miRNome profiling of extracellular vesicles in severe COVID-19 patients and identification of predictors of mortality.

BACKGROUND: Extracellular vesicles (EVs), containing microRNAs (miRNAs) and other molecules, play a central role in intercellular communication, especially in viral infections caused by SARS-CoV-2. This study explores the miRNA profiles in plasma-derived EVs from severe COVID-19 patients referred to controls, identifying potential mortality miRNA predictors. METHODS: A prospective study was carried out, including 36 severe COVID-19 patients and 33 non-COVID-19 controls. EVs-derived miRNAs were sequenced, and bioinformatics and differential expression analysis between groups were performed. The plasma miRNA profile of an additional cohort of severe COVID-19 patients (n=32) and non-COVID-19 controls (n=12) was used to compare with our data. Survival analysis was used to identify potential mortality predictors among the SDE miRNAs in EVs. RESULTS: Severe COVID-19 patients showed 50 significantly differentially expressed (SDE) miRNAs in plasma-derived EVs. These miRNAs were associated with pathways related to inflammation and cell adhesion. Fifteen of these plasma-derived EVs miRNAs were also SDE in the plasma of severe patients vs controls. Two miRNAs, hsa-miR-1469 and hsa-miR-6124, were identified as strong mortality predictors with an área under the ROC Curve (AUC) of 0.938. CONCLUSION: : This research provides insights into the role of miRNAs found within EVs in severe COVID-19 and their potential as clinical biomarkers for mortality.

COVID-19-associated pulmonary aspergillosis (CAPA) in hematological patients: Could antifungal prophylaxis be necessary? A nationwide study.

BACKGROUND: COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as a relatively common complication. Multiple studies described this relationship in critical patients, however its incidence and outcome in other risk groups such as immunosuppressed patients remains unknown. In this sense, we aimed to evaluate the rates and outcomes of CAPA in hematological patients and according to the different hematological malignances, comparing to invasive pulmonary aspergillosis (IPA) in non-COVID-19 ones. METHODS: Nationwide, population-based and retrospective observational cohort study including all adult patients with hematological malignancies admitted in Spain since March 1, 2020 to December 31, 2021. The main outcome variable was the diagnosis of IPA during hospitalization in hematological patients with or without COVID-19 at admission. The rate of CAPA compared to IPA in non-COVID-19 patients in each hematological malignancy was also performed, as well as survival curve analysis. FINDINGS: COVID-19 was diagnosed in 3.85 % (4367 out of 113,525) of the hematological adult inpatients. COVID-19 group developed more fungal infections (5.1 % vs. 3 %; p < 0.001). Candida spp. showed higher rate in non-COVID-19 (74.2 % vs. 66.8 %; p = 0.015), meanwhile Aspergillus spp. confirmed its predominance in COVID-19 hematological patients (35.4 % vs. 19.1 %; p < 0.001). IPA was diagnosed in 703 patients and 11.2 % (79 cases) were CAPA. The multivariate logistic regression analysis found that the diagnosis of COVID-19 disease at hospital admission increased more than two-fold IPA development [OR: 2.5, 95CI (1.9-3.1), p < 0.001]. B-cell malignancies - specifically B-cell non-Hodgkin lymphoma, multiple myeloma, chronic lymphocytic leukemia and acute lymphoblastic leukemia - showed between four- and six-fold higher CAPA development and 90-day mortality rates ranging between 50 % and 72 %. However, myeloid malignancies did not show higher CAPA rates compared to IPA in non-COVID-19 patients. CONCLUSION: COVID-19 constitutes an independent risk factor for developing aspergillosis in B-cell hematological malignancies and the use of antifungal prophylaxis during hospitalizations may be warranted.

Asociación del grupo sanguíneo A con mayor comorbilidad hospitalaria en pacientes infectados por SARS-CoV-2 / Association of blood group A with hospital comorbidity in patients infected by SARS-CoV-2

Fundamento y objetivosEn la pandemia provocada por SARS-CoV-2 es importante identificar qué factores de riesgo se asocian a las formas más graves de la enfermedad. El grupo sanguíneo A se ha presentado en diversos estudios como factor de mal pronóstico. El objetivo de este estudio radica en evaluar si los pacientes de grupo sanguíneo A asocian comorbilidades más importantes, medido por el Índice de Charlson, que puedan justificar también su peor evolución clínica.Pacientes y métodoEstudio prospectivo y consecutivo con 100 pacientes diagnosticados de COVID-19 ingresados en marzo de 2020. Se empleó un modelo de regresión lineal multivariante para evaluar la asociación del grupo sanguíneo A con el Índice de Charlson.ResultadosLos pacientes del grupo A presentaron mayor índice de Charlson (p=0,037), linfopenia (p=0,039), trombocitopenia (p=0,014) y mortalidad hospitalaria (p=0,044).El grupo sanguíneo A demostró ser un factor independiente asociado a dicho índice (B 0,582; IC 95% [0,02-1,14], p=0,041).ConclusionesEl grupo A se asocia de forma independiente a mayor comorbilidad, asociando un incremento de 0,582 puntos en el índice de Charlson con respecto al resto de grupos sanguíneos. Además, asocia una tendencia de menor mortalidad hospitalaria. (AU)

Background and objectivesIn the pandemic caused by SARS-CoV-2, identifying which risk factors are associated with the most serious forms of the disease is important. Blood group A has been presented in various studies as a poor prognostic factor. The objective of this study was to evaluate whether patients with blood group A were associated with more important comorbidities, measured by the Charlson Index, which may explain their worse clinical evolution.Patients and methodsA prospective and consecutive study examined 100 patients diagnosed with COVID-19 and admitted in March 2020. A multivariate linear regression model was used to evaluate the association of blood group A with the Charlson Index.ResultsPatients in group A had a higher Charlson Index (P=.037), rate of lymphopenia (P=.039) and thrombopenia (P=.014), and hospital mortality (P=.044). Blood group A was an independent factor associated with the Charlson Index (B 0.582, 95% CI 0.02-1.14, P=0.041).ConclusionsGroup A was independently associated with greater comorbidity, associated with an increase of 0.582 points in the Charlson Index compared to other blood groups. It was also associated with lower hospital mortality. (AU)