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1.
Lancet ; 398(10303): 843-855, 2021 09 04.
Article in English | MEDLINE | ID: covidwho-2106189

ABSTRACT

BACKGROUND: A previous efficacy trial found benefit from inhaled budesonide for COVID-19 in patients not admitted to hospital, but effectiveness in high-risk individuals is unknown. We aimed to establish whether inhaled budesonide reduces time to recovery and COVID-19-related hospital admissions or deaths among people at high risk of complications in the community. METHODS: PRINCIPLE is a multicentre, open-label, multi-arm, randomised, controlled, adaptive platform trial done remotely from a central trial site and at primary care centres in the UK. Eligible participants were aged 65 years or older or 50 years or older with comorbidities, and unwell for up to 14 days with suspected COVID-19 but not admitted to hospital. Participants were randomly assigned to usual care, usual care plus inhaled budesonide (800 µg twice daily for 14 days), or usual care plus other interventions, and followed up for 28 days. Participants were aware of group assignment. The coprimary endpoints are time to first self-reported recovery and hospital admission or death related to COVID-19, within 28 days, analysed using Bayesian models. The primary analysis population included all eligible SARS-CoV-2-positive participants randomly assigned to budesonide, usual care, and other interventions, from the start of the platform trial until the budesonide group was closed. This trial is registered at the ISRCTN registry (ISRCTN86534580) and is ongoing. FINDINGS: The trial began enrolment on April 2, 2020, with randomisation to budesonide from Nov 27, 2020, until March 31, 2021, when the prespecified time to recovery superiority criterion was met. 4700 participants were randomly assigned to budesonide (n=1073), usual care alone (n=1988), or other treatments (n=1639). The primary analysis model includes 2530 SARS-CoV-2-positive participants, with 787 in the budesonide group, 1069 in the usual care group, and 974 receiving other treatments. There was a benefit in time to first self-reported recovery of an estimated 2·94 days (95% Bayesian credible interval [BCI] 1·19 to 5·12) in the budesonide group versus the usual care group (11·8 days [95% BCI 10·0 to 14·1] vs 14·7 days [12·3 to 18·0]; hazard ratio 1·21 [95% BCI 1·08 to 1·36]), with a probability of superiority greater than 0·999, meeting the prespecified superiority threshold of 0·99. For the hospital admission or death outcome, the estimated rate was 6·8% (95% BCI 4·1 to 10·2) in the budesonide group versus 8·8% (5·5 to 12·7) in the usual care group (estimated absolute difference 2·0% [95% BCI -0·2 to 4·5]; odds ratio 0·75 [95% BCI 0·55 to 1·03]), with a probability of superiority 0·963, below the prespecified superiority threshold of 0·975. Two participants in the budesonide group and four in the usual care group had serious adverse events (hospital admissions unrelated to COVID-19). INTERPRETATION: Inhaled budesonide improves time to recovery, with a chance of also reducing hospital admissions or deaths (although our results did not meet the superiority threshold), in people with COVID-19 in the community who are at higher risk of complications. FUNDING: National Institute of Health Research and United Kingdom Research Innovation.


Subject(s)
Budesonide/administration & dosage , COVID-19/drug therapy , Glucocorticoids/administration & dosage , Administration, Inhalation , Aged , Bayes Theorem , COVID-19/mortality , Female , Hospitalization , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , SARS-CoV-2 , Treatment Outcome
2.
Lancet ; 396(10250): 535-544, 2020 08 22.
Article in English | MEDLINE | ID: covidwho-2106188

ABSTRACT

BACKGROUND: Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level. METHODS: 35 883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61 075 participants (75·1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximising either specificity (positive for both tests) or sensitivity (positive for either test). FINDINGS: Seroprevalence was 5·0% (95% CI 4·7-5·4) by the point-of-care test and 4·6% (4·3-5·0) by immunoassay, with a specificity-sensitivity range of 3·7% (3·3-4·0; both tests positive) to 6·2% (5·8-6·6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years (<3·1% by the point-of-care test). There was substantial geographical variability, with higher prevalence around Madrid (>10%) and lower in coastal areas (<3%). Seroprevalence among 195 participants with positive PCR more than 14 days before the study visit ranged from 87·6% (81·1-92·1; both tests positive) to 91·8% (86·3-95·3; either test positive). In 7273 individuals with anosmia or at least three symptoms, seroprevalence ranged from 15·3% (13·8-16·8) to 19·3% (17·7-21·0). Around a third of seropositive participants were asymptomatic, ranging from 21·9% (19·1-24·9) to 35·8% (33·1-38·5). Only 19·5% (16·3-23·2) of symptomatic participants who were seropositive by both the point-of-care test and immunoassay reported a previous PCR test. INTERPRETATION: The majority of the Spanish population is seronegative to SARS-CoV-2 infection, even in hotspot areas. Most PCR-confirmed cases have detectable antibodies, but a substantial proportion of people with symptoms compatible with COVID-19 did not have a PCR test and at least a third of infections determined by serology were asymptomatic. These results emphasise the need for maintaining public health measures to avoid a new epidemic wave. FUNDING: Spanish Ministry of Health, Institute of Health Carlos III, and Spanish National Health System.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Antibodies, Viral/blood , Betacoronavirus/immunology , COVID-19 , Child , Child, Preschool , Female , Humans , Immunoassay , Immunoglobulin G/blood , Immunoglobulin M/blood , Infant , Infant, Newborn , Male , Middle Aged , Pandemics , Point-of-Care Testing , Prevalence , Risk Factors , SARS-CoV-2 , Seroepidemiologic Studies , Spain/epidemiology , Young Adult
3.
G Ital Med Lav Ergon ; 44(1): 93, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-2101833

ABSTRACT

SUMMARY: To the editor, during these pandemic years, COVID-19 is taking away focus from other respiratory diseases such as pneumoconiosis, which should not be overlooked. We would like to emphasize the possible role of small airways in subjects with asbestos exposure. In a very interesting study, Yang et al (1) investigated the relation between increased small airway obstruction and asbestos exposure in patients with asbestosis. The authors evaluated lung function in a cohort of 281 patients with newly diagnosed asbestosis during an eight-year period, evidencing that patients with asbestosis have small airway obstructive defects that are significantly associated with asbestos exposure (1). These results are very consistent and in line with our previous study, in which we showed that a population of 655 long-term residents in an environmental asbestos (tremolite)-exposed area had a higher prevalence of smallairways disease compared to a group of 653 individuals living in areas not tremolite-exposed (2). Odds Ratio for small-airways obstruction was 3.46, irrespective of smoking status (2). To date, our knowledge on the role of small airways in pulmonary diseases is still matter of debate. Although small airways have a minor contribution to airway resistance in healthy subjects, it has been shown that small airways are the major site of airflow limitation in diseases such as asthma and Chronic Obstructive Pulmonary Disease (3). Taken these data together, we warmly encourage clinicians and researchers to always consider small airways parameters when performing lung function on asbestosexposed subjects. Moreover, long-term investigations are warranted to explore the decline in airflow over time in patients with either occupational or environmental asbestos exposure and with asbestosis.


Subject(s)
Airway Obstruction , Asbestos , Asbestosis , COVID-19 , Occupational Exposure , Humans , Asbestosis/epidemiology , COVID-19/epidemiology , Asbestos/adverse effects , Airway Obstruction/complications , Risk Factors , Occupational Exposure/adverse effects
4.
Risk Anal ; 42(7): 1571-1584, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-2097864

ABSTRACT

Understanding is still developing about spatial risk factors for COVID-19 infection or mortality. This is a secondary analysis of patient records in a confined area of eastern England, covering persons who tested positive for SARS-CoV-2 through end May 2020, including dates of death and residence area. We obtained residence area data on air quality, deprivation levels, care home bed capacity, age distribution, rurality, access to employment centers, and population density. We considered these covariates as risk factors for excess cases and excess deaths in the 28 days after confirmation of positive Covid status relative to the overall case load and death recorded for the study area as a whole. We used the conditional autoregressive Besag-York-Mollie model to investigate the spatial dependency of cases and deaths allowing for a Poisson error structure. Structural equation models were applied to clarify relationships between predictors and outcomes. Excess case counts or excess deaths were both predicted by the percentage of population age 65 years, care home bed capacity and less rurality: older population and more urban areas saw excess cases. Greater deprivation did not correlate with excess case counts but was significantly linked to higher mortality rates after infection. Neither excess cases nor excess deaths were predicted by population density, travel time to local employment centers, or air quality indicators. Only 66% of mortality was explained by locally high case counts. Higher deprivation clearly linked to higher COVID-19 mortality separate from wider community prevalence and other spatial risk factors.


Subject(s)
Air Pollution , COVID-19 , Aged , Air Pollution/adverse effects , England/epidemiology , Humans , Mortality , Risk Factors , SARS-CoV-2
5.
Stud Health Technol Inform ; 299: 63-74, 2022 Nov 03.
Article in English | MEDLINE | ID: covidwho-2099072

ABSTRACT

INTRODUCTION: COVID-19 has affected people in several countries around the world. They experience respiratory symptoms that can be mild, moderate, or severe. Several reviews that characterize the risk factors of COVID-19 have been performed, but most address only risk factors associated with medical conditions, ignoring environmental and sociodemographic-socioeconomic factors. OBJECTIVE: This study aims at characterizing different risk factors in the published literature that influence contagion by COVID-19. METHODS: The review consists of three stages, including a systematic mapping with studies found in the Scopus database, an analysis of results, and finally the identification of relevant COVID-19 risk factors. RESULTS: A map of studies id provided considering two main groups: the type of research and context. Most studies consider risk factors associated with medical conditions, while research on other factors is scarce. CONCLUSIONS: Medical conditions such as diabetes, obesity, cardiovascular disease, hypertension, and factors such as age and sex, appear to be the ones that increase the risk of contracting COVID-19. Further research is needed on environmental, sociodemographic, and socioeconomic risk factors.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Risk Factors
6.
Respir Res ; 23(1): 297, 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2098346

ABSTRACT

BACKGROUND: Routine follow-up of patients hospitalised with COVID-19 is recommended, however due to the ongoing high number of infections this is not without significant health resource and economic burden. In a previous study we investigated the prevalence of, and risk factors for, persistent chest radiograph (CXR) abnormalities post-hospitalisation with COVID-19 and identified a 5-point composite score that strongly predicted risk of persistent CXR abnormality at 12-weeks. Here we sought to validate and refine our findings in an independent cohort of patients. METHODOLOGY: A single-centre prospective study of consecutive patients attending a virtual post-hospitalisation COVID-19 clinic and CXR as part of their standard clinical care between 2nd March - 22nd June 2021. Inpatient and follow-up CXRs were scored by the assessing clinician for extent of pulmonary infiltrates (0-4 in each lung) with complete resolution defined as a follow-up score of zero. RESULTS: 182 consecutive patients were identified of which 31% had persistent CXR abnormality at 12-weeks. Patients with persistent CXR abnormality were significantly older (p < 0.001), had a longer hospital length of stay (p = 0.005), and had a higher incidence of both level 2 or 3 facility admission (level 2/3 care) (p = 0.003) and ever-smoking history (p = 0.038). Testing our composite score in the present cohort we found it predicted persistent CXR abnormality with reasonable accuracy (area under the receiver operator curve [AUROC 0.64]). Refining this score replacing obesity with Age ≥ 50 years, we identify the SHADE-750 score (1-point each for; Smoking history, Higher-level care (level 2/3 admission), Age ≥ 50 years, Duration of admission ≥ 15 days and Enzyme-lactate dehydrogenase (LDH ≥ 750U/L), that accurately predicted risk of persistent CXR abnormality, both in the present cohort (AUROC 0.73) and when retrospectively applied to our 1st cohort (AUROC 0.79). Applied to both cohorts combined (n = 213) it again performed strongly (AUROC 0.75) with all patients with a score of zero (n = 18) having complete CXR resolution at 12-weeks. CONCLUSIONS: In two independent cohorts of patients hospitalised with COVID-19, we identify a 5-point score which accurately predicts patients at risk of persistent CXR abnormality at 12-weeks. This tool could be used by clinicians to identify patients in which radiological follow-up may not be required.


Subject(s)
COVID-19 , Humans , Middle Aged , SARS-CoV-2 , Retrospective Studies , Prospective Studies , Radiography, Thoracic , Hospitalization , L-Lactate Dehydrogenase , Risk Factors , Polymerase Chain Reaction
7.
Eur Respir Rev ; 31(166)2022 Dec 31.
Article in English | MEDLINE | ID: covidwho-2098297

ABSTRACT

Persistent breathlessness >28 days after acute COVID-19 infection has been identified as a highly debilitating post-COVID symptom. However, the prevalence, risk factors, mechanisms and treatments for post-COVID breathlessness remain poorly understood. We systematically searched PubMed and Embase for relevant studies published from 1 January 2020 to 1 November 2021 (PROSPERO registration number: CRD42021285733) and included 119 eligible papers. Random-effects meta-analysis of 42 872 patients with COVID-19 reported in 102 papers found an overall prevalence of post-COVID breathlessness of 26% (95% CI 23-29) when measuring the presence/absence of the symptom, and 41% (95% CI 34-48) when using Medical Research Council (MRC)/modified MRC dyspnoea scale. The pooled prevalence decreased significantly from 1-6 months to 7-12 months post-infection. Post-COVID breathlessness was more common in those with severe/critical acute infection, those who were hospitalised and females, and was less likely to be reported by patients in Asia than those in Europe or North America. Multiple pathophysiological mechanisms have been proposed (including deconditioning, restrictive/obstructive airflow limitation, systemic inflammation, impaired mental health), but the body of evidence remains inconclusive. Seven cohort studies and one randomised controlled trial suggested rehabilitation exercises may reduce post-COVID breathlessness. There is an urgent need for mechanistic research and development of interventions for the prevention and treatment of post-COVID breathlessness.


Subject(s)
COVID-19 , Female , Humans , Prevalence , Dyspnea/diagnosis , Dyspnea/epidemiology , Dyspnea/therapy , Risk Factors , Exercise Therapy
8.
Infect Control Hosp Epidemiol ; 42(4): 392-398, 2021 04.
Article in English | MEDLINE | ID: covidwho-2096426

ABSTRACT

OBJECTIVE: The seroprevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) IgG antibody was evaluated among employees of a Veterans Affairs healthcare system to assess potential risk factors for transmission and infection. METHODS: All employees were invited to participate in a questionnaire and serological survey to detect antibodies to SARS-CoV-2 as part of a facility-wide quality improvement and infection prevention initiative regardless of clinical or nonclinical duties. The initiative was conducted from June 8 to July 8, 2020. RESULTS: Of the 2,900 employees, 51% participated in the study, revealing a positive SARS-CoV-2 seroprevalence of 4.9% (72 of 1,476; 95% CI, 3.8%-6.1%). There were no statistically significant differences in the presence of antibody based on gender, age, frontline worker status, job title, performance of aerosol-generating procedures, or exposure to known patients with coronavirus infectious disease 2019 (COVID-19) within the hospital. Employees who reported exposure to a known COVID-19 case outside work had a significantly higher seroprevalence at 14.8% (23 of 155) compared to those who did not 3.7% (48 of 1,296; OR, 4.53; 95% CI, 2.67-7.68; P < .0001). Notably, 29% of seropositive employees reported no history of symptoms for SARS-CoV-2 infection. CONCLUSIONS: The seroprevalence of SARS-CoV-2 among employees was not significantly different among those who provided direct patient care and those who did not, suggesting that facility-wide infection control measures were effective. Employees who reported direct personal contact with COVID-19-positive persons outside work were more likely to have SARS-CoV-2 antibodies. Employee exposure to SARS-CoV-2 outside work may introduce infection into hospitals.


Subject(s)
COVID-19/epidemiology , Health Personnel/statistics & numerical data , SARS-CoV-2 , Seroepidemiologic Studies , United States Department of Veterans Affairs/statistics & numerical data , Adolescent , Adult , COVID-19/etiology , Female , Humans , Male , Michigan/epidemiology , Middle Aged , Occupational Exposure/statistics & numerical data , Risk Factors , United States/epidemiology , Young Adult
9.
Infect Control Hosp Epidemiol ; 41(9): 1011-1015, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-2096316

ABSTRACT

OBJECTIVE: To determine whether ambient air pollutants and meteorological variables are associated with daily COVID-19 incidence. DESIGN: A retrospective cohort from January 25 to February 29, 2020. SETTING: Cities of Wuhan, Xiaogan, and Huanggang, China. PATIENTS: The COVID-19 cases detected each day. METHODS: We collected daily data of COVID-19 incidence, 8 ambient air pollutants (particulate matter of ≤2.5 µm [PM2.5], particulate matter ≤10 µm [PM10], sulfur dioxide [SO2], carbon monoxide [CO], nitrogen dioxide [NO2], and maximum 8-h moving average concentrations for ozone [O3-8h]) and 3 meteorological variables (temperature, relative humidity, and wind) in China's 3 worst COVID-19-stricken cities during the study period. The multivariate Poisson regression was performed to understand their correlation. RESULTS: Daily COVID-19 incidence was positively associated with PM2.5 and humidity in all cities. Specifically, the relative risk (RR) of PM2.5 for daily COVID-19 incidences were 1.036 (95% confidence interval [CI], 1.032-1.039) in Wuhan, 1.059 (95% CI, 1.046-1.072) in Xiaogan, and 1.144 (95% CI, 1.12-1.169) in Huanggang. The RR of humidity for daily COVID-19 incidence was consistently lower than that of PM2.5, and this difference ranged from 0.027 to 0.111. Moreover, PM10 and temperature also exhibited a notable correlation with daily COVID-19 incidence, but in a negative pattern The RR of PM10 for daily COVID-19 incidence ranged from 0.915 (95% CI, 0.896-0.934) to 0.961 (95% CI, 0.95-0.972, while that of temperature ranged from 0.738 (95% CI, 0.717-0.759) to 0.969 (95% CI, 0.966-0.973). CONCLUSIONS: Our data show that PM2.5 and humidity are substantially associated with an increased risk of COVID-19 and that PM10 and temperature are substantially associated with a decreased risk of COVID-19.


Subject(s)
Air Pollutants/toxicity , Air Pollution/adverse effects , Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Weather , Air Pollutants/analysis , Air Pollution/analysis , Air Pollution/statistics & numerical data , COVID-19 , China/epidemiology , Coronavirus Infections/etiology , Humans , Incidence , Pandemics , Pneumonia, Viral/etiology , Poisson Distribution , Retrospective Studies , Risk Factors , SARS-CoV-2
14.
Croat Med J ; 63(5): 448-452, 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2092960

ABSTRACT

AIM: To assess the differences in clinical and laboratory parameters of non-hospitalized patients with deep venous thrombosis (DVT) according to the SARS-CoV-2 status. METHODS: We retrospectively reviewed demographic, clinical, laboratory, and ultrasound data of adult patients admitted to the Emergency Department of University Hospital Split between March 2020 and January 2021. Patients were classified into three groups: recent COVID-19 (<1 month), non-recent COVID-19 (1 to 12 months), and non-COVID-19. RESULTS: Fifty (47.2%) of 106 patients had a history of SARS-CoV-2 infection (23 patients in the recent COVID-19 and 27 in non-recent COVID-19 group). The three groups did not significantly differ in demographic and clinical parameters, including the location of deep venous thrombosis. The recent COVID-19 group had significantly higher neutrophils and CRP levels, and significantly lower prothrombin than the other two groups. CONCLUSION: Our results confirm the role of elevated inflammatory and coagulation response in DVT development in the first month after the infection, but not in non-recent COVID-19 or non-COVID-19 patients.


Subject(s)
COVID-19 , Venous Thrombosis , Adult , Humans , COVID-19/complications , Retrospective Studies , SARS-CoV-2 , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/etiology , Risk Factors
16.
J Med Internet Res ; 24(10): e35860, 2022 10 21.
Article in English | MEDLINE | ID: covidwho-2089625

ABSTRACT

BACKGROUND: COVID-19 has been observed to be associated with venous and arterial thrombosis. The inflammatory disease prolongs hospitalization, and preexisting comorbidities can intensity the thrombotic burden in patients with COVID-19. However, venous thromboembolism, arterial thrombosis, and other vascular complications may go unnoticed in critical care settings. Early risk stratification is paramount in the COVID-19 patient population for proactive monitoring of thrombotic complications. OBJECTIVE: The aim of this exploratory research was to characterize thrombotic complication risk factors associated with COVID-19 using information from electronic health record (EHR) and insurance claims databases. The goal is to develop an approach for analysis using real-world data evidence that can be generalized to characterize thrombotic complications and additional conditions in other clinical settings as well, such as pneumonia or acute respiratory distress syndrome in COVID-19 patients or in the intensive care unit. METHODS: We extracted deidentified patient data from the insurance claims database IBM MarketScan, and formulated hypotheses on thrombotic complications in patients with COVID-19 with respect to patient demographic and clinical factors using logistic regression. The hypotheses were then verified with analysis of deidentified patient data from the Research Patient Data Registry (RPDR) Mass General Brigham (MGB) patient EHR database. Data were analyzed according to odds ratios, 95% CIs, and P values. RESULTS: The analysis identified significant predictors (P<.001) for thrombotic complications in 184,831 COVID-19 patients out of the millions of records from IBM MarketScan and the MGB RPDR. With respect to age groups, patients 60 years and older had higher odds (4.866 in MarketScan and 6.357 in RPDR) to have thrombotic complications than those under 60 years old. In terms of gender, men were more likely (odds ratio of 1.245 in MarketScan and 1.693 in RPDR) to have thrombotic complications than women. Among the preexisting comorbidities, patients with heart disease, cerebrovascular diseases, hypertension, and personal history of thrombosis all had significantly higher odds of developing a thrombotic complication. Cancer and obesity were also associated with odds>1. The results from RPDR validated the IBM MarketScan findings, as they were largely consistent and afford mutual enrichment. CONCLUSIONS: The analysis approach adopted in this study can work across heterogeneous databases from diverse organizations and thus facilitates collaboration. Searching through millions of patient records, the analysis helped to identify factors influencing a phenotype. Use of thrombotic complications in COVID-19 patients represents only a case study; however, the same design can be used across other disease areas by extracting corresponding disease-specific patient data from available databases.


Subject(s)
COVID-19 , Thrombosis , Humans , Female , COVID-19/complications , COVID-19/epidemiology , Thrombosis/epidemiology , Thrombosis/etiology , Risk Factors , Retrospective Studies , Odds Ratio
17.
Emerg Microbes Infect ; 11(1): 2762-2780, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2087657

ABSTRACT

This systematic review examined pre-existing and clinical risk factors for post Covid-19 condition (≥12 weeks after onset), and interventions during acute and post-acute phases of illness that could potentially prevent post Covid-19 condition. The review focuses on studies collecting data during the early phases of the pandemic and prior to the emergence of variants of concern and widespread vaccination. We searched bibliographic databases and grey literature. Two investigators independently reviewed abstracts and full-text articles, and data extraction and risk of bias assessments were verified. Meta-analysis was performed when suitable and we assessed the certainty of evidence using GRADE. We included 31 studies. We found small-to-moderate associations (e.g. adjusted odds ratios 1.5 to <2.0) between female sex and higher non-recovery, fatigue, and dyspnea (moderate certainty). Severe or critical acute-phase Covid-19 severity (versus not) has probably (moderate certainty) a large association (adjusted ratio ≥2.0) with increased cognitive impairment, a small-to-moderate association with more non-recovery, and a little-to-no association with dyspnea. There may be (low certainty) large associations between hospitalization and increased non-recovery, increased dyspnea, and reduced return to work. Other outcomes had low certainty of small-to-moderate or little-to-no association or very low certainty. Several potential preventive interventions were examined, but effects are very uncertain. Guidelines in relation to surveillance, screening, and other services such as access to sickness and disability benefits, might need to focus on females and those with previously severe Covid-19 illness. Continuous assessment of emerging evidence, especially on whether different variants and vaccination impact outcomes, will be important. PROSPERO registration: CRD42021270354.


Subject(s)
COVID-19 , Female , Humans , COVID-19/prevention & control , Pandemics/prevention & control , Vaccination , Risk Factors , Dyspnea
19.
JAMA ; 327(13): 1282-1283, 2022 04 05.
Article in English | MEDLINE | ID: covidwho-2084328

Subject(s)
Bias , Risk Factors
20.
Gac Med Mex ; 158(4): 190-195, 2022.
Article in English | MEDLINE | ID: covidwho-2081414

ABSTRACT

INTRODUCTION: Chronic diseases are associated with a higher risk of mortality from COVID-19. OBJECTIVE: To compare the efficacy of the Mechanistic Score and COVID-19 Mortality Risk scales for assessing the risk of mortality in patients hospitalized for COVID-19. METHODS: Comparative, observational, retrospective study. The mortality rate of COVID-19-positive patients was assessed by comparing both scales, according to information obtained from the records of patients hospitalized for COVID-19 in a specialty hospital. RESULTS: Two-hundred and twenty-one patients were evaluated, out of whom 61% were men and 39% were women; 89% had comorbidity: obesity (88%), hypertension (40%), diabetes mellitus (31%) and cancer (6%). At discharge, 65% survived. The COVID-19 Mortality Risk scale showed a sensitivity of 79% and specificity of 88% for predicting mortality risk. In patients with low risk, the Mechanistic Score showed a sensitivity and specificity of 24 and 97%, respectively; in cases with mild risk, 44 and 97%; with moderate risk, 57 and 77%; with high risk, 95 and 91%; and with remarkably high risk, 100 and 100%. CONCLUSION: The COVID-19 Mortality Risk scale has higher efficacy than the Mechanistic Score for assessing mortality risk in patients with COVID-19.


INTRODUCCIÓN: Las enfermedades crónicas se asocian a riesgo mayor de mortalidad por COVID-19. OBJETIVO: Comparar la eficacia de las escalas Mechanistic Score y COVID-19 Mortality Risk para evaluar el riesgo de mortalidad en pacientes hospitalizados por COVID-19. MÉTODOS: Estudio comparativo, observacional, retrospectivo. Se valoró la tasa de mortalidad de los pacientes positivos a COVID-19, mediante la comparación de las dos escalas, de acuerdo con información de los expedientes de pacientes hospitalizados por COVID-19 en un hospital de especialidades. RESULTADOS: Se evaluaron 221 pacientes, 61 % hombres y 39 % mujeres; 89 % presentó alguna comorbilidad: obesidad (88 %), hipertensión (40 %), diabetes mellitus (31 %) y cáncer (6 %). Al egreso, 65 % sobrevivió. La escala COVID-19 Mortality Risk presentó sensibilidad de 79 % y especificidad de 88 % para predecir riesgo de mortalidad. Respecto al riesgo bajo, Mechanistic Score presentó sensibilidad y especificidad de 24 y 97 %, respectivamente; 44 y 97 % respecto al riesgo leve, 57 y 77 % en el riesgo moderado, 95 y 91 % en el riesgo alto y 100 y 100 % en el riesgo muy alto. CONCLUSIÓN: La escala COVID-19 Mortality Risk presenta eficacia mayor que Mechanistic Score para evaluar el riesgo de mortalidad en pacientes con COVID-19.


Subject(s)
COVID-19 , Male , Humans , Female , SARS-CoV-2 , Retrospective Studies , Hospitalization , Comorbidity , Risk Factors
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