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1.
JAMA Netw Open ; 4(7): e2116901, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-34255046

RESUMEN

Importance: The National COVID Cohort Collaborative (N3C) is a centralized, harmonized, high-granularity electronic health record repository that is the largest, most representative COVID-19 cohort to date. This multicenter data set can support robust evidence-based development of predictive and diagnostic tools and inform clinical care and policy. Objectives: To evaluate COVID-19 severity and risk factors over time and assess the use of machine learning to predict clinical severity. Design, Setting, and Participants: In a retrospective cohort study of 1 926 526 US adults with SARS-CoV-2 infection (polymerase chain reaction >99% or antigen <1%) and adult patients without SARS-CoV-2 infection who served as controls from 34 medical centers nationwide between January 1, 2020, and December 7, 2020, patients were stratified using a World Health Organization COVID-19 severity scale and demographic characteristics. Differences between groups over time were evaluated using multivariable logistic regression. Random forest and XGBoost models were used to predict severe clinical course (death, discharge to hospice, invasive ventilatory support, or extracorporeal membrane oxygenation). Main Outcomes and Measures: Patient demographic characteristics and COVID-19 severity using the World Health Organization COVID-19 severity scale and differences between groups over time using multivariable logistic regression. Results: The cohort included 174 568 adults who tested positive for SARS-CoV-2 (mean [SD] age, 44.4 [18.6] years; 53.2% female) and 1 133 848 adult controls who tested negative for SARS-CoV-2 (mean [SD] age, 49.5 [19.2] years; 57.1% female). Of the 174 568 adults with SARS-CoV-2, 32 472 (18.6%) were hospitalized, and 6565 (20.2%) of those had a severe clinical course (invasive ventilatory support, extracorporeal membrane oxygenation, death, or discharge to hospice). Of the hospitalized patients, mortality was 11.6% overall and decreased from 16.4% in March to April 2020 to 8.6% in September to October 2020 (P = .002 for monthly trend). Using 64 inputs available on the first hospital day, this study predicted a severe clinical course using random forest and XGBoost models (area under the receiver operating curve = 0.87 for both) that were stable over time. The factor most strongly associated with clinical severity was pH; this result was consistent across machine learning methods. In a separate multivariable logistic regression model built for inference, age (odds ratio [OR], 1.03 per year; 95% CI, 1.03-1.04), male sex (OR, 1.60; 95% CI, 1.51-1.69), liver disease (OR, 1.20; 95% CI, 1.08-1.34), dementia (OR, 1.26; 95% CI, 1.13-1.41), African American (OR, 1.12; 95% CI, 1.05-1.20) and Asian (OR, 1.33; 95% CI, 1.12-1.57) race, and obesity (OR, 1.36; 95% CI, 1.27-1.46) were independently associated with higher clinical severity. Conclusions and Relevance: This cohort study found that COVID-19 mortality decreased over time during 2020 and that patient demographic characteristics and comorbidities were associated with higher clinical severity. The machine learning models accurately predicted ultimate clinical severity using commonly collected clinical data from the first 24 hours of a hospital admission.


Asunto(s)
COVID-19 , Bases de Datos Factuales , Predicción , Hospitalización , Modelos Biológicos , Índice de Severidad de la Enfermedad , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/etnología , COVID-19/mortalidad , Comorbilidad , Grupos Étnicos , Oxigenación por Membrana Extracorpórea , Femenino , Humanos , Concentración de Iones de Hidrógeno , Masculino , Persona de Mediana Edad , Pandemias , Respiración Artificial , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2 , Estados Unidos , Adulto Joven
2.
CMAJ Open ; 9(3): E718-E727, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34257090

RESUMEN

BACKGROUND: As in other jurisdictions, the demographics of people infected with SARS-CoV-2 changed in Quebec over the course of the first COVID-19 pandemic wave, and affected those living in residential care facilities (RCFs) disproportionately. We evaluated the association between clinical characteristics and outcomes of hospitalized patients with COVID-19, comparing those did or did not live in RCFs. METHODS: We conducted a retrospective case series of all consecutive adults (≥ 18 yr) admitted to the Jewish General Hospital in Montréal with laboratory-confirmed SARS-CoV-2 infection from Mar. 4 to June 30, 2020, with in-hospital follow-up until Aug. 6, 2020. We collected patient demographics, comorbidities and outcomes (i.e., admission to the intensive care unit, mechanical ventilation and death) from medical and laboratory records and compared patients who did or did not live in public and private RCFs. We evaluated factors associated with the risk of in-hospital death with a Cox proportional hazard model. RESULTS: In total, 656 patients were hospitalized between March and June 2020, including 303 patients who lived in RCFs and 353 patients who did not. The mean age was 72.9 (standard deviation 18.3) years (range 21 to 106 yr); 349 (53.2%) were female and 118 (18.0%) were admitted to the intensive care unit. The overall mortality rate was 23.8% (156/656), but was higher among patients living in RCFs (36.6% [111/303]) compared with those not living in RCFs (12.7% [45/353]). Increased risk of death was associated with age 80 years and older (hazard ratio [HR] 2.39, 95% confidence interval [CI] 1.35-4.24), male sex (HR 1.74, 95% CI 1.25-2.41), the presence of 4 or more comorbidities (HR 2.01, 95% CI 1.18-3.42) and living in an RCF (HR 1.62, 95% CI 1.09-2.39). INTERPRETATION: During the first wave of the COVID-19 epidemic in Montréal, more than one-third of RCF residents hospitalized with SARS-CoV-2 infection died during hospitalization. Policies and practices that prevent future outbreaks of SARS-CoV-2 infection in this setting must be implemented to prevent high mortality in this vulnerable population.


Asunto(s)
Instituciones de Vida Asistida/estadística & datos numéricos , COVID-19/mortalidad , Hospitalización/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Instituciones de Vida Asistida/tendencias , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/virología , Estudios de Casos y Controles , Comorbilidad , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Modelos de Riesgos Proporcionales , Quebec/epidemiología , Respiración Artificial/mortalidad , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación , Poblaciones Vulnerables/estadística & datos numéricos
3.
J Cardiothorac Surg ; 16(1): 198, 2021 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-34284809

RESUMEN

BACKGROUND: Poor glycemic control has been associated with an increased risk of wound complications after various types of operations. However, it remains unclear how hemoglobin A1c (HbA1c) and preoperative glycemia can be used in clinical decision-making to prevent sternal wound complications (SWC) following off-pump coronary artery bypass grafting (OPCAB). METHODS: We conducted a retrospective study of 1774 consecutive patients who underwent OPCAB surgery between January 2010 and November 2016. A new four-grade classification for SWC was used. The associations of HbA1c and preoperative glycemia with incidence and grade of SWC were analysed using logistic regression analysis and proportional odds models, respectively. RESULTS: During a median follow-up of 326 days (interquartile range (IQR) 21-1261 days), SWC occurred in 133/1316 (10%) of non-diabetes and 82/458 (18%) of diabetes patients (p < 0.001). Higher HbA1c was significantly associated with a higher incidence of SWC (odds ratio, OR 1.24 per 1% increase, 95% confidence interval, CI 1.04;1.48, p = 0.016) as well as a higher grade of SWC (OR 1.25, 95% CI 1.06;1.48, p = 0.010). There was no association between glycemia and incidence (p = 0.539) nor grade (p = 0.607) of SWC. Significant modifiers of these effects were found: HbA1c was associated with SWC in diabetes patients younger than 70 years (OR 1.41, 95% CI 1.17;1.71, p < 0.001), whereas it was not in those older than 70 years. Glycemia was associated with SWC in patients who underwent non-urgent surgery (OR 2.48, 95% CI 1.26;4.88, p = 0.009), in diabetes patients who received skeletonised grafts (OR 4.83, 95% CI 1.28;18.17, p = 0.020), and in diabetes patients with a BMI < 30 (OR 2.19, 95% CI 1.01;4.76, p = 0.047), whereas it was not in the counterparts of these groups. CONCLUSIONS: Under certain conditions, HbA1c and glycemia are associated SWC following OPCAB. These findings are helpful in planning the procedure with minimal risk of SWC.


Asunto(s)
Puente de Arteria Coronaria Off-Pump/efectos adversos , Enfermedad de la Arteria Coronaria/cirugía , Toma de Decisiones , Diabetes Mellitus/epidemiología , Hemoglobina A Glucada/metabolismo , Anciano , Biomarcadores/sangre , Glucemia/metabolismo , Comorbilidad , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/epidemiología , Diabetes Mellitus/sangre , Femenino , Humanos , Incidencia , Masculino , Oportunidad Relativa , Periodo Preoperatorio , Estudios Retrospectivos , Resultado del Tratamiento
4.
Pan Afr Med J ; 38: 326, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34285749

RESUMEN

Introduction: although the main manifestations of COVID-19 are respiratory, several neurological symptoms and complications have also been reported. The pandemic seems to have some epidemiological specificities in sub-Saharan Africa, and this may be reflected in the type and frequency of neurological symptoms. This study aimed to report neurological manifestations associated with symptomatic COVID-19 in a sub-Saharan African setting. Methods: we conducted a retrospective review of symptomatic PCR-confirmed COVID-19 cases admitted to the Bafoussam Regional Hospital between March and September 2020. Patients' files were reviewed at discharge by a consultant neurologist. Socio-demographic characteristics, co-morbidities, symptoms on admission, neurological symptoms during hospitalization, management, and in-hospital outcome were recorded. Comparisons between patients with and without neurological symptoms were performed using Fisher's exact and Mann-Whitney U test. Results: we enrolled 177 symptomatic patients (68% men). Mean age was 54.6 ± 17.8 years (range 2-99 years). Co-morbidities were present in 57.6% of patients, including hypertension (27.1%) and diabetes mellitus (25.4%). Neurological symptoms were found in 113 (63.8%) patients. The most frequent were headache (39.0%), myalgia (35.6%), anosmia (11.9%), impaired consciousness (10.7%) and delirium (5.6%). Regarding the presenting symptoms, fever was more frequent in patients with neurological symptoms than in those without (81.4% versus 50.0%, p< 0.001), while digestive symptoms were less frequent in patients with neurological symptoms (0.9% versus 9.4%, p= 0.004). Conclusion: neurological manifestations are frequent and heterogeneous in patients with symptomatic COVID-19. Further studies are needed to clarify the pathophysiology of neurological symptoms in COVID-19 and their impact on patients' long-term outcome.


Asunto(s)
COVID-19/complicaciones , Hospitalización , Enfermedades del Sistema Nervioso/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Camerún , Niño , Preescolar , Comorbilidad , Femenino , Fiebre/epidemiología , Fiebre/virología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/fisiopatología , Estudios Retrospectivos , Adulto Joven
5.
J Environ Public Health ; 2021: 6662476, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34239576

RESUMEN

Objectives: This study evaluated the clinical manifestation of COVID-19 and adverse outcomes in patients with comorbidities (outcome: death). Methods: A comparative follow-up investigation involving 148 confirmed cases of COVID-19 was performed for a month (between April and May 2020) at Qaha Hospital to describe the clinical characteristics and outcomes resulting from comorbidities. Participants were divided into two clusters based on the presence of comorbidities. Group I comprised cases with comorbidities, and Group II included subjects without comorbidity. Survival distributions were outlined for the group with comorbidities after the follow-up period. Results: Fever (74.3%), headache (78.4%), cough (78.4%), sore throat (78.4%), fatigue (78.4%), and shortness of breath (86.5%) were the most prevalent symptoms observed in COVID-19 patients with comorbidities. Such patients also suffered from acute respiratory distress syndrome (37.8%) and pneumonia three times more than patients without comorbidities. The survival distributions were statistically significant (chi-square = 26.06, p ≤ 0.001). Conclusion: Multiple comorbidities in COVID-19 patients are linked to severe clinical symptoms, disease complications, and critical disease progression. The presence of one or more comorbidities worsened the survival rate of patients.


Asunto(s)
COVID-19/epidemiología , COVID-19/mortalidad , Comorbilidad , Neumonía/epidemiología , Neumonía/mortalidad , Síndrome de Dificultad Respiratoria/epidemiología , Síndrome de Dificultad Respiratoria/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Egipto/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , SARS-CoV-2 , Adulto Joven
6.
Pediatr Infect Dis J ; 40(8): e287-e293, 2021 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-34250967

RESUMEN

BACKGROUND: We aimed to identify risk factors causing critical disease in hospitalized children with COVID-19 and to build a predictive model to anticipate the probability of need for critical care. METHODS: We conducted a multicenter, prospective study of children with SARS-CoV-2 infection in 52 Spanish hospitals. The primary outcome was the need for critical care. We used a multivariable Bayesian model to estimate the probability of needing critical care. RESULTS: The study enrolled 350 children from March 12, 2020, to July 1, 2020: 292 (83.4%) and 214 (73.7%) were considered to have relevant COVID-19, of whom 24.2% required critical care. Four major clinical syndromes of decreasing severity were identified: multi-inflammatory syndrome (MIS-C) (17.3%), bronchopulmonary (51.4%), gastrointestinal (11.6%), and mild syndrome (19.6%). Main risk factors were high C-reactive protein and creatinine concentration, lymphopenia, low platelets, anemia, tachycardia, age, neutrophilia, leukocytosis, and low oxygen saturation. These risk factors increased the risk of critical disease depending on the syndrome: the more severe the syndrome, the more risk the factors conferred. Based on our findings, we developed an online risk prediction tool (https://rserver.h12o.es/pediatria/EPICOAPP/, username: user, password: 0000). CONCLUSIONS: Risk factors for severe COVID-19 include inflammation, cytopenia, age, comorbidities, and organ dysfunction. The more severe the syndrome, the more the risk factor increases the risk of critical illness. Risk of severe disease can be predicted with a Bayesian model.


Asunto(s)
COVID-19/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Adolescente , Teorema de Bayes , COVID-19/epidemiología , Niño , Preescolar , Comorbilidad , Cuidados Críticos , Enfermedad Crítica , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Prospectivos , Factores de Riesgo , SARS-CoV-2/aislamiento & purificación , Índice de Severidad de la Enfermedad , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología
7.
Rev Cardiovasc Med ; 22(2): 343-351, 2021 06 30.
Artículo en Inglés | MEDLINE | ID: mdl-34258902

RESUMEN

Coronavirus disease 2019 (COVID-19), a mystified cryptic virus has challenged the mankind that has brought life to a standstill. Catastrophic loss of life, perplexed healthcare system and the downfall of global economy are some of the outcomes of this pandemic. Humans are raging a war with an unknown enemy. Infections, irrespective of age and gender, and more so in comorbidities are escalating at an alarming rate. Cardiovascular diseases, are the leading cause of death globally with an estimate of 31% of deaths worldwide out of which nearly 85% are due to heart attacks and stroke. Theoretically and practically, researchers have observed that persons with pre-existing cardiovascular conditions are comparatively more vulnerable to the COVID-19 infection. Moreover, they have studied the data between less severe and more severe cases, survivors and non survivors, intensive care unit (ICU) patients and non ICU patients, to analyse the relationship and the influence of COVID-19 on cardiovascular health of an individual, further the risk of susceptibility to submit to the virus. This review aims to provide a comprehensive particular on the possible effects, either direct or indirect, of COVID-19 on the cardiovascular heath of an individual.


Asunto(s)
COVID-19/virología , Enfermedades Cardiovasculares/virología , Sistema Cardiovascular/virología , SARS-CoV-2/patogenicidad , Antivirales/uso terapéutico , COVID-19/tratamiento farmacológico , COVID-19/mortalidad , COVID-19/fisiopatología , COVID-19/terapia , Fármacos Cardiovasculares/uso terapéutico , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/fisiopatología , Enfermedades Cardiovasculares/terapia , Sistema Cardiovascular/efectos de los fármacos , Sistema Cardiovascular/fisiopatología , Comorbilidad , Interacciones Huésped-Patógeno , Humanos , Pronóstico , Medición de Riesgo , Factores de Riesgo , SARS-CoV-2/efectos de los fármacos
8.
BMC Infect Dis ; 21(1): 688, 2021 Jul 16.
Artículo en Inglés | MEDLINE | ID: mdl-34271860

RESUMEN

BACKGROUND: Being able to use COVID-19 RT-PCR Ct values as simple clinical markers of disease outcome or prognosis would allow for the easy and proactive identification and triaging of high-risk cases. This study's objective was thus to explore whether a correlation exists between COVID-19 viral loads, as indicated by RT-PCR Ct values, and disease severity, as indicated by respiratory indices. RESULTS: A multi-centre cross-sectional retrospective study was conducted, using data obtained from Bahrain's National COVID-19 Task force's centralised database. The study period ranged from May 2, 2020 to July 31, 2020. A multivariable logistic regression was used to assess for a correlation using data from a total of 1057 admitted COVID-19 cases. The covariates adjusted for included sex, age, presentation, and comorbidities. In our cohort, Ct value showed no statistical significance for an association with requirement for oxygenation on admission (Odds ratio 1.046; 95%CI 0.999 to 1.096, p = 0.054). CONCLUSION: Viral load, as indicated by Ct values, did not seem to be associated with requirement for oxygenation on admission in our cohort. We postulate however that time since onset of symptom may have acted as an unaccounted-for confounder. As such, RT-PCR Ct values may not be a useful prognostic clinical tool in isolation.


Asunto(s)
COVID-19/diagnóstico , COVID-19/patología , SARS-CoV-2/fisiología , Carga Viral/fisiología , Adulto , Anciano , Bahrein/epidemiología , COVID-19/epidemiología , COVID-19/virología , Estudios de Cohortes , Comorbilidad , Estudios Transversales , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Pulmón/patología , Pulmón/virología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación , Pruebas Serológicas , Índice de Severidad de la Enfermedad , Carga Viral/estadística & datos numéricos
9.
BMC Infect Dis ; 21(1): 687, 2021 Jul 16.
Artículo en Inglés | MEDLINE | ID: mdl-34271868

RESUMEN

BACKGROUND: COVID-19 can occur asymptomatically, as influenza-like illness, or as more severe forms, which characterize severe acute respiratory syndrome (SARS). Its mortality rate is higher in individuals over 80 years of age and in people with comorbidities, so these constitute the risk group for severe forms of the disease. We analyzed the factors associated with death in confirmed cases of COVID-19 in the state of Rio de Janeiro. This cross-sectional study evaluated the association between individual demographic, clinical, and epidemiological variables and the outcome (death) using data from the Unified Health System information systems. METHODS: We used the extreme boosting gradient (XGBoost) model to analyze the data, which uses decision trees weighted by the estimation difficulty. To evaluate the relevance of each independent variable, we used the SHapley Additive exPlanations (SHAP) metric. From the probabilities generated by the XGBoost model, we transformed the data to the logarithm of odds to estimate the odds ratio for each independent variable. RESULTS: This study showed that older individuals of black race/skin color with heart disease or diabetes who had dyspnea or fever were more likely to die. CONCLUSIONS: The early identification of patients who may progress to a more severe form of the disease can help improve the clinical management of patients with COVID-19 and is thus essential to reduce the lethality of the disease.


Asunto(s)
COVID-19/epidemiología , COVID-19/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , COVID-19/diagnóstico , COVID-19/patología , Niño , Preescolar , Ciudades/epidemiología , Comorbilidad , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Mortalidad , Pronóstico , Medición de Riesgo , Factores de Riesgo , SARS-CoV-2/fisiología , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Análisis de Supervivencia , Adulto Joven
10.
S Afr Fam Pract (2004) ; 63(1): e1-e5, 2021 06 10.
Artículo en Inglés | MEDLINE | ID: mdl-34212748

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a public health crisis that threatens the current health system. The sudden expansion in the need for inpatient and intensive care facilities raised concerns about optimal clinical management and resource allocation. Despite the pressing need for evidence to make context-specific decisions on COVID-19 management, evidence from South Africa remained limited. This study aimed to describe the clinical characteristics and outcomes of COVID-19 hospitalised patients. METHODS: A retrospective cross-sectional study design was used to evaluate the clinical outcomes of hospitalised adult patients (≥ 18 years old) with laboratory-confirmed COVID-19 illness at Mthatha Regional Hospital (MRH), Eastern Cape. RESULTS: Of the 1814 patients tested for COVID-19 between 20 March 2020 and 31 July 2020 at MRH, two-thirds (65.4%) were female. About two-thirds (242) of the 392 patients (21.6%) who tested positive for this disease were hospitalised and one-third (150) were quarantined at home. The mean age of the patients tested for COVID-19 was 42.6 years and there was no difference between males and females. The mean age of hospitalised patients was 55.5 years and the mean age of hospitalised patients who died (61.3 years) was much higher than recovered (49.5 years). Overall, 188 (77.6%) hospitalised patients had clinical comorbidity on admission. Diabetes (36.8%) and hypertension (33.1%) were the most common comorbidities amongst COVID-19 hospitalised patients. CONCLUSION: The majority of the patients who were hospitalised for COVID-19 were elderly and had high baseline comorbidities. Advance age and underlying comorbidities (diabetes, hypertension and HIV) were associated with high mortality in hospitalised COVID-19 patients.


Asunto(s)
COVID-19 , Control de Enfermedades Transmisibles , Diabetes Mellitus/epidemiología , Hospitalización/estadística & datos numéricos , Hipertensión/epidemiología , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/terapia , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Comorbilidad , Estudios Transversales , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Manejo de Atención al Paciente/métodos , SARS-CoV-2/aislamiento & purificación , Sudáfrica/epidemiología
11.
Int J Med Sci ; 18(13): 2789-2798, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34220307

RESUMEN

Coronavirus disease 2019 (COVID-19) has spread widely in the communities in many countries. Although most of the mild patients could be cured by their body's ability to self-heal, many patients quickly progressed to severe disease and had to undergo treatment in the intensive care unit (ICU). Thus, it is very important to effectively predict which patients with mild disease are more likely to progress to severe disease. A total of 72 patients hospitalized with COVID-19 in Shandong Provincial Public Health Clinical Center and 1141 patients included in the published papers were enrolled in this study. We determined that the combination of interleukin-6 (IL-6), Neutrophil (NEUT), and Natural Killer (NK) cells had the highest prediction accuracy (with 75% sensitivity and 95% specificity) for progression of COVID-19 infection. A binomial regression equation that accounted for a multiple risk score for the combination of IL-6, NEUT, and NK was also established. The multiple risk score is a good indicator for early stratification of mild patients into risk categories, which is very important for adjusting the treatment plan and preventing death.


Asunto(s)
Biomarcadores/análisis , COVID-19/etiología , Anciano , Biomarcadores/sangre , Recuento de Células Sanguíneas , COVID-19/epidemiología , Comorbilidad , Progresión de la Enfermedad , Humanos , Interleucina-6/sangre , Células Asesinas Naturales , Persona de Mediana Edad , Neutrófilos , Estudios Retrospectivos
12.
BMC Infect Dis ; 21(1): 657, 2021 Jul 07.
Artículo en Inglés | MEDLINE | ID: mdl-34233630

RESUMEN

BACKGROUND: HIV-positive patients are increasingly being affected by non-communicable diseases such as coronary artery disease (CAD). Data from high-income countries (HICs) indicate that HIV-positive patients have different risk-factor profiles for acute coronary syndrome (ACS) as well as different cardiac manifestations of this syndrome compared to HIV-negative patients. There is limited data from Sub-Saharan Africa (SSA), and particularly from South Africa with the biggest HIV epidemic in the world. The objective of this study was to determine the 12-month period prevalence of HIV in patients with ACS and to compare the risk-factor profile, ACS presentation and management between HIV-positive and HIV-negative adults. METHODS: We included all patients hospitalised with ACS from 01 January to 31 December 2018 in a tertiary hospital, Tygerberg Hospital, in Cape Town, South Africa. The HIV-status of all patients was determined using routine clinical records. We performed multiple conditional logistic regression on HIV-positive and HIV-negative patients (1:3 ratio) to compare the risk factor profile, ACS presentation and management between the groups. RESULTS: Among 889 patients, 30 (3.4%) were HIV-positive (95% confidence interval (CI): 2.3-4.8). HIV-positive patients were younger, more frequently men, and had a lower prevalence of medical comorbidities and a family history of CAD. They were more likely to present with ST-elevation myocardial infarction (STEMI) [odd's ratio (OR) (95% CI): 3.12 (1.2-8.4)], and have single-vessel disease [OR (95% CI): 3.03 (1.2-8.0)]. Angiographic and echocardiographic data, as well as management, did not differ between the groups. Among HIV-positive patients, 17 (65%) were virally suppressed (HIV viral load < 200 copies/mL) with a median CD4+ count of 271 cells/mm3. The majority (20, 67%) of HIV-positive patients were receiving antiretroviral therapy at the time of the ACS. CONCLUSIONS: We found an HIV-prevalence of 3.4% (95% CI 2.3-4.8) in adults with ACS in a high endemic HIV region. HIV-positive patients were younger and more likely to present with STEMIs and single-vessel disease, but had fewer CAD risk factors, suggesting additional mechanisms for the development of ACS.


Asunto(s)
Síndrome Coronario Agudo/epidemiología , Enfermedad de la Arteria Coronaria/epidemiología , Infecciones por VIH/epidemiología , Síndrome Coronario Agudo/terapia , Adulto , Anciano , Comorbilidad , Estudios Transversales , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Sudáfrica/epidemiología
13.
BMC Infect Dis ; 21(1): 656, 2021 Jul 07.
Artículo en Inglés | MEDLINE | ID: mdl-34233638

RESUMEN

BACKGROUND: Coronavirus Disease 2019 (Covid-19) is expanding worldwide. The characteristics of this infection in patients varies from country to country. To move forward, clinical data on infected patients are needed. Here, we report a comparison between fatalities and recovery of patients with severe Covid-19, based on demographic and clinical characteristics. METHODS: Between 5 March and 12 May 2020 in Mashhad, Iran, 1278 of 4000 suspected Covid-19 patients were confirmed positive by real-time reverse-transcriptase-polymerase-chain-reaction assay of upper respiratory specimens. We compared the demographic, exposure history and clinical symptoms of 925 survivors and 353 fatal cases with confirmed disease. RESULTS: Mean (SD) age for all confirmed patients was 56.9 (18.7) years, 67.1 (15.9) years in fatal cases and 53.0 (18.3) years in survivors. Multivariate logistic regression analysis showed that the outcome of patients was associated with age (odds ratio = 1.049, P = 0.0001, 95% CI = 1.040-1.057). Despite a high burden of Covid-19 infections in the 30-39 and 40-49 year age groups, most of these (89.6 and 87.2%, respectively) recovered. The median (IQR) duration of hospitalization was 9.0 (6.0-14.0) days. The most prevalent co-morbidities were cardiovascular disorders (21%) and diabetes (16.3%). Dyspnoea (72.7%), cough (68.1%) and fever (63.8%) were the most frequent clinical symptoms. Healthcare workers, of whom two (3%) died, comprised 5.2% of infected cases. Combination antiviral and antibiotic therapy was used in 43.0% of cases. CONCLUSIONS: The characteristics of severe Covid-19 varied substantially between fatal cases and survivors, with diabetes and cardiovascular disorders the most prevalent co-morbidities. In contrast to other studies, there were a higher number of fatalities in younger patients in our setting.


Asunto(s)
COVID-19/diagnóstico , Hospitalización/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , COVID-19/tratamiento farmacológico , COVID-19/mortalidad , Enfermedades Cardiovasculares/epidemiología , Niño , Preescolar , Comorbilidad , Tos/etiología , Estudios Transversales , Diabetes Mellitus/epidemiología , Disnea/etiología , Femenino , Fiebre/etiología , Humanos , Lactante , Recién Nacido , Irán/epidemiología , Masculino , Persona de Mediana Edad , Reacción en Cadena en Tiempo Real de la Polimerasa , SARS-CoV-2 , Resultado del Tratamiento , Adulto Joven
14.
Clin Exp Rheumatol ; 39(4): 705-720, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34238403

RESUMEN

Management of rheumatoid arthritis (RA) has evolved over the years as a result of better understanding of the role of different therapeutic strategies, as well as following an increasing availability of new disease-modifying antirheumatic drugs. However, the role of patients in sharing decisions, as well as the rules informing precision medicine or the principles to follow in case of specific comorbidities or extra-articular manifestations are still areas for improvement. Moreover, in 2020, the novel Coronavirus disease-19 outbreak has completely changed many attitudes in terms of assessment and treatment paradigms in most clinical diseases, including RA. In this narrative review, the authors report their specific point of view on the management of RA, based on a critical revision of literature published in 2020, focusing on relevant novelties and future research directions.


Asunto(s)
Antirreumáticos , Artritis Reumatoide , COVID-19 , Antirreumáticos/efectos adversos , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/epidemiología , Comorbilidad , Humanos , SARS-CoV-2
15.
Medicina (Kaunas) ; 57(6)2021 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-34207966

RESUMEN

Childhood onset bipolar disorder (CO-BD) presents a panoply of difficulties associated with early recognition and treatment. CO-BD is associated with a variety of precursors and comorbidities that have been inadequately studied, so treatment remains obscure. The earlier the onset, the longer is the delay to first treatment, and both early onset and treatment delay are associated with more depressive episodes and a poor prognosis in adulthood. Ultra-rapid and ultradian cycling, consistent with a diagnosis of BP-NOS, are highly prevalent in the youngest children and take long periods of time and complex treatment regimens to achieve euthymia. Lithium and atypical antipsychotics are effective in mania, but treatment of depression remains obscure, with the exception of lurasidone, for children ages 10-17. Treatment of the common comorbid anxiety disorders, oppositional defiant disorders, pathological habits, and substance abuse are all poorly studied and are off-label. Cognitive dysfunction after a first manic hospitalization improves over the next year only on the condition that no further episodes occur. Yet comprehensive expert treatment after an initial manic hospitalization results in many fewer relapses than traditional treatment as usual, emphasizing the need for combined pharmacological, psychosocial, and psycho-educational approaches to this difficult and highly recurrent illness.


Asunto(s)
Antipsicóticos , Trastorno Bipolar , Trastornos Relacionados con Sustancias , Adolescente , Adulto , Antipsicóticos/uso terapéutico , Trastorno Bipolar/complicaciones , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/tratamiento farmacológico , Niño , Comorbilidad , Humanos , Litio/uso terapéutico , Trastornos Relacionados con Sustancias/epidemiología
16.
Nutrients ; 13(6)2021 Jun 16.
Artículo en Inglés | MEDLINE | ID: mdl-34208529

RESUMEN

On 11 March 2020, coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO). This study focuses on a narrative review about the illness during the first year of the pandemic in relation to obesity. Databases were used to search studies published up to 8 December 2020. In total, 4430 articles and other scientific literature were found, and 24 articles were included in this one-year narrative review. The mean BMI value of severe COVID-19 patients ranged from 24.5 to 33.4 kg/m2, versus <18.5 to 24.3 kg/m2 for non-severe patients. Articles using the terms obesity or overweight without indicating the BMI value in these patients were common, but this is not useful, as the anthropometric parameters, when not defined by this index, are confusing due to the classification being different in the West compared to among Asian and Korean criteria-based adults. We proposed a new term, called COVID obesity, to define the importance of this anthropometric parameter, among others, in relation with this pandemic.


Asunto(s)
Índice de Masa Corporal , COVID-19/epidemiología , Obesidad/epidemiología , Pandemias , Comorbilidad , Humanos , Sobrepeso/epidemiología , SARS-CoV-2 , Índice de Severidad de la Enfermedad
17.
PLoS One ; 16(7): e0252384, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34214101

RESUMEN

Early prediction of patient mortality risks during a pandemic can decrease mortality by assuring efficient resource allocation and treatment planning. This study aimed to develop and compare prognosis prediction machine learning models based on invasive laboratory and noninvasive clinical and demographic data from patients' day of admission. Three Support Vector Machine (SVM) models were developed and compared using invasive, non-invasive, and both groups. The results suggested that non-invasive features could provide mortality predictions that are similar to the invasive and roughly on par with the joint model. Feature inspection results from SVM-RFE and sparsity analysis displayed that, compared with the invasive model, the non-invasive model can provide better performances with a fewer number of features, pointing to the presence of high predictive information contents in several non-invasive features, including SPO2, age, and cardiovascular disorders. Furthermore, while the invasive model was able to provide better mortality predictions for the imminent future, non-invasive features displayed better performance for more distant expiration intervals. Early mortality prediction using non-invasive models can give us insights as to where and with whom to intervene. Combined with novel technologies, such as wireless wearable devices, these models can create powerful frameworks for various medical assignments and patient triage.


Asunto(s)
COVID-19/mortalidad , Pandemias , SARS-CoV-2 , Máquina de Vectores de Soporte , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Registros Electrónicos de Salud , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Modelos Teóricos , Riesgo , Índice de Severidad de la Enfermedad , Evaluación de Síntomas , Triaje , Adulto Joven
18.
PLoS One ; 16(7): e0253977, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34214116

RESUMEN

SARS-CoV-2 pandemic is causing high morbidity and mortality burden worldwide with unprecedented strain on health care systems. To investigate the time course of the antibody response in relation to the outcome we performed a study in hospitalized COVID-19 patients. As comparison we also investigated the time course of the antibody response in SARS-CoV-2 asymptomatic subjects. Study results show that patients produce a strong antibody response to SARS-CoV-2 with high correlation between different viral antigens (spike protein and nucleoprotein) and among antibody classes (IgA, IgG, and IgM and neutralizing antibodies). The antibody peak is reached by 3 weeks from hospital admission followed by a sharp decrease. No difference was observed in any parameter of the antibody classes, including neutralizing antibodies, between subjects who recovered or with fatal outcome. Only few asymptomatic subjects developed antibodies at detectable levels.


Asunto(s)
Anticuerpos Neutralizantes/biosíntesis , Anticuerpos Antivirales/biosíntesis , Infecciones Asintomáticas , COVID-19/inmunología , SARS-CoV-2/inmunología , Anciano , Anticuerpos Neutralizantes/sangre , Anticuerpos Neutralizantes/inmunología , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , COVID-19/mortalidad , Comorbilidad , Femenino , Hospitalización , Humanos , Inmunoglobulina A/biosíntesis , Inmunoglobulina A/sangre , Inmunoglobulina A/inmunología , Inmunoglobulina G/biosíntesis , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Inmunoglobulina M/biosíntesis , Inmunoglobulina M/sangre , Inmunoglobulina M/inmunología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Admisión del Paciente , Estudios Retrospectivos
19.
Rev Soc Bras Med Trop ; 54: e01382021, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34231772

RESUMEN

INTRODUCTION: We investigated the association of self-reported comorbidities with fatality risk among individuals infected with Coronavirus disease 2019 (COVID-19) in Espírito Santo State, Brazil. METHODS: We included 212,620 individuals, ≥30 years old. The data were obtained from the COVID-19 panel. Kaplan-Meier curves and Cox regression model were used. RESULTS: COVID-19-positive individuals presenting with chronic conditions were at a higher risk of fatality than individuals without these comorbidities. Age had a significant effect on these relationships. CONCLUSIONS: Comorbidities were associated with an increased risk of fatality. Middle-aged people (30-59 years) with comorbidities should also be considered as a vulnerable group.


Asunto(s)
COVID-19 , Adulto , Brasil/epidemiología , Comorbilidad , Ambiente , Humanos , Persona de Mediana Edad , SARS-CoV-2
20.
BMC Infect Dis ; 21(1): 663, 2021 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-34238232

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with a high mortality rate, especially in patients with severe illness. We conducted a systematic review and meta-analysis to assess the potential predictors of mortality in patients with COVID-19. METHODS: PubMed, EMBASE, the Cochrane Library, and three electronic Chinese databases were searched from December 1, 2019 to April 29, 2020. Eligible studies reporting potential predictors of mortality in patients with COVID-19 were identified. Unadjusted prognostic effect estimates were pooled using the random-effects model if data from at least two studies were available. Adjusted prognostic effect estimates were presented by qualitative analysis. RESULTS: Thirty-six observational studies were identified, of which 27 were included in the meta-analysis. A total of 106 potential risk factors were tested, and the following important predictors were associated with mortality: advanced age, male sex, current smoking status, preexisting comorbidities (especially chronic kidney, respiratory, and cardio-cerebrovascular diseases), symptoms of dyspnea, complications during hospitalization, corticosteroid therapy and a severe condition. Additionally, a series of abnormal laboratory biomarkers of hematologic parameters, hepatorenal function, inflammation, coagulation, and cardiovascular injury were also associated with fatal outcome. CONCLUSION: We identified predictors of mortality in patients with COVID-19. These findings could help healthcare providers take appropriate measures and improve clinical outcomes in such patients.


Asunto(s)
COVID-19/diagnóstico , COVID-19/mortalidad , Corticoesteroides/administración & dosificación , Distribución por Edad , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Bases de Datos Factuales , Disnea/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Inflamación/epidemiología , Riñón/fisiopatología , Hígado/fisiopatología , Masculino , Estudios Observacionales como Asunto , Pronóstico , Factores de Riesgo , Distribución por Sexo , Fumadores/estadística & datos numéricos
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