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BackgroundPre-pandemic psychiatric disorders have been associated with an increased risk of COVID-19. However, the underlying mechanisms remain unknown, e.g. to what extent genetic predisposition to psychiatric disorders contributes to the observed association. MethodsThe analytic sample consisted of white British participants of UK Biobank registered in England, with available genetic data, and alive on Jan 31, 2020 (i.e., the start of the COVID-19 outbreak in the UK) (n=346,554). We assessed individuals genetic predisposition to different psychiatric disorders, including substance misuse, depression, anxiety, and psychotic disorder, using polygenic risk score (PRS). Diagnoses of psychiatric disorders were identified through the UK Biobank hospital inpatient data. We performed a GWAS analysis for each psychiatric disorder in a randomly selected half of the study population who were free of COVID-19 (i.e., the base dataset). For the other half (i.e., the target dataset), PRS was calculated for each psychiatric disorder using the discovered genetic variants from the base dataset. We then examined the association between PRS of each psychiatric disorder and risk of COVID-19, or severe COVID-19 (i.e., hospitalization and death), using logistic regression models. The ascertainment of COVID-19 was through the Public Health England dataset, the UK Biobank hospital inpatient data and death registers, updated until July 26, 2020. For validation, we repeated the PRS analyses based on publicly available GWAS summary statistics. Results155,988 participants (including 1,451 COVID-19 cases), with a mean age of 68.50 years at COVID-19 outbreak, were included for PRS analysis. Higher genetic liability forwards psychiatric disorders was associated with increased risk of both any COVID-19 and severe COVID-19, especially genetic risk for substance misuse and depression. The adjusted odds ratios (ORs) for any COVID-19 were 1.15 (95% confidence interval [CI] 1.02-1.31) and 1.26 (1.11-1.42) among individuals with a high genetic risk (above the upper tertile of PRS) for substance misuse and depression, respectively, compared with individuals with a low genetic risk (below the lower tertile). Largely similar ORs were noted for severe COVID-19 and similar albeit slightly lower estimates using PRSs generated from GWAS summary statistics from independent samples. ConclusionIn the UK Biobank, genetic predisposition to psychiatric disorders was associated with an increased risk of COVID-19, including severe course of the disease. These findings suggest the potential role of genetic factors in the observed phenotypic association between psychiatric disorders and COVID-19, underscoring the need of increased medical surveillance of for this vulnerable population during the pandemic.
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ObjectiveTo determine the association between pre-pandemic psychiatric disorders and the risk of COVID-19. DesignCommunity-based prospective cohort study. SettingUK Biobank population. Participants421,048 participants who were recruited in England and alive by January 31st 2020, i.e., the start of COVID-19 outbreak in the UK. 50,815 individuals with psychiatric disorders recorded in the UK Biobank inpatient hospital data before the outbreak were included in the exposed group, while 370,233 participants without such conditions were in the unexposed group. MeasurementsWe obtained information on positive results of COVID-19 test as registered in the Public Health England, COVID-19 related hospitalizations in the UK Biobank inpatient hospital data, and COIVD-19 related deaths from the death registers. We also identified individuals who was hospitalized for infections other than COVID-19 during the follow-up. Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs), controlling for multiple confounders. ResultsThe mean age at outbreak was 67.8 years and around 43% of the study participants were male. We observed an elevated risk of COVID-19 among individuals with pre-pandemic psychiatric disorder, compared with those without such diagnoses. The fully adjusted ORs were 1.44 (95%CI 1.27 to 1.64), 1.67 (1.42 to 1.98), and 2.03 (1.56 to 2.63) for any COVID-19, inpatient COVID-19, COVID-19 related death, respectively. The excess risk was observed across all levels of somatic comorbidities and subtypes of pre-pandemic psychiatric disorders, while further increased with greater number of pre-pandemic psychiatric disorders. We also observed an association between pre-pandemic psychiatric disorders and increased risk of hospitalization for other infections (1.85 [1.65 to 2.07]). ConclusionsPre-pandemic psychiatric disorders are associated with increased risk of COVID-19, especially severe and fatal COVID-19. The similar association observed for hospitalization for other infections suggests a shared pathway between psychiatric disorders and different infections, including altered immune responses. Summary boxO_ST_ABSWhat is already known on this topic?C_ST_ABSPsychiatric morbidities have been associated with risks of severe infections through compromised immunity and/or health-behaviors. While recent studies showed that unhealthy lifestyle and psychosocial factors (including self-reported psychological distress) increased the risk of COVID-19 hospitalization, data on the role of clinically confirmed psychiatric disorders in COVID-19 susceptibility are to date absent. What this study adds?Using the large community-based data in UK Biobank, our analysis is the first to demonstrate an increase in the risk of COVID-19, especially severe and fatal COVID-19, among individuals with pre-pandemic psychiatric disorders, independently of many important confounders. A similar association was also observed between pre-pandemic psychiatric disorder and hospitalization due to other infections during the COVID-19 outbreak, suggesting a shared pathway between psychiatric disorders and different infections, including altered immune responses. This finding underscores the need of surveillance and care in vulnerable populations with history of psychiatric disorders during the COVID-19 outbreak.
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Objective To assess the value of 64-slice computer tomography used in the preoperative evaluation of rectal cancer to predict the operative procedures. Methods There were 51 pathologically proven rectal cancer patients recruited, undergoing multi-slice computer tomagraphy (MSCT) assessment preoperatively. Preoperative MSCT stage and predictive operative procedures were recorded to compare with postoperative pathological stage and practical operative procedures. Kappa Coefficient for Diagnosis Coherence and Spearman correlation analysis were performed. Results The overall accuracy of CT-TNM stages were 74.5% which led to high coherence to pathological TNM stage ( Kappa value = 0.658,P=0.000). The univariate analysis showed that distance from tumor to dentate line (F = 3.386, P =0.042 ) and tumor thickness (F = 4.542, P = 0.016) was a statistically risk factor for operative procedures. Moreover, the significant correlation between tumor thickness (cc =0.319, P =0.023 ), as well as CT-M stage (cc = 0.369, P = 0.008) and CT-TNM stage ( cc = 0.365, P = 0. 008), and operative procedures was observed, by means of conducting Spearman correlation. The possibility of developing palliative stoma was 75%, when sufficing both CT-MI stage and tumor thickness ≥20 mm; The possibility of performing sphincter sparing radical operation reached 86% when both CT-T stage < 4 and distance from tumor to dentate line were referred by MSCT. Conclusion The objective parameters influencing development of operative procedures, involving tumor thickness, CT-M stage and CT-T stage, can be rendered by MSCT preoperative assessment, which served as valuable reference for clinical decision of operative procedures in retal cancer.