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Xie Y, Li Y, Su Z, Han X, Liu Z, Huang Z, Cheng A, Zhou X, Li J, Qin R, Wei X, Liu Y, Xia X, Song Q, Zhao L, Chung KF, Xiao D, Wang C. Estimating the association between cigarette and e-cigarette use patterns and SARS-CoV-2 negative conversion time: retrospective online survey in China. BMC Infect Dis 2025; 25:161. [PMID: 39901130 PMCID: PMC11792595 DOI: 10.1186/s12879-025-10545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 01/23/2025] [Indexed: 02/05/2025] Open
Abstract
BACKGROUND Cigarette smoking has been reported to be associated with SARS-CoV-2 negative conversion, while little is known about the effect of its dual use with e-cigarettes. This study aimed to investigate whether tobacco product use patterns including e-cigarette use were linked with delayed negative conversion of SARS-CoV-2. METHODS An online national survey was conducted from January 28 through February 21, 2023, targeting a community-based population in mainland of China after peak waves of the coronavirus disease 2019 (COVID-19). Participants were followed from the onset of COVID-19 symptoms until the negative conversion day or the day of answering the questionnaire as the endpoint of the study. Multi-variable adjusted Cox proportional hazard models were used to compare the negative conversion time of SARS-CoV-2 across different cigarette and e-cigarette use patterns. RESULTS A total of 66,537 participants infected with COVID-19 were enrolled and 13,294 were included in the analyses. During the median duration of 7 days (interquartile range 5 to 10 days), a total of 11,587 (87.2%) had a negative conversion. Compared with never users, current exclusive smokers (multi-variable adjusted HR 0.59, 95% CI 0.48-0.71), current dual users (HR 0.31, 95% CI 0.22-0.44), and previous smokers (HR 0.56, 95% CI 0.37-0.83) took longer to turn negative after 10 days of follow-up. CONCLUSIONS Both current exclusive cigarette use and dual use of cigarettes and e-cigarettes were associated with the delayed negative conversion of SARS-CoV-2, which strengthens the importance of smoking and vaping cessation messaging and community-based tobacco control strategies during pandemics like COVID-19 next time.
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Affiliation(s)
- Ying Xie
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Yinghua Li
- China Health Education Center, Beijing, China
| | - Zheng Su
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Xueyan Han
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhao Liu
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Zhenxiao Huang
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Anqi Cheng
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Xinmei Zhou
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Jinxuan Li
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Rui Qin
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Xiaowen Wei
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Yi Liu
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin Xia
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qingqing Song
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Liang Zhao
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London and Royal Brompton and Harefield NHS Trust, London, UK
| | - Dan Xiao
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China.
| | - Chen Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China.
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Vlaming-van Eijk LE, Ertugrul IA, Upasani V, Wold KI, Vincenti-Gonzalez MF, Veloo ACM, Bourgonje AR, Pantano D, Gard L, de Boer G, Niesters HGM, Friedrich AW, Knoester M, van der Gun BTF, Rodenhuis-Zybert IA, Tami A. Temporal Dynamics and (Para)Clinical Factors Associated With (Long) Viral RNA Shedding in COVID-19 Nonhospitalized Individuals - The COVID-HOME Study. J Med Virol 2024; 96:e70125. [PMID: 39690930 DOI: 10.1002/jmv.70125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 11/28/2024] [Accepted: 12/03/2024] [Indexed: 12/19/2024]
Abstract
Understanding temporal patterns and determinants of RNA shedding is important to comprehend SARS-CoV-2 transmission and improve biosafety/isolation guidelines. Nonhospitalized SARS-CoV-2-infected individuals and household members were enrolled between March 2020 and June 2021 and followed prospectively ≥ 3 weeks during acute disease and at 3-, 6-, 12-, and 18-months to obtain (para)clinical data and biospecimens. Flow cytometry-based surrogate assay (FlowSA) detected viable SARS-CoV-2. Determinants of long RNA shedding ( ≥ 21 days) were investigated. RNA shedding median duration was 14 days (IQR 8.0-21.0) for nasopharyngeal/throat (NPT) and 7 days (IQR 1.0-27.0) for feces- but 20 days (IQR 7.0-27.8) when excluding individuals positive at a single timepoint (25.2%). Among 17 NPT long shedders with FlowSA results, 12 (70.6%) demonstrated viable virus. NPT long shedding was independently positively associated with endocrine disease and chills. Fecal long shedding was independently inversely associated with age, female sex, and fatigue, but positively with vomiting. No associations with long-term COVID-19-related complaints were observed. Finally, fecal long shedders demonstrated higher anti-spike(S1) IgG levels over 18-month follow-up than non-long shedders (p = 0.006). (Long) SARS-CoV-2 RNA shedding in NPT and feces associates with age and acute-but not prolonged-symptoms. The roles of prolonged infectious shedding and fecal shedding in transmission and immunity remain unclear.
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Affiliation(s)
- Larissa E Vlaming-van Eijk
- Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Imran A Ertugrul
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Vinit Upasani
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin I Wold
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - María F Vincenti-Gonzalez
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alida C M Veloo
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arno R Bourgonje
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Medicine, The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Daniele Pantano
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- University Hospital Münster, Münster, Germany
| | - Lilli Gard
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerolf de Boer
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hubert G M Niesters
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alexander W Friedrich
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- University Hospital Münster, Münster, Germany
| | - Marjolein Knoester
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bernardina T F van der Gun
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Izabela A Rodenhuis-Zybert
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adriana Tami
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Zhang ML, Wei XY, Su N, Jiang JH, Xu GP, Zeng DX. Efficacy of azvudine plus dexamethasone in severe hospitalized patients with Omicron infection: a prospective multicenter study. Front Cell Infect Microbiol 2024; 14:1390098. [PMID: 39650837 PMCID: PMC11621066 DOI: 10.3389/fcimb.2024.1390098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 10/31/2024] [Indexed: 12/11/2024] Open
Abstract
Background Azvudine (AZV), the first Chinese oral anti-coronavirus disease 2019 (COVID-19) drug, has shown substantial clinical benefits to viral clearance and prognosis in patients with mild and common COVID-19. However, there is no evidence in severe hospitalized COVID-19 patients. Methods In this multicenter study, we analyzed 209 severe hospitalized COVID-19 patients in four hospitals. All the clinical data and the 28-day composite outcomes were recorded. All of the patients were categorized into two groups according to drug: the dexamethasone (DXM) group and the azvudine plus dexamethasone (AZV+DXM) group. Results There were no differences in sex, age, BMI, and underlying diseases between the two groups. The ratio of the 28-day composite outcome was lower for the AZV+DXM group than that for the DXM group (16.97% vs. 31.82%, p = 0.029). The viral clearance time was shorter in the AZV+DXM group than in the DXM group (7.32 ± 2.57 vs. 8.55 ± 2.34 days, p = 0.017). The PaO2/FiO2 levels on day 5 (258.89 ± 55.22 vs. 233.12 ± 60.51, p = 0.026) and day 10 (289.48 ± 44.09 vs. 261.52 ± 37.34, p = 0.015) were higher in the AZV+DXM group than the DXM group. However, data on the hospitalization duration of the two groups were similar. Cox analysis showed the benefit of AZV+DXM in the subgroups of ≥65 years old, multiple organ dysfunction syndrome (MODS), cerebrovascular disease, C-reactive protein (CRP) ≥70mg/L, and D-dimer ≥1 µg/L. Conclusion This study is the first to indicate that treatment with AZV+DXM might benefit severe Omicron-infected patients compared with DXM treatment alone. This finding demonstrates, at least partly, the necessity of antiviral treatment in severe patients.
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Affiliation(s)
- Meng-Lan Zhang
- Department of Pulmonary and Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University, Suzhou Dushu Lake Hospital, Suzhou, China
- Department of Pulmonary and Critical Care Medicine, Medical Center of Soochow University, Suzhou, China
| | - Xiao-Ying Wei
- Department of Pulmonary and Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University, Suzhou Dushu Lake Hospital, Suzhou, China
- Department of Pulmonary and Critical Care Medicine, Medical Center of Soochow University, Suzhou, China
| | - Nan Su
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jung-Hong Jiang
- Department of Pulmonary and Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University, Suzhou Dushu Lake Hospital, Suzhou, China
- Department of Pulmonary and Critical Care Medicine, Medical Center of Soochow University, Suzhou, China
| | - Guo-Peng Xu
- Department of Pulmonary and Critical Care, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
- Gusu School, Nanjing Medical University, Suzhou, China
| | - Da-Xiong Zeng
- Department of Pulmonary and Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University, Suzhou Dushu Lake Hospital, Suzhou, China
- Department of Pulmonary and Critical Care Medicine, Medical Center of Soochow University, Suzhou, China
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Wang Y, Ma X, Wei X, Zhang M, Su N, Jiang J, Xu G, Wang R, Zeng D. Early Versus Delayed Usage of Paxlovid in Severe Omicron-Infected Patients With Hypoxemia: A Prospective Multiple-Center Cohort Study. Health Sci Rep 2024; 7:e70177. [PMID: 39534861 PMCID: PMC11554588 DOI: 10.1002/hsr2.70177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 10/03/2024] [Accepted: 10/17/2024] [Indexed: 11/16/2024] Open
Abstract
Background and Aims Early stage administration of Paxlovid has been shown to improve the prognosis of mild to moderate COVID-19 patients with high risk. However, few evidence was validated in severe COVID-19 patients with hypoxemia. It is also unclear whether delayed usage of Paxlovid affected prognosis in COVID-19 patients or not. Methods In this multiple-centers prospective study, we collected the clinical data in hospitalized severe adult Omicron infection patients with hypoxemia. All patients were divided into two groups according to the time of Paxlovid usage after the symptom onset: early group (Paxlovid administration in 5 days after symptom onset) and delayed group (Paxlovid administration beyond 5 days after symptom onset). The 28-day composite outcomes were evaluated. Results Totally 198 hospitalized severe omicron-infected subjects with hypoxemia were enrolled. There was no difference between the two groups about the baseline characteristics and laboratory parameters, except for leukocytes (5.29 × 109 vs. 7.90 × 109/L, p = 0.01) and albumin levels (35 vs. 31 g/L, p = 0.04). The 28-day composite outcomes in early group were slightly lower than that in delayed group but with no difference (12.8% vs. 16.67%, p = 0.602). The viral clearance ratio at Day 7 after Paxlovid treatment in early group was higher than that in delayed group (79.48% vs. 58.33%, p = 0.029). The medium hospitalized duration in early group was shorter than that in delayed group (11.31 vs. 15.32 days, p = 0.005). Logistic analysis showed the independent risk factors of prognosis including underlying diseases ≥ 3 kinds (ORR = 1.72), d-dimer ≥ 2.0 μg/mL (ORR = 1.35), and MODS (ORR = 14.01). Conclusions In Omicron-infected subjects with hypoxemia, early usage of Paxlovid received benefits in hospitalized time and viral clearance, but delayed usage did not result in a worse composite prognosis. This result might provide direct evidence of antiviral strategy in severe Omicron infection subjects with hypoxemia.
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Affiliation(s)
- Yu‐Ji Wang
- Department of Pulmonary and Critical Care MedicineThe Fourth Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
- Medical Center of Soochow UniversitySuzhouPeople's Republic of China
| | - Xi‐Yan Ma
- Department of Pulmonary and Critical Care MedicineThe Fourth Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
- Medical Center of Soochow UniversitySuzhouPeople's Republic of China
| | - Xiao‐Ying Wei
- Department of Pulmonary and Critical Care MedicineThe Fourth Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
- Medical Center of Soochow UniversitySuzhouPeople's Republic of China
| | - Meng‐Lan Zhang
- Department of Pulmonary and Critical Care MedicineThe Fourth Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
- Medical Center of Soochow UniversitySuzhouPeople's Republic of China
| | - Nan Su
- Department of Pulmonary and Critical Care MedicineFirst Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
| | - Jun‐Hong Jiang
- Department of Pulmonary and Critical Care MedicineThe Fourth Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
- Medical Center of Soochow UniversitySuzhouPeople's Republic of China
| | - Guo‐Peng Xu
- Department of Pulmonary and Critical CareThe Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal HospitalSuzhouPeople's Republic of China
- Gusu SchoolNanjing Medical UniversitySuzhouPeople's Republic of China
| | - Ran Wang
- Department of Pulmonary and Critical CareThe Affiliated Hospital of Anhui Medical UniversityHefeiPeople's Republic of China
| | - Da‐Xiong Zeng
- Department of Pulmonary and Critical Care MedicineThe Fourth Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
- Medical Center of Soochow UniversitySuzhouPeople's Republic of China
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Zhang X, Zhang L, Zhang K, Chen Y, Wang L. Immunocompromised states caused the prolonged duration of viral shedding in middle-aged and elderly hemodialysis patients infected with the Omicron variant of COVID-19. Ther Apher Dial 2023; 27:720-725. [PMID: 36691341 DOI: 10.1111/1744-9987.13969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/01/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023]
Abstract
INTRODUCTION To evaluate the impact of hemodialysis on the duration of viral shedding in middle-aged and elderly patients with the Omicron variant of COVID-19. METHODS The study was a descriptive, paired cohort study. Hemodialysis participants (the HD group) aged 45-99 years infected with the Omicron variant of COVID-19 were matched (in a 1:2 ratio) with patients not undergoing hemodialysis (the non-HD group) according to age, gender, vaccination doses, and comorbidity. The duration of viral shedding and clinical data were collected. RESULTS Ninety-nine patients met the inclusion criteria. The duration of recovery was significantly longer for HD patients than for non-HD patients (p < 0.05). Lower counts for CD45+ cells and lymphocytes, along with lower levels of albumin and hemoglobin were associated with a longer duration of viral shedding (p < 0.05). CONCLUSION Hemodialysis patients with immunocompromised state, anemia, and hypoalbuminemia might lead to prolongation of the duration of viral shedding.
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Affiliation(s)
- Xianwen Zhang
- Nephropathy Department, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Linli Zhang
- Nephropathy Department, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kun Zhang
- Nephropathy Department, Tongji Hospital Affiliated to Tongji University, Shanghai, China
| | - Yiping Chen
- Nephropathy Department, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lin Wang
- Nephropathy Department, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Li F, Deng J, Xie C, Wang G, Xu M, Wu C, Li J, Zhong Y. The differences in virus shedding time between the Delta variant and original SARS-CoV-2 infected patients. Front Public Health 2023; 11:1132643. [PMID: 37559731 PMCID: PMC10408444 DOI: 10.3389/fpubh.2023.1132643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/06/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The worldwide epidemic of Coronavirus Disease 2019 (COVID-19) has evolved into multiple variants. The Delta variant is known for its ability to spread and replicate, while data are limited about the virus shedding time in patients infected by the Delta variant. METHODS 56 Delta variant and 56 original SARS-CoV-2 infected patients from Hunan, China, matched according to age and gender divided into two groups and compared the baseline characteristics and laboratory findings with appropriate statistical methods. RESULTS Patients infected with the Delta variant had significantly fewer symptoms of fever (p < 0.001), fatigue (p = 0.004), anorexia (p < 0.001), shortness of breath (p = 0.004), diarrhea (p = 0.006), positive pneumonia rate of chest CT (p = 0.019) and chest CT ground glass opacities (p = 0.004) than those of patients with the original SARS-CoV-2. Patients of the Delta variant group had a significantly longer virus shedding time [41.5 (31.5, 46.75) vs. 18.5 (13, 25.75), p < 0.001] compared with the original SARS-CoV-2 group. The correlation analyses between the virus shedding time and clinical or laboratory parameters showed that the virus shedding time was positively related to the viral strain, serum creatinine and creatine kinase isoenzyme, while negatively correlated with lymphocyte count, total bilirubin and low-density lipoprotein. Finally, the viral strain and lymphocyte count were thought of as the independent risk factors of the virus shedding time demonstrated by multiple linear regression. CONCLUSION COVID-19 patients infected with the Delta variant exhibited fewer gastrointestinal symptoms and prolonged virus shedding time than those infected with the original SARS-CoV-2. Delta variant and fewer lymphocyte were correlated with prolonged virus shedding time.
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Affiliation(s)
- Fanglin Li
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Hematology and Critical Care Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jiayi Deng
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Canbin Xie
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guyi Wang
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Min Xu
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chenfang Wu
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jinxiu Li
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yanjun Zhong
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
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Arfijanto MV, Asmarawati TP, Bramantono B, Rusli M, Rachman BE, Mahdi BA, Nasronudin N, Hadi U. Duration of SARS-CoV-2 RNA Shedding Is Significantly Influenced by Disease Severity, Bilateral Pulmonary Infiltrates, Antibiotic Treatment, and Diabetic Status: Consideration for Isolation Period. PATHOPHYSIOLOGY 2023; 30:186-198. [PMID: 37218914 DOI: 10.3390/pathophysiology30020016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/24/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) ribonucleic acid (RNA) shedding is an important parameter for determining the optimal length of isolation period required for coronavirus disease 2019 (COVID-19) patients. However, the clinical (i.e., patient and disease) characteristics that could influence this parameter have yet to be determined. In this study, we aim to explore the potential associations between several clinical features and the duration of SARS-CoV-2 RNA shedding in patients hospitalized with COVID-19. A retrospective cohort study involving 162 patients hospitalized for COVID-19 in a tertiary referral teaching hospital in Indonesia was performed from June to December 2021. Patients were grouped based on the mean duration of viral shedding and were compared based on several clinical characteristics (e.g., age, sex, comorbidities, COVID-19 symptoms, severity, and therapies). Subsequently, clinical factors potentially associated with the duration of SARS-CoV-2 RNA shedding were further assessed using multivariate logistic regression analysis. As a result, the mean duration of SARS-CoV-2 RNA shedding was found to be 13 ± 8.44 days. In patients with diabetes mellitus (without chronic complications) or hypertension, the duration of viral shedding was significantly prolonged (≥13 days; p = 0.001 and p = 0.029, respectively). Furthermore, patients with dyspnea displayed viral shedding for longer durations (p = 0.011). The multivariate logistic regression analysis reveals that independent risk factors associated with the duration of SARS-CoV-2 RNA shedding include disease severity (adjusted odds ratio [aOR] = 2.94; 95% CI = 1.36-6.44), bilateral lung infiltrates (aOR = 2.79; 95% CI = 1.14-6.84), diabetes mellitus (aOR = 2.17; 95% CI = 1.02-4.63), and antibiotic treatment (aOR = 3.66; 95% CI = 1.74-7.71). In summary, several clinical factors are linked with the duration of SARS-CoV-2 RNA shedding. Disease severity is positively associated with the duration of viral shedding, while bilateral lung infiltrates, diabetes mellitus, and antibiotic treatment are negatively linked with the duration of viral shedding. Overall, our findings suggest the need to consider different isolation period estimations for specific clinical characteristics of patients with COVID-19 that affect the duration of SARS-CoV-2 RNA shedding.
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Affiliation(s)
| | - Tri Pudy Asmarawati
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia
- Universitas Airlangga Hospital, Airlangga University, Surabaya 60115, Indonesia
| | - Bramantono Bramantono
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia
| | - Musofa Rusli
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia
| | - Brian Eka Rachman
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia
- Universitas Airlangga Hospital, Airlangga University, Surabaya 60115, Indonesia
| | - Bagus Aulia Mahdi
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia
| | - Nasronudin Nasronudin
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia
- Universitas Airlangga Hospital, Airlangga University, Surabaya 60115, Indonesia
| | - Usman Hadi
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia
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Sun CY, Huang JR, Shen HC, Liao YT, Ko HJ, Chang CJ, Chen YM, Feng JY, Chen WC, Yang KY. Comparison of clinical outcomes in critically ill COVID-19 patients on mechanical ventilation with nosocomial pneumonia between Alpha and Omicron variants. Ther Adv Respir Dis 2023; 17:17534666231213642. [PMID: 38018405 PMCID: PMC10685785 DOI: 10.1177/17534666231213642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/24/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), a pandemic that has resulted in millions of deaths worldwide. Critically ill COVID-19 patients who require intubation and develop nosocomial pneumonia, commonly caused by gram-negative bacilli, have a higher mortality rate than those without nosocomial pneumonia. OBJECTIVES The aim of this study is to compare the clinical characteristics and outcomes and associated risk factors of Alpha and Omicron SARS-CoV-2 variants in critically ill patients on mechanical ventilation (MV) with nosocomial pneumonia. DESIGN This is a retrospective single-center cohort study. METHODS This observational study was conducted at Taipei Veterans General Hospital, Taiwan from May 2021 to September 2022. Critically ill patients who had confirmed SARS-CoV-2 infection and intubated on a MV with bacterial pneumonia were enrolled. Demographic data, laboratory results, and treatment information were collected and analyzed. In addition, clinical outcomes among different SARS-CoV-2 variants were examined. RESULTS This study included 94 critically ill COVID-19 patients who required intubation and intensive care unit (ICU) admission. The Alpha group had a longer duration of SARS-CoV-2 viral shedding, MV days, and ICU stay, while the Omicron group had older age, more comorbidities, higher APACHE II scores, and higher in-hospital mortality (47.0% versus 25.0%, p = 0.047). However, independent risk factors for in-hospital mortality included malignancy, lower serum albumin levels, and lack of Remdesivir treatment, except for the SARS-CoV-2 variant. CONCLUSION Our study discovered a higher in-hospital mortality rate in severe COVID-19 patients with MV and secondary pneumonia infected with the Omicron variant compared to the Alpha variant; however, real independent risk factors for in-hospital mortality are malignancy, lower serum albumin level, and lack of Remdesivir treatment.
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Affiliation(s)
- Chuan-Yen Sun
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei
| | - Jhong-Ru Huang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei
| | - Hsiao-Chin Shen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei
| | - Ying-Ting Liao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei
| | - Hung-Jui Ko
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei
| | - Chih-Jung Chang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Wei-Chih Chen
- Room 530, 14 floor Chung-Cheng Building, No.2o1, Sec.2, Shipai Rd., Beitou District, Taipei City, Taipei City, Taiwan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112201
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei
- Cancer Progression Research Center, National Yang Ming Chiao Tung University, Taipei
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9
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Measuring the Effectiveness of COVID-19 Vaccines Used during a Surge of the Delta Variant of SARS-CoV-2 in Bangladesh: A Test-Negative Design Evaluation. Vaccines (Basel) 2022; 10:vaccines10122069. [PMID: 36560479 PMCID: PMC9780914 DOI: 10.3390/vaccines10122069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND From May to December 2021, Bangladesh experienced a major surge in the Delta variant of SARS-CoV-2. The earlier rollout of several vaccines offered the opportunity to evaluate vaccine effectiveness against this variant. METHODS A prospective, test-negative case-control study was conducted in five large hospitals in Dhaka between September and December 2021. The subjects were patients of at least 18 years of age who presented themselves for care, suffering COVID-like symptoms of less than 10 days' duration. The cases had PCR-confirmed infections with SARS-CoV-2, and up to 4 PCR test-negative controls were matched to each case, according to hospital, date of presentation, and age. Vaccine protection was assessed as being the association between the receipt of a complete course of vaccine and the occurrence of SARS-CoV-2 disease, with symptoms beginning at least 14 days after the final vaccine dose. RESULTS In total, 313 cases were matched to 1196 controls. The genotyping of case isolates revealed 99.6% to be the Delta variant. Receipt of any vaccine was associated with 12% (95% CI: -21 to 37, p = 0.423) protection against all episodes of SARS-CoV-2. Among the three vaccines for which protection was evaluable (Moderna (mRNA-1273); Sinopharm (Vero Cell-Inactivated); Serum Institute of India (ChAdOx1 nCoV-19)), only the Moderna vaccine was associated with significant protection (64%; 95% CI: 10 to 86, p = 0.029). Protection by the receipt of any vaccine against severe disease was 85% (95% CI: 27 to 97, p = 0.019), with protection estimates of 75% to 100% for the three vaccines. CONCLUSIONS Vaccine protection against COVID-19 disease of any severity caused by the Delta variant was modest in magnitude and significant for only one of the three evaluable vaccines. In contrast, protection against severe disease was high in magnitude and consistent for all three vaccines. Because our findings are not in complete accord with evaluations of the same vaccines in more affluent settings, our study underscores the need for country-level COVID-19 vaccine evaluations in developing countries.
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Dong WY, Zhou MJ, Huang L, Zhang C, Wang FS, Xie ZH. Prolonged Viral Shedding in Three Young Adult Cases of COVID-19. INFECTIOUS DISEASES & IMMUNITY 2022; 2:289-292. [PMID: 37520896 PMCID: PMC9612418 DOI: 10.1097/id9.0000000000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Indexed: 08/01/2023]
Abstract
Severe acute respiratory syndrome coronavirus-2 infection is usually self-limited, with a short duration for viral shedding within several weeks. However, prolonged viral shedding has been observed in severe or immune-compromised coronavirus disease 2019 (COVID-19) cases. Here, we reported that three young adult cases of COVID-19 patients, who were either immunosuppressed nor severe, showed prolonged viral RNA shedding from the upper respiratory tract for 58, 81, and 137 days since initial diagnosis. To our knowledge, this is the longest duration of viral shedding reported to date in young adult patients. Further studies on factors relevant to prolonged viral positivity, as well as the correlation between viral positivity and transmission risk are needed for the optimal management of COVID-19 patients with prolonged nucleic acid positive.
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Affiliation(s)
- Wen-Yi Dong
- Guangxi AIDS Clinical Treatment Centre, The Fourth People’s Hospital of Nanning, Nanning 530013, China
| | - Ming-Ju Zhou
- Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Medical Department of Infectious Diseases, The Fifth Medical Centre of Chinese PLA General Hospital, National Clinical Research Centre for Infectious Diseases, Beijing 100039, China
| | - Lei Huang
- Medical Department of Infectious Diseases, The Fifth Medical Centre of Chinese PLA General Hospital, National Clinical Research Centre for Infectious Diseases, Beijing 100039, China
| | - Chao Zhang
- Guangxi AIDS Clinical Treatment Centre, The Fourth People’s Hospital of Nanning, Nanning 530013, China
- Medical Department of Infectious Diseases, The Fifth Medical Centre of Chinese PLA General Hospital, National Clinical Research Centre for Infectious Diseases, Beijing 100039, China
| | - Fu-Sheng Wang
- Guangxi AIDS Clinical Treatment Centre, The Fourth People’s Hospital of Nanning, Nanning 530013, China
- Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Medical Department of Infectious Diseases, The Fifth Medical Centre of Chinese PLA General Hospital, National Clinical Research Centre for Infectious Diseases, Beijing 100039, China
| | - Zhou-Hua Xie
- Guangxi AIDS Clinical Treatment Centre, The Fourth People’s Hospital of Nanning, Nanning 530013, China
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11
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Loader J, Taylor FC, Lampa E, Sundström J. Renin-Angiotensin Aldosterone System Inhibitors and COVID-19: A Systematic Review and Meta-Analysis Revealing Critical Bias Across a Body of Observational Research. J Am Heart Assoc 2022; 11:e025289. [PMID: 35624081 PMCID: PMC9238740 DOI: 10.1161/jaha.122.025289] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/07/2022] [Indexed: 12/18/2022]
Abstract
Background Renin-angiotensin aldosterone system (RAAS) inhibitor-COVID-19 studies, observational in design, appear to use biased methods that can distort the interaction between RAAS inhibitor use and COVID-19 risk. This study assessed the extent of bias in that research and reevaluated RAAS inhibitor-COVID-19 associations in studies without critical risk of bias. Methods and Results Searches were performed in MEDLINE, EMBASE, and CINAHL databases (December 1, 2019 to October 21, 2021) identifying studies that compared the risk of infection and/or severe COVID-19 outcomes between those using or not using RAAS inhibitors (ie, angiotensin-converting enzyme inhibitors or angiotensin II type-I receptor blockers). Weighted hazard ratios (HR) and 95% CIs were extracted and pooled in fixed-effects meta-analyses, only from studies without critical risk of bias that assessed severe COVID-19 outcomes. Of 169 relevant studies, 164 had critical risks of bias and were excluded. Ultimately, only two studies presented data relevant to the meta-analysis. In 1 351 633 people with uncomplicated hypertension using a RAAS inhibitor, calcium channel blocker, or thiazide diuretic in monotherapy, the risk of hospitalization (angiotensin-converting enzyme inhibitor: HR, 0.76; 95% CI, 0.66-0.87; P<0.001; angiotensin II type-I receptor blockers: HR, 0.86; 95% CI, 0.77-0.97; P=0.015) and intubation or death (angiotensin-converting enzyme inhibitor: HR, 0.64; 95% CI, 0.48-0.85; P=0.002; angiotensin II type-I receptor blockers: HR, 0.74; 95% CI, 0.58-0.95; P=0.019) with COVID-19 was lower in those using a RAAS inhibitor. However, these protective effects are probably not clinically relevant. Conclusions This study reveals the critical risk of bias that exists across almost an entire body of COVID-19 research, raising an important question: Were research methods and/or peer-review processes temporarily weakened during the surge of COVID-19 research or is this lack of rigor a systemic problem that also exists outside pandemic-based research? Registration URL: www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021237859.
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Affiliation(s)
- Jordan Loader
- Department of Medical SciencesUppsala UniversityUppsalaSweden
- Inserm U1300 – HP2CHU Grenoble AlpesGrenobleFrance
| | - Frances C. Taylor
- Baker Heart and Diabetes InstituteMelbourneVictoriaAustralia
- Mary MacKillop Institute for Health Research, Australian Catholic UniversityMelbourneVictoriaAustralia
| | - Erik Lampa
- Department of Medical SciencesUppsala UniversityUppsalaSweden
| | - Johan Sundström
- Department of Medical SciencesUppsala UniversityUppsalaSweden
- The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
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12
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Zang X, Xiong L, Zhu J, Zhao F, Wang S, Zeng W, Yu K, Zhai Y. The Value of Early Positive Nucleic Acid Test and Negative Conversion Time of SARS-CoV-2 RNA in the Clinical Outcome of COVID-19 Patients. Front Med (Lausanne) 2022; 9:826900. [PMID: 35572983 PMCID: PMC9095906 DOI: 10.3389/fmed.2022.826900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background The outbreak of coronavirus disease (COVID-19) poses a great threat to global public health. At present, the number of newly confirmed COVID-19 cases and deaths is increasing worldwide. The strategy of comprehensive and scientific detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through quantitative real-time polymerase chain reaction (qRT-PCR) for special populations and environments provides great support for the prevention and control of this pandemic in China. Our study focused on determining the factors associated with the length of time from symptom onset to the first positive nucleic acid test of throat swabs in COVID-19 patients, evaluating the effect of early positive nucleic acid detection on the disease severity and its significance in prognosis, and predicting the factors associated with the time from positive SARS-CoV-2 RNA test to negative conversion (negative conversion of SARS-CoV-2 virus) in COVID-19 patients. Methods This study included 116 hospitalized patients with COVID-19 from January 30, 2020 to March 4, 2020 in Wuhan, China. Throat swab samples were collected for qRT-PCR testing of SARS-CoV-2 RNA, and all patients included in this study were positive for this test. Results The multivariate Cox proportional hazards model showed that disease severity (HR = 0.572; 95% CI 0.348–0.942; p = 0.028) was a protective factor for the time from symptom onset to positive nucleic acid detection. Meanwhile, the time from symptom onset to positive nucleic acid detection (HR = 1.010; 95% CI 1.005–1.020; p = 0.0282) was an independent risk factor for the delay in negative conversion time of SARS-CoV-2 virus. However, the severity of the disease (HR=1.120; 95% CI 0.771–1.640; p = 0.544) had no correlation with the negative conversion time of SARS-CoV-2 virus. Conclusions Patients with more severe disease had a shorter time from symptom onset to a positive nucleic acid test. Prolonged time from symptom onset to positive nucleic acid test was an independent risk factor for the delay in negative conversion time of SARS-CoV-2 virus, and the severity of the disease had no correlation with negative conversion time of SARS-CoV-2 virus.
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Affiliation(s)
- Xin Zang
- Department of Infectious Disease, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liangkun Xiong
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Junyao Zhu
- Department of Infectious Disease, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fangfang Zhao
- Department of Infectious Disease, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China
| | - Shihong Wang
- Department of Paediatrics, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenhui Zeng
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Kaihuan Yu
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Kaihuan Yu
| | - Yongzhen Zhai
- Department of Infectious Disease, Shengjing Hospital of China Medical University, Shenyang, China
- Yongzhen Zhai
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Toori KU, Chaudhry A, Qureshi MA. Time to negative PCR in various disease categories of COVID-19 infection in Pakistani population. Pak J Med Sci 2022; 38:243-247. [PMID: 35035433 PMCID: PMC8713225 DOI: 10.12669/pjms.38.1.4476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/20/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives: To identify association of epidemiological characteristics, presence of underlying pre-morbidities and disease severity with time to first negative PCR in Corona virus disease 2019. Methods: Total 842 Corona Virus Real Time Polymerase-Chain-Reaction positive patients were included in this cross-sectional study. Patients were admitted to Department of Medicine at KRL Hospital Islamabad from April to August 2020. Age, gender, symptoms, pre-morbidities and disease severity were recorded. Outcome (recovered versus died) was documented. World Health Organization categories to classify disease severity (asymptomatic, mild, moderate and severe) were used. Time to negative PCR was documented as time between first positive PCR to first negative PCR. Results: The mean age of patients was 39.04 ± 11.32 years with 99.8 % being males. Majority of patients (78.4%) were asymptomatic. Amongst symptoms, fever was the most common symptom. Diabetes mellitus and hypertension were the most commonly recorded co-morbidity. Mean time to negative PCR was 8.8 ± 3.1 days. A large proportion of patients recovered (99.9%). Significant positive correlation (p value < 0.05) was found between age, gender, presence of underlying pre-morbidities and disease severity categories with time to first negative PCR. Conclusion: The underlying epidemiological factors, pre-morbidities and disease severity are associated with time to negative PCR and hence affect frequency of recovery samples.
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Affiliation(s)
- Kaleem Ullah Toori
- Dr. Kaleem Ullah Toori, FRCP (Glasgow) Department of Medicine, KRL Hospital, Islamabad, Pakistan
| | - Asma Chaudhry
- Dr. Asma Chaudhry, MRCP (UK), FCPS General Medicine, (Pakistan) Department of Medicine and Endocrinology, Southend University Hospital, Southend-on-Sea, United Kingdom
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Qutub M, Aldabbagh Y, Mehdawi F, Alraddadi A, Alhomsy M, Alnahdi A, Fakeeh M, Maghrabi A, Alwagdani M, Bahabri N. Duration of viable SARS-CoV-2 shedding from respiratory tract in different human hosts and its impact on isolation discontinuation polices revision; a narrative review. CLINICAL INFECTION IN PRACTICE 2022; 13:100140. [PMID: 35190799 PMCID: PMC8848577 DOI: 10.1016/j.clinpr.2022.100140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The duration of viable viral shedding is important to be defined in regards of viral transmission in SARS-CoV-2 infection with the backdrop of the current worldwide effort for revising isolation polices and establishing the duration of infectiousness. METHODS In this review we searched databases including Medline and google scholar for research articles published between January 2020 and January 2022. We included case reports, case series, cross sectional, cohort, and randomized control trials that reported the duration of shedding of viable SARS-CoV-2 virus. After evaluating the criteria for inclusion, 32 articles (2721 patients) were included. RESULT This review showed that the median for the last day of successful viral isolation was 11 (8.5-14.5 95% CI) , 20 (9.0-57.5 95 %CI), 20 (9.0-103 95 %CI) for the general population, critical patients and immunocompromised individuals, respectively, with significant association between prolonged viral shedding, disease severity (P-Value 0.024) and immunosuppressive status (P-Value 0.023).The corresponding higher cutoff of CTv to culturable virus ranged between 26.25 and 34.00 (95% confidence interval) with median of 30.5, and higher values were observed when critical (25.0-37.37 95 %CI) and immunocompromised patients (20.0-37.82 95 %CI) have been excluded, this deviation did not represent a statistical significance (P-Value 0.997 and 0.888) respectively. CONCLUSION Our review highlights that repeating SARS-CoV-2 viral RNA test solely in recovering patients has no importance in determining infectivity and emphasizes the individualization of de-isolation decisions based on the host factors and a combined symptom and testing-based approaches with the later benefiting most of correlation with recently introduced rapid antigen test. Our finding in the review also opposes the most recent CDC Guidance on shortening isolation duration in term of the last days of viable transmissible virus, therefore caution should be considered when revising such protocols.
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Affiliation(s)
- Mohammed Qutub
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Yasser Aldabbagh
- Adult Infectious Diseases division, Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia,Adult Infectious Diseases division, Department of Medicine, Al-Moosa Specialist Hospital, Al-Ahsa, Saudi Arabia,Corresponding author
| | - Fahtima Mehdawi
- Department of Medicine, Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Abdullah Alraddadi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohanna Alhomsy
- Department of Critical Care, Suliman Al Habeeb Medical Group, Riyadh, Saudi Arabia
| | - Abdulaziz Alnahdi
- Department of Medicine, Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Majed Fakeeh
- Department of Medicine, Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Abdullah Maghrabi
- Department of Medicine, Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Meshari Alwagdani
- Department of Medicine, Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Nezar Bahabri
- Department of Medicine, Doctor Samir Abbas Hospital, Jeddah, Saudi Arabia
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Kılıçaslan E, Erdoğan Özünal I, Elibol T, Öztürk E. Are Hematologic Patients Trojan Horse for COVID-19? Indian J Hematol Blood Transfus 2021; 38:529-535. [PMID: 34667375 PMCID: PMC8517942 DOI: 10.1007/s12288-021-01498-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) which is caused by severe acute respiratory distress syndrome virus (SARS-CoV-2) continues to affect people all around the world. This study aimed to compare the SARS-CoV-2 viral shedding time between patients diagnosed with hematologic diseases (HD) and a control group. A total of 110 patients were enrolled in this retrospective study; 55 patients with a diagnosis of HD and 55 sex and comorbidity matched controls without a diagnosis of HD, who caught COVID-19 at the same period. Thirty-eight patients were hospitalized in each group. Viral shedding time, COVID-19 severity, need for intensive care unit support, and mortality rates were compared between groups. Median viral shedding time was 24 days in hospitalized HD patients and 12 days in the hospitalized control group (p < 0.01) as 20 days in outpatient HD patients and 10 days in the outpatient control group (p = 0.02). Viral shedding time was longer in severe + critical COVID-19 cases in the whole cohort (median 22 days in severe + critical, and 12 days in mild + moderate) (p < 0.01). Severe + critical COVID-19 was more common in the HD group than the control group (47.2% versus 25.4%, respectively) (p = 0.017). Twenty-five patients were dead in the whole cohort. One patient was in the control group and 24 patients were in the HD group, therefore the mortality rate for the HD group was 43.6%. Because of statistically significant longer viral shedding time, longer-term isolation may be necessary for hematologic patients diagnosed with COVID-19.
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Affiliation(s)
- Emrah Kılıçaslan
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Işıl Erdoğan Özünal
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Tayfun Elibol
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Erman Öztürk
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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16
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Li J, Liao X, Zhou Y, Wang L, Yang H, Zhang W, Zhang Z, Kang Y. Association between glucocorticoids treatment and viral clearance delay in patients with COVID-19: a systematic review and meta-analysis. BMC Infect Dis 2021; 21:1063. [PMID: 34649502 PMCID: PMC8514812 DOI: 10.1186/s12879-021-06548-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/06/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Evidence of glucocorticoids on viral clearance delay of COVID-19 patients is not clear. METHODS In this systematic review and meta-analysis, we searched for studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, and ClinicalTrials.gov from 2019 to April 20, 2021. We mainly pooled the risk ratios (RRs) and mean difference (MD) for viral clearance delay and did subgroup analyses by the severity of illness and doses of glucocorticoids. RESULTS 38 studies with a total of 9572 patients were identified. Glucocorticoids treatment was associated with delayed viral clearance in COVID-19 patients (adjusted RR 1.52, 95% CI 1.29 to 1.80, I2 = 52%), based on moderate-quality evidence. In subgroup analyses, risk of viral clearance delay was significant both for COVID-19 patients being mild or moderate ill (adjusted RR 1.86, 95% CI 1.35 to 2.57, I2 = 48%), and for patients of being severe or critical ill (adjusted RR 1.59, 95% CI 1.23 to 2.07, I2 = 0%); however, this risk significantly increased for patients taking high doses (unadjusted RR 1.85, 95% CI 1.08 to 3.18; MD 7.19, 95% CI 2.78 to 11.61) or medium doses (adjusted RR 1.86, 95% CI 0.96 to 3.62, I2 = 45%; MD 3.98, 95% CI 3.07 to 4.88, I2 = 4%), rather those taking low doses (adjusted RR 1.38, 95% CI 0.94 to 2.02, I2 = 59%; MD 1.46, 95% CI -0.79 to 3.70, I2 = 82%). CONCLUSIONS Glucocorticoids treatment delayed viral clearance in COVID-19 patients of taking high doses or medium doses, rather in those of taking low doses of glucocorticoids.
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Affiliation(s)
- Jianbo Li
- Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China
| | - Xuelian Liao
- Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China
| | - Yue Zhou
- Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China
| | - Luping Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China
| | - Hang Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China
| | - Wei Zhang
- Molecular Medicine Research Center, State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China.
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China.
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17
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Loader J, Lampa E, Gustafsson S, Cars T, Sundström J. Renin-Angiotensin Aldosterone System Inhibitors in Primary Prevention and COVID-19. J Am Heart Assoc 2021; 10:e021154. [PMID: 34320843 PMCID: PMC8475700 DOI: 10.1161/jaha.120.021154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Considering the widespread risk of collider bias and confounding by indication in previous research, the associations between renin‐angiotensin aldosterone system (RAAS) inhibitor use and COVID‐19 remain unknown. Accordingly, this study tested the hypothesis that RAAS inhibitors influence the summation effect of COVID‐19 and its progression to severe outcomes. Methods and Results This nationwide cohort study compared all residents of Sweden, without prior cardiovascular disease, in monotherapy (as of January 1, 2020) with a RAAS inhibitor to those using a calcium channel blocker or a thiazide diuretic. Comparative cohorts were balanced using machine‐learning‐derived propensity score methods. Of 165 355 people in the analysis (51% women), 367 were hospitalized or died with COVID‐19 (246 using a RAAS inhibitor versus 121 using a calcium channel blocker or thiazide diuretic; Cox proportional hazard ratio [HR], 0.97; 95% CI, 0.74–1.27). When each outcome was assessed separately, 335 people were hospitalized with COVID‐19 (HR, 0.92; 95% CI, 0.70–1.22), and 64 died with COVID‐19 (HR, 1.22; 95% CI, 0.68–2.19). The severity of COVID‐19 outcomes did not differ between those using a RAAS inhibitor and those using a calcium channel blocker or thiazide diuretic (ordered logistic regression odds ratio, 1.01; 95% CI, 0.89–1.14). Conclusions Despite potential limitations, this study is among the best available evidence that RAAS inhibitor use in primary prevention does not increase the risk of severe COVID‐19 outcomes; presenting strong data from which scientists and policy makers alike can base, with greater confidence, their current position on the safety of using RAAS inhibitors during the COVID‐19 pandemic.
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Affiliation(s)
- Jordan Loader
- Department of Medical Sciences Uppsala University Uppsala Sweden
| | - Erik Lampa
- Department of Medical Sciences Uppsala University Uppsala Sweden
| | | | - Thomas Cars
- Department of Medical Sciences Uppsala University Uppsala Sweden
| | - Johan Sundström
- Department of Medical Sciences Uppsala University Uppsala Sweden.,The George Institute for Global HealthUniversity of New South Wales Sydney NSW Australia
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18
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Colson P, Devaux CA, Lagier JC, Gautret P, Raoult D. A Possible Role of Remdesivir and Plasma Therapy in the Selective Sweep and Emergence of New SARS-CoV-2 Variants. J Clin Med 2021; 10:3276. [PMID: 34362060 PMCID: PMC8348317 DOI: 10.3390/jcm10153276] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/14/2021] [Accepted: 06/24/2021] [Indexed: 01/18/2023] Open
Abstract
Since summer 2020, SARS-CoV-2 strains at the origin of the COVID-19 pandemic have suddenly been replaced by new SARS-CoV-2 variants, some of which are highly transmissible and spread at a high rate. These variants include the Marseille-4 lineage (Nextclade 20A.EU2) in Europe, the 20I/501Y.V1 variant first detected in the UK, the 20H/501Y.V2 variant first detected in South Africa, and the 20J/501Y.V3 variant first detected in Brazil. These variants are characterized by multiple mutations in the viral spike protein that is targeted by neutralizing antibodies elicited in response to infection or vaccine immunization. The usual coronavirus mutation rate through genetic drift alone cannot account for such rapid changes. Recent reports of the occurrence of such mutations in immunocompromised patients who received remdesivir and/or convalescent plasma or monoclonal antibodies to treat prolonged SARS-CoV-2 infections led us to hypothesize that experimental therapies that fail to cure the patients from COVID-19 could favor the emergence of immune escape SARS-CoV-2 variants. We review here the data that support this hypothesis and urge physicians and clinical trial promoters to systematically monitor viral mutations by whole-genome sequencing for patients who are administered these treatments.
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Affiliation(s)
- Philippe Colson
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France; (P.C.); (C.A.D.); (J.-C.L.); (P.G.)
- Microbes Evolution Phylogeny and Infections (MEPHI), Institut de Recherche pour le Développement (IRD), Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), 264 rue Saint-Pierre, 13005 Marseille, France
| | - Christian A. Devaux
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France; (P.C.); (C.A.D.); (J.-C.L.); (P.G.)
- Microbes Evolution Phylogeny and Infections (MEPHI), Institut de Recherche pour le Développement (IRD), Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France
- CNRS, 13009 Marseille, France
| | - Jean-Christophe Lagier
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France; (P.C.); (C.A.D.); (J.-C.L.); (P.G.)
- Microbes Evolution Phylogeny and Infections (MEPHI), Institut de Recherche pour le Développement (IRD), Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), 264 rue Saint-Pierre, 13005 Marseille, France
| | - Philippe Gautret
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France; (P.C.); (C.A.D.); (J.-C.L.); (P.G.)
- Assistance Publique-Hôpitaux de Marseille (AP-HM), 264 rue Saint-Pierre, 13005 Marseille, France
- Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), Institut de Recherche pour le Développement (IRD), Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Didier Raoult
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France; (P.C.); (C.A.D.); (J.-C.L.); (P.G.)
- Microbes Evolution Phylogeny and Infections (MEPHI), Institut de Recherche pour le Développement (IRD), Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), 264 rue Saint-Pierre, 13005 Marseille, France
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19
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Kute VB, Ray DS, Yadav DK, Pathak V, Bhalla AK, Godara S, Kumar A, Guleria S, Khullar D, Thukral S, Mondal RRS, Jain M, Jha PK, Hegde U, Abraham M A, Dalal S, Patel H, Bahadur MM, Shingare A, Sharma A, Kumar Sharma R, Anandh U, Gulati S, Gumber M, Siddini V, Deshpande R, Kaswan K, Varyani U, Kakde S, Kenwar DB, Shankar Meshram H, Kher V. A Multicenter Cohort Study From India of 75 Kidney Transplants in Recipients Recovered After COVID-19. Transplantation 2021; 105:1423-1432. [PMID: 33724246 DOI: 10.1097/tp.0000000000003740] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors. METHODS We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative severe acute respiratory syndrome coronavirus 2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 d and significant social distancing for 14 d before surgery. RESULTS Clinical severity in patients ranged from asymptomatic (n = 17, 22.7%), mild (n = 36.48%), moderate (n = 15.20%), and severe (n = 7.9.3%) disease. Median duration between PCR positive to transplant was 60 d (overall) and increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d, P 0.019), respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow-up of 81 (56-117) d without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. CONCLUSIONS Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pretransplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. To date, this remains the first and the largest study of kidney transplantation in COVID-19 survivors.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Deepak S Ray
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Dinesh Kumar Yadav
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Vivek Pathak
- Department of Nephrology, Kovai Medical Center and Hospital, Coimbatore, Tamil-Nadu, India
| | - Anil K Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Suraj Godara
- Department of Nephrology, Mahatma Gandhi Medical College & Hospital, Jaipur, India
| | - Anil Kumar
- Department of Nephrology BGS Global Hospital, Bengaluru, Karnataka, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Dinesh Khullar
- Nephrology and Renal Transplant Medicine, Max Saket Complex, Max Super Speciality Hospital, Saket, Delhi, India
| | - Sharmila Thukral
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Rabi Ranjan Sow Mondal
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Manish Jain
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Pranaw Kumar Jha
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Abi Abraham M
- Nephrology and Renal Transplant Services, VPS Lakeshore Hospital, Kochi, India
| | - Sonal Dalal
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, India
| | - Himanshu Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Madan M Bahadur
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashay Shingare
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Raj Kumar Sharma
- Nephrology and Kidney Transplant Medicine, Kidney & Urology Institute, Medanta, Lucknow, India
| | - Urmila Anandh
- Department of Nephrology, Yashoda Hospital, Secunderabad, India
| | - Sanjeev Gulati
- Nephrology and Kidney Transplant Fortis Group of Hospitals, New Delhi, India
| | - Manoj Gumber
- Department of Nephrology, Apollo Hospitals International Limited, Gandhi Nagar, Ahmedabad, Gujarat, India
| | | | - Rushi Deshpande
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Kamal Kaswan
- Department of Nephrology, Narayana Multispeciality Hospital, Jaipur, India
| | - Umesh Varyani
- Department of Nephrology Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | - Deepesh B Kenwar
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Vijay Kher
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
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20
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SeyedAlinaghi S, Abbasian L, Solduzian M, Ayoobi Yazdi N, Jafari F, Adibimehr A, Farahani A, Salami Khaneshan A, Ebrahimi Alavijeh P, Jahani Z, Karimian E, Ahmadinejad Z, Khalili H, Seifi A, Ghiasvand F, Ghaderkhani S, Rasoolinejad M. Predictors of the prolonged recovery period in COVID-19 patients: a cross-sectional study. Eur J Med Res 2021; 26:41. [PMID: 33957992 PMCID: PMC8100933 DOI: 10.1186/s40001-021-00513-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The clinical course of COVID-19 may vary significantly. The presence of comorbidities prolongs the recovery time. The recovery in patients with mild-to-moderate symptoms might take 10 days, while in those with a critical illness or immunocompromised status could take 15 days. Considering the lack of data about predictors that could affect the recovery time, we conducted this study to identify them. METHODS This cross-sectional study was implemented in the COVID-19 clinic of a teaching and referral university hospital in Tehran. Patients with the highly suggestive symptoms who had computed tomography (CT) imaging results with typical findings of COVID-19 or positive results of reverse transcriptase-polymerase chain reaction (RT-PCR) were enrolled in the study. Inpatient and outpatient COVID-19 participants were followed up by regular visits or phone calls, and the recovery period was recorded. RESULTS A total of 478 patients were enrolled. The mean age of patients was 54.11 ± 5.65 years, and 44.2% were female. The median time to recovery was 13.5 days (IQR: 9). Although in the bivariate analysis, multiple factors, including hypertension, fever, diabetes mellitus, gender, and admission location, significantly contributed to prolonging the recovery period, in multivariate analysis, only dyspnea had a significant association with this variable (p = 0.02, the adjusted OR of 2.05; 95% CI 1.12-3.75). CONCLUSION This study supports that dyspnea is a predictor of recovery time. It seems like optimal management of the comorbidities plays the most crucial role in recovery from COVID-19.
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Affiliation(s)
- SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Ladan Abbasian
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
- Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, 1419733141 Iran
| | - Mohammad Solduzian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Science, Golgasht St, Tabriz, 5166414766 Iran
| | - Niloofar Ayoobi Yazdi
- Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Jafari
- Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, 1419733141 Iran
| | - Alireza Adibimehr
- Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, 1419733141 Iran
| | - Aazam Farahani
- Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, 1419733141 Iran
| | - Arezoo Salami Khaneshan
- Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, 1419733141 Iran
| | - Parvaneh Ebrahimi Alavijeh
- Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, 1419733141 Iran
| | - Zahra Jahani
- Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, 1419733141 Iran
| | - Elnaz Karimian
- Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, 1419733141 Iran
| | - Zahra Ahmadinejad
- Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, 1419733141 Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Seifi
- Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, 1419733141 Iran
| | - Fereshteh Ghiasvand
- Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, 1419733141 Iran
| | - Sara Ghaderkhani
- Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, 1419733141 Iran
| | - Mehrnaz Rasoolinejad
- Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, 1419733141 Iran
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21
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Wang CS, Gao Y, Kang K, Fei DS, Meng XL, Liu HT, Luo YP, Yang W, Dai QQ, Gao Y, Zhao MY, Yu KJ. Standardization of critical care management of non-critically ill patients with COVID-19. World J Clin Cases 2021; 9:2696-2702. [PMID: 33969052 PMCID: PMC8058685 DOI: 10.12998/wjcc.v9.i12.2696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/12/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
The large global outbreak of coronavirus disease 2019 (COVID-19) has seriously endangered the health care system in China and globally. The sudden surge of patients with severe acute respiratory syndrome coronavirus 2 infection has revealed the shortage of critical care medicine resources and intensivists. Currently, the management of non-critically ill patients with COVID-19 is performed mostly by non-intensive care unit (ICU) physicians, who lack the required professional knowledge, training, and practice in critical care medicine, especially in terms of continuous monitoring of the respiratory function, intervention, and feedback on treatment effects. This clinical problem needs an urgent solution. Therefore, here, we propose a series of clinical strategies for non-ICU physicians aimed at the standardization of the management of non-critically ill patients with COVID-19 from the perspective of critical care medicine. Isolation management is performed to facilitate the implementation of hierarchical monitoring and intervention to ensure the reasonable distribution of scarce critical care medical resources and intensivists, highlight the key patients, timely detection of disease progression, and early and appropriate intervention and organ function support, and thus improve the prognosis. Different management objectives are also set based on the high-risk factors and the severity of patients with COVID-19. The approaches suggested herein will facilitate the timely detection of disease progression, and thus ensure the provision of early and appropriate intervention and organ function support, which will eventually improve the prognosis.
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Affiliation(s)
- Chang-Song Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Yang Gao
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Kai Kang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Dong-Sheng Fei
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Xiang-Lin Meng
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Hai-Tao Liu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Yun-Peng Luo
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Wei Yang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Qing-Qing Dai
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Yan Gao
- Department of Critical Care Medicine, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Ming-Yan Zhao
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Kai-Jiang Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
- Institute of Critical Care Medicine, The Sino Russian Medical Research Center of Harbin Medical University, Harbin 150081, Heilongjiang Province, China
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22
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Machine learning based on clinical characteristics and chest CT quantitative measurements for prediction of adverse clinical outcomes in hospitalized patients with COVID-19. Eur Radiol 2021; 31:7925-7935. [PMID: 33856514 PMCID: PMC8046645 DOI: 10.1007/s00330-021-07957-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/03/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023]
Abstract
Objectives To develop and validate a machine learning model for the prediction of adverse outcomes in hospitalized patients with COVID-19. Methods We included 424 patients with non-severe COVID-19 on admission from January 17, 2020, to February 17, 2020, in the primary cohort of this retrospective multicenter study. The extent of lung involvement was quantified on chest CT images by a deep learning–based framework. The composite endpoint was the occurrence of severe or critical COVID-19 or death during hospitalization. The optimal machine learning classifier and feature subset were selected for model construction. The performance was further tested in an external validation cohort consisting of 98 patients. Results There was no significant difference in the prevalence of adverse outcomes (8.7% vs. 8.2%, p = 0.858) between the primary and validation cohorts. The machine learning method extreme gradient boosting (XGBoost) and optimal feature subset including lactic dehydrogenase (LDH), presence of comorbidity, CT lesion ratio (lesion%), and hypersensitive cardiac troponin I (hs-cTnI) were selected for model construction. The XGBoost classifier based on the optimal feature subset performed well for the prediction of developing adverse outcomes in the primary and validation cohorts, with AUCs of 0.959 (95% confidence interval [CI]: 0.936–0.976) and 0.953 (95% CI: 0.891–0.986), respectively. Furthermore, the XGBoost classifier also showed clinical usefulness. Conclusions We presented a machine learning model that could be effectively used as a predictor of adverse outcomes in hospitalized patients with COVID-19, opening up the possibility for patient stratification and treatment allocation. Key Points • Developing an individually prognostic model for COVID-19 has the potential to allow efficient allocation of medical resources. • We proposed a deep learning–based framework for accurate lung involvement quantification on chest CT images. • Machine learning based on clinical and CT variables can facilitate the prediction of adverse outcomes of COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07957-z.
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23
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Naveed H, Elshafeey A, Al-Ali D, Janjua E, Nauman A, Kawas H, Kaul R, Saed Aldien A, Elshazly MB, Zakaria D. The Interplay Between the Immune System, the Renin-Angiotensin-Aldosterone System (RAAS), and RAAS Inhibitors May Modulate the Outcome of COVID-19: A Systematic Review. J Clin Pharmacol 2021; 61:987-1000. [PMID: 33635546 PMCID: PMC8014479 DOI: 10.1002/jcph.1852] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/22/2021] [Indexed: 01/18/2023]
Abstract
Since the discovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), numerous research has been undertaken to delineate the various effects of the virus which manifests in many ways all over the body. The association between the SARS-CoV-2 invasion mechanism and the renin-angiotensin-aldosterone system (RAAS) receptors, created many debates about the possible consequences of using RAAS-modulating drugs including angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) during the pandemic. Many clinical studies were conducted to assess the outcomes of coronavirus disease 2019 (COVID-19) in patients who use ACEi/ARBs following the arguments claiming to discontinue these drugs as a precautionary measure. Although several studies mainly analyzed the outcomes of the disease, this review aimed to compare specific blood markers in both groups of COVID-19 patients to gain better insight into the interaction of ACEi/ARBs with different body functions during the infection. Several databases were searched using a combination of keywords followed by screening and data extraction. Only 28 studies met our inclusion criteria, the majority of which showed no significant difference between the inflammation markers of COVID-19 patients who used or did not use ACEi/ARBs. Interestingly, 6 studies reported lower inflammatory markers in COVID-19 patients who used ACEi/ARBs, and 6 studies reported better outcomes among the same group. We therefore concluded that the use of ACEi/ARBs may not lead to worse prognosis of COVID-19 and may even play a protective role against the hyperinflammatory response associated with COVID-19.
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Affiliation(s)
- Hiba Naveed
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Abdallah Elshafeey
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Dana Al-Ali
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Emmad Janjua
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Areej Nauman
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Hussam Kawas
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Ridhima Kaul
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Arwa Saed Aldien
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Mohamed B Elshazly
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Dalia Zakaria
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
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24
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Zheng M, Song L. Shift in the Distributions of Pre-existing Medical Condition, Gender and Age across Different COVID-19 Outcomes. Aging Dis 2021; 12:327-329. [PMID: 33815866 PMCID: PMC7990362 DOI: 10.14336/ad.2020.1222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Ming Zheng
- Institute of Military Cognition and Brain Sciences, Academy of Military Medical Sciences, Beijing 100850, China
| | - Lun Song
- Institute of Military Cognition and Brain Sciences, Academy of Military Medical Sciences, Beijing 100850, China
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25
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Feng Z, Zhao H, Kang W, Liu Q, Wu J, Bragazzi NL, Ma X, Wang W, Rong P. Association of Paraspinal Muscle Measurements on Chest Computed Tomography With Clinical Outcomes in Patients With Severe Coronavirus Disease 2019. J Gerontol A Biol Sci Med Sci 2021; 76:e78-e84. [PMID: 33355656 PMCID: PMC7799309 DOI: 10.1093/gerona/glaa317] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Indexed: 01/08/2023] Open
Abstract
Background Skeletal muscle depletion is common in the elderly and individuals with chronic comorbidities, who have an increased risk of developing severe coronavirus disease 2019 (COVID-19), which is defined by hypoxia requiring supplemental oxygen. This study aimed to determine the association between skeletal muscle depletion and clinical outcomes in patients with severe COVID-19. Methods One hundred and sixteen patients with severe COVID-19 who underwent chest computed tomography (CT) scan on admission were included in this multicentre, retrospective study. Paraspinal muscle index (PMI) and radiodensity (PMD) were measured using CT images. The primary composite outcome was the occurrence of critical illness (respiratory failure requiring mechanical ventilation, shock, or intensive care unit admission) or death, and the secondary outcomes were the duration of viral shedding and pulmonary fibrosis in the early rehabilitation phase. Logistic regression and Cox proportional hazards models were employed to evaluate the associations. Results The primary composite outcome occurred in 48 (41.4%) patients, who were older and had lower PMD (both P < 0.05). Higher PMD was associated with reduced risk of critical illness or death in a fully adjusted model overall (OR per SD increment: 0.87, 95% CI: 0.80-0.95; P = 0.002) and in female patients (OR per SD increment: 0.71, 95% CI: 0.56-0.91; P = 0.006), although the effect was not statistically significant in male patients (P = 0.202). Higher PMD (HR per SD increment: 1.08, 95% CI: 1.02-1.14; P = 0.008) was associated with shorter duration of viral shedding among female survivors. However, no significant association was found between PMD and pulmonary fibrosis in the early rehabilitation phase, or between PMI and any outcome in both men and women. Conclusion Higher PMD, a proxy measure of lower muscle fat deposition, was associated with a reduced risk of disease deterioration and decreased likelihood of prolonged viral shedding among female patients with severe COVID-19.
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Affiliation(s)
- Zhichao Feng
- Department of Radiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Molecular Imaging Research Center, Central South University, Changsha, Hunan, China
| | - Huafei Zhao
- Department of Radiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wendi Kang
- Department of Radiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qin Liu
- Department of Radiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jianzhen Wu
- Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | | | - Xiaoqian Ma
- Department of Radiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Molecular Imaging Research Center, Central South University, Changsha, Hunan, China
| | - Wei Wang
- Department of Radiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Molecular Imaging Research Center, Central South University, Changsha, Hunan, China
| | - Pengfei Rong
- Department of Radiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Molecular Imaging Research Center, Central South University, Changsha, Hunan, China
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26
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Yin T, Li Y, Ying Y, Luo Z. Prevalence of comorbidity in Chinese patients with COVID-19: systematic review and meta-analysis of risk factors. BMC Infect Dis 2021; 21:200. [PMID: 33618678 PMCID: PMC7897883 DOI: 10.1186/s12879-021-05915-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/09/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is an infectious disease characterized by cough, fever, and fatigue and 20% of cases will develop into severe conditions resulting from acute lung injury with the manifestation of the acute respiratory distress syndrome (ARDS) that accounts for more than 50% of mortality. Currently, it has been reported that some comorbidities are linked with an increased rate of severity and mortality among COVID-19 patients. To assess the role of comorbidity in COVID-19 progression, we performed a systematic review with a meta-analysis on the relationship of COVID-19 severity with 8 different underlying diseases. METHODS PubMed, Web of Science, and CNKI were searched for articles investigating the prevalence of comorbidities in severe and non-severe COVID-19 patients. A total of 41 studies comprising 12,526 patients were included. RESULTS Prevalence of some commodities was lower than that in general population such as hypertension (19% vs 23.2%), diabetes (9% vs 10.9%), chronic kidney disease (CKD) (2% vs 9.5%), chronic liver diseases (CLD) (3% vs 24.8%) and chronic obstructive pulmonary disease (COPD) (3% vs 8.6%), while some others including cancer (1% vs 0.6%), cardiovascular disease (6% vs 1.8%) and cerebrovascular disease (2% vs 0.9%) exhibited greater percentage in COVID-19. Cerebrovascular disease (OR = 3.70, 95%CI 2.51-5.45) was found to be the strongest risk factor in disease exacerbation, followed by CKD (OR = 3.60, 95%CI 2.18-5.94), COPD (OR = 3.14, 95% CI 2.35-4.19), cardiovascular disease (OR = 2.76, 95% CI 2.18-3.49), malignancy (OR = 2.63, 95% CI 1.75-3.95), diabetes (OR = 2.49, 95% CI 2.10-2.96) and hypertension (OR = 2.13, 95% CI 1.81-2.51). We found no correlation between CLD and increased disease severity (OR = 1.32, 95% CI 0.96-1.82). CONCLUSION The impact of all eight underlying diseases on COVID-19 deterioration seemed to be higher in patients outside Hubei. Based on different comorbidities, COVID-19 patients tend to be at risk of developing poor outcomes to a varying degree. Thus, tailored infection prevention and monitoring and treatment strategies targeting these high-risk subgroups might improve prognosis during the COVID-19 pandemic.
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Affiliation(s)
- Tingxuan Yin
- Queen Mary School, Nanchang University, Nanchang, Jiangxi, China
| | - Yuanjun Li
- Jiangxi Province Key Laboratory of Tumor Pathogenesis and Molecular Pathology and Department of Pathophysiology, School of Basic Medical Sciences, Nanchang University, Nanchang, Jiangxi, China
| | - Ying Ying
- Jiangxi Province Key Laboratory of Tumor Pathogenesis and Molecular Pathology and Department of Pathophysiology, School of Basic Medical Sciences, Nanchang University, Nanchang, Jiangxi, China
| | - Zhijun Luo
- Queen Mary School, Nanchang University, Nanchang, Jiangxi, China. .,Jiangxi Province Key Laboratory of Tumor Pathogenesis and Molecular Pathology and Department of Pathophysiology, School of Basic Medical Sciences, Nanchang University, Nanchang, Jiangxi, China.
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27
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Mackey K, Kansagara D, Vela K. Update Alert 7: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults. Ann Intern Med 2021; 174:W25-W29. [PMID: 33395346 PMCID: PMC7791405 DOI: 10.7326/l20-1446] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Kathryn Vela
- VA Portland Health Care System, Portland, Oregon
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28
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Kwee RM, Adams HJA, Kwee TC. Chest CT in Patients with COVID-19: Toward a Better Appreciation of Study Results and Clinical Applicability. Radiology 2021; 298:E113-E114. [PMID: 33289615 PMCID: PMC7735193 DOI: 10.1148/radiol.2020203702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Robert M. Kwee
- Department of Radiology, Zuyderland Medical Center,
Heerlen/Sittard/Geleen, Henri Dunantstraat 5, 6419 PC Heerlen, the
Netherlands
| | - Hugo J. A. Adams
- Department of Radiology, Zuyderland Medical Center,
Heerlen/Sittard/Geleen, Henri Dunantstraat 5, 6419 PC Heerlen, the
Netherlands
- Department of Radiology, Nuclear Medicine and Molecular Imaging.
University Medical Center Groningen, University of Groningen, Groningen, the
Netherlands
| | - Thomas C. Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging.
University Medical Center Groningen, University of Groningen, Groningen, the
Netherlands
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29
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Peng Y, Tao H, Satyanarayanan SK, Jin K, Su H. A Comprehensive Summary of the Knowledge on COVID-19 Treatment. Aging Dis 2021; 12:155-191. [PMID: 33532135 PMCID: PMC7801274 DOI: 10.14336/ad.2020.1124] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023] Open
Abstract
Currently, the world is challenged by the coronavirus disease 2019 (COVID-19) pandemic. Epidemiologists and researchers worldwide are invariably trying to understand and combat this precarious new disease. Scrutinizing available drug options and developing potential new drugs are urgent needs to subdue this pandemic. Several intervention strategies are being considered and handled worldwide with limited success, and many drug candidates are yet in the trial phase. Despite these limitations, the development of COVID-19 treatment strategies has been accelerated to improve the clinical outcome of patients with COVID-19, and some countries have efficiently kept it under control. Recently, the use of natural and traditional medicine has also set the trend in coronavirus treatment. This review aimed to discuss the prevailing COVID-19 treatment strategies available globally by examining their efficacy, potential mechanisms, limitations, and challenges in predicting a future potential treatment candidate and bridging them with the effective traditional Chinese medicine (TCM). The findings might enrich the knowledge on traditional alternative medication and its complementary role with Western medicine in managing the COVID-19 epidemic.
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Affiliation(s)
- Yu Peng
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.
| | - Hongxun Tao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.
| | - Senthil Kumaran Satyanarayanan
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.
| | - Kunlin Jin
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
| | - Huanxing Su
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.
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30
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Aggarwal A, Agarwal R, Dhooria S, Prasad K, Sehgal I, Muthu V. Impact of chronic obstructive pulmonary disease on severity and outcomes in COVID-19 patients: A systematic review. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2021. [DOI: 10.4103/jncd.jncd_7_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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31
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Mackey K, Kansagara D, Vela K. Update Alert 6: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults. Ann Intern Med 2021; 174:W17. [PMID: 33253036 PMCID: PMC7729487 DOI: 10.7326/l20-1355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Kathryn Vela
- VA Portland Health Care System, Portland, Oregon
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32
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Patwardhan A. Sustained Positivity and Reinfection With SARS-CoV-2 in Children: Does Quarantine/Isolation Period Need Reconsideration in a Pediatric Population? Cureus 2020; 12:e12012. [PMID: 33324532 PMCID: PMC7732141 DOI: 10.7759/cureus.12012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is a once in a lifetime public health catastrophe that has driven the world not only into a medical crisis but has pushed to the brink of economic collapse. Prevention of transmission of the replication-competent virus to the susceptible host is the key to the control of COVID-19. The phenomenon of "sustained-positivity," "reinfections," and their role in disease transmission are poorly understood in adults and not even recognized in the pediatric population yet. This information is crucial for ascertaining the quarantine/isolation period for test-positive patients. Most of the time, adult studies' results are extrapolated and applied to children, but severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has treated children differently than adults. MATERIAL AND METHODS The Institutional Review Board (IRB) approval has been obtained. A retrospective electronic chart review of 989 SARS-CoV-2 polymerase chain reaction (PCR)/reverse transcription-PCR (RT-PCR) positive pediatric patients was performed. The aim was to look at the existence of sustained positivity and SARS -CoV-2 reinfection in the pediatric population, as was reported in the adults. Results: We present our retrospective observational study on 989 SARS-CoV-2 positive pediatric patients; 172 of these had repeated multiple testings, 68 had multiple consecutive positive tests over time, and 27 qualified for sustained-positive status. We also report on four pediatric COVID-19 reinfections. CONCLUSION This is the first report on pediatric SARS-CoV-2 reinfection, one of very few on pediatric SARS-CoV-2 sustained positivity and reinfection. These two phenomena occur in children also as reported in adults but have several differences. The reinfection is possible within one to three weeks of becoming negative as against adults who have been reported to become positive in a minimum of 45-90 days from becoming negative. More extensive reporting is essential to ascertain the accurate quarantine/isolation recommendation in children.
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Affiliation(s)
- Anjali Patwardhan
- Child Health, University of Arkansas Health Sciences, Little Rock, USA
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