive. Chest X-ray and HRCT demonstrated severe pulmonary involvement. Immediately, he was admitted to the emergency ward, and the treatment was started according to the national COVID-19 treatment protocol. Subsequently, diagnostic measures were taken to investigate the patient's non-heterogeneous peripheral (spinal) neuromuscular manifestations. Brain CT scan and MRI were normal, but spinal MRI with gadolinium contrast showed extensive increased T2 signal involving central gray matter and dorsal columns, extended from C7 to T12 with linear enhancement in the sagittal plane, posteriorly within the mid and lower thoracic cord. The CSF specimen demonstrated pleocytosis, positive RT-PCR for SARS-CoV-2, and elevated IgG index. Clinical presentation, MRI, CSF, and laboratory findings prioritized the acute transverse myelitis (ATM) as a probable complication of COVID-19 infection over other differential diagnoses. Intravenous methylprednisolone and, subsequently, IV human immunoglobulin were added to the treatment regimen. In the end, the complete resolution of dysesthesia, urinary retention, and constipation were achieved. After continuous and extended respiratory and motor rehabilitation programs, he was discharged asymptomatic.


Subject(s)
COVID-19/complications , Myelitis, Transverse/virology , Paraplegia/virology , COVID-19/drug therapy , COVID-19/therapy , Diabetes Mellitus, Type 2/epidemiology , Humans , Kidney Failure, Chronic/epidemiology , Male , Middle Aged , Myelitis, Transverse/therapy , Myocardial Ischemia/epidemiology , SARS-CoV-2
9.
Acta Anaesthesiol Scand ; 65(6): 770-777, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1105177

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) may be associated with cardiac arrhythmias in hospitalized patients, but data from the ICU setting are limited. We aimed to describe the epidemiology of cardiac arrhythmias in ICU patients with COVID-19. METHODS: We conducted a multicenter, retrospective cohort study including all ICU patients with an airway sample positive for severe acute respiratory syndrome corona-virus 2 from March 1st to June 1st in the Capital Region of Denmark (1.8 million inhabitants). We registered cardiac arrhythmias in ICU, potential risk factors, interventions used in ICU and outcomes. RESULTS: From the seven ICUs we included 155 patients with COVID-19. The incidence of cardiac arrhythmias in the ICU was 57/155 (37%, 95% confidence interval 30-45), and 39/57 (68%) of these patients had this as new-onset arrhythmia. Previous history of tachyarrhythmias and higher disease severity at ICU admission were associated with cardiac arrhythmias in the adjusted analysis. Fifty-four of the 57 (95%) patients had supraventricular origin of the arrhythmia, 39/57 (68%) received at least one intervention against arrhythmia (eg amiodarone, IV fluid or magnesium) and 38/57 (67%) had recurrent episodes of arrhythmia in ICU. Patients with arrhythmias in ICU had higher 60-day mortality (63%) as compared to those without arrhythmias (39%). CONCLUSION: New-onset supraventricular arrhythmias were frequent in ICU patients with COVID-19 and were related to previous history of tachyarrhythmias and severity of the acute disease. The mortality was high in these patients despite the frequent use of interventions against arrhythmias.


Subject(s)
Arrhythmias, Cardiac/etiology , COVID-19/complications , Critical Illness , SARS-CoV-2 , Aged , Arrhythmias, Cardiac/epidemiology , COVID-19/epidemiology , Comorbidity , Denmark/epidemiology , Diabetes Mellitus/epidemiology , Disease Susceptibility , Female , Hospital Mortality , Humans , Hypertension/epidemiology , Incidence , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Myocardial Ischemia/epidemiology , Pulmonary Disease, Chronic Obstructive/epidemiology , Recurrence , Retrospective Studies , Risk Factors
10.
Sci Rep ; 11(1): 4263, 2021 02 19.
Article in English | MEDLINE | ID: covidwho-1091460

ABSTRACT

Infection by the new corona virus strain SARS-CoV-2 and its related syndrome COVID-19 has been associated with more than two million deaths worldwide. Patients of higher age and with preexisting chronic health conditions are at an increased risk of fatal disease outcome. However, detailed information on causes of death and the contribution of pre-existing health conditions to death yet is missing, which can be reliably established by autopsy only. We performed full body autopsies on 26 patients that had died after SARS-CoV-2 infection and COVID-19 at the Charité University Hospital Berlin, Germany, or at associated teaching hospitals. We systematically evaluated causes of death and pre-existing health conditions. Additionally, clinical records and death certificates were evaluated. We report findings on causes of death and comorbidities of 26 decedents that had clinically presented with severe COVID-19. We found that septic shock and multi organ failure was the most common immediate cause of death, often due to suppurative pulmonary infection. Respiratory failure due to diffuse alveolar damage presented as immediate cause of death in fewer cases. Several comorbidities, such as hypertension, ischemic heart disease, and obesity were present in the vast majority of patients. Our findings reveal that causes of death were directly related to COVID-19 in the majority of decedents, while they appear not to be an immediate result of preexisting health conditions and comorbidities. We therefore suggest that the majority of patients had died of COVID-19 with only contributory implications of preexisting health conditions to the mechanism of death.


Subject(s)
COVID-19/mortality , Cause of Death , Hospital Mortality , Adult , Aged , Aged, 80 and over , Autopsy , Berlin/epidemiology , COVID-19/complications , COVID-19/therapy , COVID-19/virology , Comorbidity , Female , Hospitals, Teaching/statistics & numerical data , Humans , Hypertension/epidemiology , Male , Middle Aged , Multiple Organ Failure/mortality , Multiple Organ Failure/virology , Myocardial Ischemia/epidemiology , Obesity/epidemiology , Prospective Studies , SARS-CoV-2/isolation & purification , Shock, Septic/mortality , Shock, Septic/virology
11.
Eur Rev Med Pharmacol Sci ; 24(23): 12500-12509, 2020 12.
Article in English | MEDLINE | ID: covidwho-995007

ABSTRACT

OBJECTIVE: Since the emergence of coronavirus disease (COVID-19), the death toll has been increasing daily. Many risk factors are associated with a high mortality rate in COVID-19. Establishment of a common pathway among these risk factors could improve our understanding of COVID-19 severity and mortality. This review aims at establishing this common pathway and its possible effect on COVID-19 mortality. MATERIALS AND METHODS: The current review was executed in five consecutive stages starting from determining the risk factors of COVID-19 mortality and trying to find a common pathway among them depending on the available literature. This was followed by proposing a mechanism explaining how this common pathway could increase the mortality. Finally, its potential role in managing COVID-19 was proposed. RESULTS: This review identified this common pathway to be a low baseline of reduced glutathione (i.e., GSH) level. In particular, this review provided an in-depth discussion regarding the pathophysiology by which COVID-19 leads to GSH depletion, tissue damage, and acute respiratory distress syndrome. In addition, the current review demonstrated how GSH depletion could result in failure of the immune system and rendering the end organs vulnerable to damage from the oxidative stress. CONCLUSIONS: This preclinical study shows that GSH depletion may have a central role in COVID-19 mortality and pathophysiology. Therefore, elevating the GSH level in tissues may decrease the severity and mortality rates of COVID-19.


Subject(s)
COVID-19/mortality , Cytokine Release Syndrome/immunology , Glutathione/metabolism , Acute Lung Injury/metabolism , Age Factors , Antioxidants/metabolism , Apoptosis , COVID-19/immunology , COVID-19/metabolism , Cytokine Release Syndrome/metabolism , Diabetes Mellitus/epidemiology , Diabetes Mellitus/metabolism , Glutathione/immunology , Humans , Hypertension/epidemiology , Hypertension/metabolism , Macrophages/immunology , Myocardial Ischemia/epidemiology , Myocardial Ischemia/metabolism , Obesity/epidemiology , Obesity/metabolism , Reactive Oxygen Species/metabolism , Respiratory Distress Syndrome/metabolism , Risk Factors , SARS-CoV-2 , Smoking/epidemiology , Smoking/metabolism
12.
J Infect Chemother ; 27(2): 306-311, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-943338

ABSTRACT

BACKGROUND: The clinical spectrum of COVID-19 has a great variation from asymptomatic infection to acute respiratory distress syndrome and eventually death. The mortality rates vary across the countries probably due to the heterogeneity in study characteristics and patient cohorts as well as treatment strategies. Therefore, we aimed to summarize the clinical characteristics and outcomes of adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia in Istanbul, Turkey. METHODS: A total of 722 adult patients with laboratory-confirmed COVID-19 pneumonia were analyzed in this single-center retrospective study between March 15 and May 1, 2020. RESULTS: A total of 722 laboratory-confirmed patients with COVID-19 pneumonia were included in the study. There were 235 (32.5%) elderly patients and 487 (67.5%) non-elderly patients. The most common comorbidities were hypertension (251 [34.8%]), diabetes mellitus (198 [27.4%]), and ischemic heart disease (66 [9.1%]). The most common symptoms were cough (512 [70.9%]), followed by fever (226 [31.3%]), and shortness of breath (201 [27.8%]). Lymphocytopenia was present in 29.7% of the patients, leukopenia in 12.2%, and elevated CRP in 48.8%. By the end of May 20, 648 (89.7%) patients had been discharged and 60 (8.5%) patients had died. According to our study, while our overall mortality rate was 8.5%, this rate was 14.5% in elderly patients, and the difference was significant. CONCLUSIONS: This case series provides characteristics and outcomes of sequentially adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia in Turkey.


Subject(s)
COVID-19/epidemiology , Hospitalization/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Antiviral Agents/therapeutic use , COVID-19/mortality , COVID-19/therapy , Comorbidity , Diabetes Mellitus/epidemiology , Female , Humans , Hypertension/epidemiology , Laboratories , Male , Middle Aged , Myocardial Ischemia/epidemiology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/mortality , Retrospective Studies , SARS-CoV-2 , Turkey/epidemiology , Young Adult
13.
PLoS One ; 15(11): e0241264, 2020.
Article in English | MEDLINE | ID: covidwho-930626

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (Covid-19) has rapidly infected millions of people worldwide. Recent studies suggest that racial minorities and patients with comorbidities are at higher risk of Covid-19. In this study, we analyzed the effects of clinical, regional, and genetic factors on Covid-19 positive status. METHODS: The UK Biobank is a longitudinal cohort study that recruited participants from 2006 to 2010 from throughout the United Kingdom. Covid-19 test results were provided to UK Biobank starting on March 16, 2020. The main outcome measure in this study was Covid-19 positive status, determined by the presence of any positive test for a single individual. Clinical risk factors were derived from UK Biobank at baseline, and regional risk factors were imputed using census features local to each participant's home zone. We used robust adjusted Poisson regression with clustering by testing laboratory to estimate relative risk. Blood types were derived using genetic variants rs8176719 and rs8176746, and genomewide tests of association were conducted using logistic-Firth hybrid regression. RESULTS: This prospective cohort study included 397,064 UK Biobank participants, of whom 968 tested positive for Covid-19. The unadjusted relative risk of Covid-19 for Black participants was 3.66 (95% CI 2.83-4.74), compared to White participants. Adjusting for Townsend deprivation index alone reduced the relative risk to 2.44 (95% CI 1.86-3.20). Comorbidities that significantly increased Covid-19 risk included chronic obstructive pulmonary disease (adjusted relative risk [ARR] 1.64, 95% CI 1.18-2.27), ischemic heart disease (ARR 1.48, 95% CI 1.16-1.89), and depression (ARR 1.32, 95% CI 1.03-1.70). There was some evidence that angiotensin converting enzyme inhibitors (ARR 1.48, 95% CI 1.13-1.93) were associated with increased risk of Covid-19. Each standard deviation increase in the number of total individuals living in a participant's locality was associated with increased risk of Covid-19 (ARR 1.14, 95% CI 1.08-1.20). Analyses of genetically inferred blood types confirmed that participants with type A blood had increased odds of Covid-19 compared to participants with type O blood (odds ratio [OR] 1.16, 95% CI 1.01-1.33). A meta-analysis of genomewide association studies across ancestry groups did not reveal any significant loci. Study limitations include confounding by indication, bias due to limited information on early Covid-19 test results, and inability to accurately gauge disease severity. CONCLUSIONS: When assessing the association of Black race with Covid-19, adjusting for deprivation reduced the relative risk of Covid-19 by 33%. In the context of sociological research, these findings suggest that discrimination in the labor market may play a role in the high relative risk of Covid-19 for Black individuals. In this study, we also confirmed the association of blood type A with Covid-19, among other clinical and regional factors.


Subject(s)
ABO Blood-Group System , Coronavirus Infections/epidemiology , Coronavirus Infections/genetics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/genetics , Adult , Aged , Betacoronavirus , Biological Specimen Banks , COVID-19 , Comorbidity , Coronavirus Infections/blood , Depression/epidemiology , Female , Humans , Longitudinal Studies , Male , Middle Aged , Myocardial Ischemia/epidemiology , Pandemics , Pneumonia, Viral/blood , Prospective Studies , Pulmonary Disease, Chronic Obstructive/epidemiology , Risk Factors , SARS-CoV-2 , United Kingdom/epidemiology
14.
Indian Heart J ; 72(6): 623-624, 2020.
Article in English | MEDLINE | ID: covidwho-912232

ABSTRACT

The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) study was published recently demonstrating that over a period of 3.3 years a routine invasive approach along with optimised medical therapy (OMT) was not superior to OMT alone in patients with stable coronary artery disease and at least moderate to severe ischemia. Considerable interest and discussion have emerged over the applicability of the trial to real-world settings and the limitations of the trial. Given the fact that no clinical trial will ever be designed that will be perfect, it is important to prise out the pearls that the findings reveal and not interpret the findings as either positive or negative towards one approach or the other.


Subject(s)
Myocardial Ischemia/surgery , Myocardial Revascularization/methods , Global Health , Humans , Morbidity/trends , Myocardial Ischemia/epidemiology
15.
J Card Surg ; 36(1): 82-88, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-901098

ABSTRACT

BACKGROUND AND AIM OF THE STUDY: To investigate the effect of myocardial injury on the prognosis of patients with severe or critical coronavirus disease 2019 (COVID-19). METHODS: Between February 10, 2020 and March 31, 2020, data of severe and critical COVID-19 patients were collected and retrospectively analyzed. Admission data included age, heart rates, mean arterial pressure, and myocardial injury markers including creatine kinase isoenzyme-MB (CK-MB), myoglobin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and interleukin-6. The endpoints included mortality, the incidence of malignant arrhythmia, and mechanical ventilation time. Univariate regression analysis, multivariate linear regression analysis, and binary logistic analysis were performed to develop the risk predictors in myocardial injury to the prognosis of severe and critical COVID-19 patients. RESULTS: Seventy-four COVID-19 patients were included (mean age of 67.2 ± 14.6 years, male of 66.2%), including 42 severe and 32 critical cases. The mortality was 62.2% (n = 46). CK-MB (odds ratio = 5.895, p < .001, 95% confidence interval: 3.097-8.692) and interleukin-6 (odds ratio = 0.379; p = .005; 95% confidence interval: 1.051-1.769) were independent risk factors of increased mechanical ventilation time; myoglobin (odds ratio = 7.710; p = .045; 95% confidence interval: 1.051-56.571) were the independent predictor of incidence of malignant arrhythmia; age (odds ratio = 1.077; p = .009; 95% confidence interval: 1.019-1.139), myoglobin (odds ratio = 9.480; p = .032; 95% confidence interval: 1.211-78.188), and NT-proBNP (odds ratio = 4.852; p = .047; 95% confidence interval: 0.956-24.627) were the independent predictors of mortality. CONCLUSIONS: In severe and critical COVID-19 patients, the obvious myocardial injury was observed. Increases of CK-MB, myoglobin, NT-proBNP, interleukin-6, and age were independently associated with poor prognosis including increased ventilation duration, the incidence of malignant arrhythmia, and mortality.


Subject(s)
COVID-19/epidemiology , Creatine Kinase, MB Form/blood , Myocardial Ischemia/etiology , Myocardium/metabolism , Natriuretic Peptide, Brain/blood , Pandemics , Peptide Fragments/blood , Troponin I/blood , Aged , Biomarkers/blood , COVID-19/complications , China/epidemiology , Female , Humans , Incidence , Male , Middle Aged , Myocardial Ischemia/blood , Myocardial Ischemia/epidemiology , Prognosis , Protein Precursors , ROC Curve , Retrospective Studies , Risk Factors , SARS-CoV-2
16.
Am J Cardiol ; 137: 111-117, 2020 12 15.
Article in English | MEDLINE | ID: covidwho-845896

ABSTRACT

Early risk stratification for complications and death related to Coronavirus disease 2019 (COVID-19) infection is needed. Because many patients with COVID-19 who developed acute respiratory distress syndrome have diffuse alveolar inflammatory damage associated with microvessel thrombosis, we aimed to investigate a common clinical tool, the CHA(2)DS(2)-VASc, to aid in the prognostication of outcomes for COVID-19 patients. We analyzed consecutive patients from the multicenter observational CORACLE registry, which contains data of patients hospitalized for COVID-19 infection in 4 regions of Italy, according to data-driven tertiles of CHA(2)DS(2)-VASc score. The primary outcomes were inpatient death and a composite of inpatient death or invasive ventilation. Of 1045 patients in the registry, 864 (82.7%) had data available to calculate CHA(2)DS(2)-VASc score and were included in the analysis. Of these, 167 (19.3%) died, 123 (14.2%) received invasive ventilation, and 249 (28.8%) had the composite outcome. Stratification by CHA(2)DS(2)-VASc tertiles (T1: ≤1; T2: 2 to 3; T3: ≥4) revealed increases in both death (8.1%, 24.3%, 33.3%, respectively; p <0.001) and the composite end point (18.6%, 31.9%, 43.5%, respectively; p <0.001). The odds ratios for mortality and the composite end point for T2 patients versus T1 CHA(2)DS(2)-VASc score were 3.62 (95% CI:2.29 to 5.73,p <0.001) and 2.04 (95% CI:1.42 to 2.93, p <0.001), respectively. Similarly, the odds ratios for mortality and the composite end point for T3 patients versus T1 were 5.65 (95% CI:3.54 to 9.01, p <0.001) and 3.36 (95% CI:2.30 to 4.90,p <0.001), respectively. In conclusion, among Italian patients hospitalized for COVID-19 infection, the CHA(2)DS(2)-VASc risk score for thromboembolic events enhanced the ability to achieve risk stratification for complications and death.


Subject(s)
COVID-19/mortality , Diabetes Mellitus/epidemiology , Heart Failure/epidemiology , Hospital Mortality , Hypertension/epidemiology , Myocardial Ischemia/epidemiology , Respiration, Artificial/statistics & numerical data , Stroke/epidemiology , Age Factors , Aged , Aged, 80 and over , COVID-19/therapy , Female , Hospitalization , Humans , Italy/epidemiology , Male , Middle Aged , Odds Ratio , Prognosis , Registries , Risk Assessment , Sex Factors
17.
Am Heart J ; 227: 11-18, 2020 09.
Article in English | MEDLINE | ID: covidwho-824286

ABSTRACT

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that causes coronavirus disease 2019 (COVID-19), has resulted in a global pandemic. Patients with cardiovascular risk factors or established cardiovascular disease are more likely to experience severe or critical COVID-19 illness and myocardial injury is a key extra-pulmonary manifestation. These patients frequently present with ST-elevation on an electrocardiogram (ECG) due to multiple etiologies including obstructive, non-obstructive, and/or angiographically normal coronary arteries. The incidence of ST-elevation myocardial infarction (STEMI) mimics in COVID-19-positive hospitalized patients, and the association with morbidity and mortality is unknown. Understanding the natural history and appropriate management of COVID-19 patients presenting with ST elevation is essential to inform patient management decisions and protect healthcare workers. Methods: The Society for Cardiovascular Angiography and Interventions (SCAI) and The Canadian Association of Interventional Cardiology (CAIC) in conjunction with the American College of Cardiology Interventional Council have collaborated to create a multi-center observational registry, NACMI. This registry will enroll confirmed COVID-19 patients and persons under investigation (PUI) with new ST-segment elevation or new onset left bundle branch block (LBBB) on the ECG with clinical suspicion of myocardial ischemia. We will compare demographics, clinical findings, outcomes and management of these patients with a historical control group of over 15,000 consecutive STEMI activation patients from the Midwest STEMI Consortium using propensity matching. The primary clinical outcome will be in- hospital major adverse cardiovascular events (MACE) defined as composite of all-cause mortality, stroke, recurrent MI, and repeat unplanned revascularization in COVID-19 confirmed or PUI. Secondary outcomes will include the following: reporting of etiologies of ST Elevation; cardiovascular mortality due to myocardial infarction, cardiac arrest and /or shock; individual components of the primary outcome; composite primary outcome at 1 year; as well as ECG and angiographic characteristics. Conclusion: The multicenter NACMI registry will collect data regarding ST elevation on ECG in COVID-19 patients to determine the etiology and associated clinical outcomes. The collaboration and speed with which this registry has been created, refined, and promoted serves as a template for future research endeavors.


Subject(s)
Betacoronavirus , Bundle-Branch Block/epidemiology , Coronavirus Infections/epidemiology , Databases, Factual , Pneumonia, Viral/epidemiology , Registries , ST Elevation Myocardial Infarction/epidemiology , Bundle-Branch Block/etiology , COVID-19 , Cause of Death , Coronavirus Infections/complications , Data Collection/methods , Electrocardiography , Humans , Myocardial Ischemia/epidemiology , Pandemics , Pneumonia, Viral/complications , SARS-CoV-2 , ST Elevation Myocardial Infarction/etiology
18.
Am J Med ; 134(4): 482-489, 2021 04.
Article in English | MEDLINE | ID: covidwho-812408

ABSTRACT

PURPOSE: We evaluated whether the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) pandemic was associated with changes in the pattern of acute cardiovascular admissions across European centers. METHODS: We set-up a multicenter, multinational, pan-European observational registry in 15 centers from 12 countries. All consecutive acute admissions to emergency departments and cardiology departments throughout a 1-month period during the COVID-19 outbreak were compared with an equivalent 1-month period in 2019. The acute admissions to cardiology departments were classified into 5 major categories: acute coronary syndrome, acute heart failure, arrhythmia, pulmonary embolism, and other. RESULTS: Data from 54,331 patients were collected and analyzed. Nine centers provided data on acute admissions to emergency departments comprising 50,384 patients: 20,226 in 2020 compared with 30,158 in 2019 (incidence rate ratio [IRR] with 95% confidence interval [95%CI]: 0.66 [0.58-0.76]). The risk of death at the emergency departments was higher in 2020 compared to 2019 (odds ratio [OR] with 95% CI: 4.1 [3.0-5.8], P < 0.0001). All 15 centers provided data on acute cardiology departments admissions: 3007 patients in 2020 and 4452 in 2019; IRR (95% CI): 0.68 (0.64-0.71). In 2020, there were fewer admissions with IRR (95% CI): acute coronary syndrome: 0.68 (0.63-0.73); acute heart failure: 0.65 (0.58-0.74); arrhythmia: 0.66 (0.60-0.72); and other: 0.68(0.62-0.76). We found a relatively higher percentage of pulmonary embolism admissions in 2020: odds ratio (95% CI): 1.5 (1.1-2.1), P = 0.02. Among patients with acute coronary syndrome, there were fewer admissions with unstable angina: 0.79 (0.66-0.94); non-ST segment elevation myocardial infarction: 0.56 (0.50-0.64); and ST-segment elevation myocardial infarction: 0.78 (0.68-0.89). CONCLUSION: In the European centers during the COVID-19 outbreak, there were fewer acute cardiovascular admissions. Also, fewer patients were admitted to the emergency departments with 4 times higher death risk at the emergency departments.


Subject(s)
COVID-19 , Cardiology Service, Hospital/statistics & numerical data , Critical Pathways/organization & administration , Emergency Service, Hospital/statistics & numerical data , Myocardial Ischemia , Patient Admission , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Europe/epidemiology , Female , Hospitalization/statistics & numerical data , Hospitalization/trends , Humans , Male , Middle Aged , Myocardial Ischemia/epidemiology , Myocardial Ischemia/therapy , Patient Admission/statistics & numerical data , Patient Admission/trends , Registries/statistics & numerical data , SARS-CoV-2
19.
Trends Endocrinol Metab ; 31(12): 918-927, 2020 12.
Article in English | MEDLINE | ID: covidwho-791591

ABSTRACT

The recent coronavirus disease 2019 (COVID-19) pandemic showed a different severity in the disease between males and females. Men have been becoming severely ill at a higher rate than women. These data along with an age-dependent disease susceptibility and mortality in the elderly suggest that sex hormones are the main factors in determining the clinical course of the infection. The differences in aging males versus females and the role of sex hormones in key phenotypes of COVID-19 infection are described in this review. Recommendations based on a dimorphic approach for males and females suggest a sex-specific management the disease.


Subject(s)
Androgens/metabolism , COVID-19/mortality , Estrogens/metabolism , Sex Factors , Age Factors , Androgens/immunology , Angiotensin-Converting Enzyme 2/metabolism , COVID-19/immunology , COVID-19/metabolism , COVID-19/physiopathology , Comorbidity , Diabetes Mellitus, Type 2/epidemiology , Estrogen Replacement Therapy , Estrogens/immunology , Estrogens/therapeutic use , Female , Hormone Replacement Therapy , Humans , Hypertension/epidemiology , Male , Myocardial Ischemia/epidemiology , Obesity/epidemiology , Postmenopause/metabolism , Pulmonary Disease, Chronic Obstructive/epidemiology , Renal Insufficiency/epidemiology , Sex Distribution , Vitamin D Deficiency/epidemiology
20.
Int J Surg ; 80: 157-161, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-644648

ABSTRACT

BACKGROUND: during the COVID-19 pandemic, the number of Acute Care Surgery procedures performed in Spanish hospitals decreased significantly. The aim of this study was to compare Acute Care Surgery activity during the COVID-19 pandemic and during a control period. MATERIAL AND METHODS: a multicenter retrospective cohort study was performed including patients who underwent Acute Care Surgery in three tertiary care hospitals in Spain during a control (11th March 2019 to 21st April 2019) and a pandemic (16th March 2020 to 26th April 2020) period. Type of surgical procedures, patients' features and postoperative complications were compared. RESULTS: two hundred and eighty-five and 117 patients were included in each group. Mean number of patients who underwent Acute Care Surgery during the control and pandemic periods was 2.3 and 0.9 patients per day and hospital (p < 0.001), representing a 58.9% decrease in Acute Care Surgery activity. Time from symptoms onset to patient arrival at the Emergency Department was longer during the pandemic (44.6 vs. 71.0 h, p < 0.001). Surgeries due to acute cholecystitis and complications from previous elective procedures decreased (26.7% vs. 9.4%) during the pandemic, while bowel obstructions and abdominal wall hernia surgeries increased (12.3% vs. 22.2%) (p = 0.001). Morbidity was higher during pandemic period (34.7% vs. 47.1%, p = 0.022), although this difference was not statistically significant in the multivariate analysis. Reoperation rate (17.9% vs. 12.8%, p = 0.212) and mortality (6.7% vs. 4.3%, p = 0.358) were similar in both groups. CONCLUSION: during the COVID-19 pandemic, a significant reduction in the performance of Acute Care Surgery procedures was observed. Moreso, a longer time from symptoms onset to patient arrival at the Emergency Department was noted. Higher morbidity was observed in patients undergoing Acute Care Surgery during the pandemic period, although there was not any difference in mortality or reoperation rate.


Subject(s)
Abscess/surgery , Appendicitis/surgery , Cholecystitis, Acute/surgery , Coronavirus Infections/epidemiology , Intestinal Obstruction/surgery , Mortality , Pneumonia, Viral/epidemiology , Postoperative Complications/epidemiology , Rectal Diseases/surgery , Abdominal Wall , Abscess/epidemiology , Acute Disease , Appendectomy/statistics & numerical data , Appendicitis/epidemiology , Betacoronavirus , COVID-19 , Cholecystitis, Acute/epidemiology , Cohort Studies , Comorbidity , Diabetes Mellitus/epidemiology , Dyslipidemias/epidemiology , Emergencies , Female , Hernia, Abdominal/epidemiology , Hernia, Abdominal/surgery , Herniorrhaphy/statistics & numerical data , Humans , Hypertension/epidemiology , Intestinal Obstruction/epidemiology , Laparoscopy/statistics & numerical data , Logistic Models , Male , Middle Aged , Myocardial Ischemia/epidemiology , Pandemics , Rectal Diseases/epidemiology , Reoperation/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Spain/epidemiology , Time-to-Treatment/statistics & numerical data
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