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1.
Rev Esp Quimioter ; 33(4): 267-273, 2020 Aug.
Artículo en Español | MEDLINE | ID: mdl-32657550

RESUMEN

OBJECTIVE: Identify which biomarkers performed in the first emergency analysis help to stratify COVID-19 patients according to mortality risk. METHODS: Observational, descriptive and cross-sectional study performed with data collected from patients with suspected COVID-19 in the Emergency Department from February 24 to March 16, 2020. The univariate and multivariate study was performed to find independent mortality markers and calculate risk by building a severity score. RESULTS: A total of 163 patients were included, of whom 33 died and 29 of them were positive for the COVID-19 PCR test. We obtained as possible factors to conform the Mortality Risk Score age> 75 years ((adjusted OR = 12,347, 95% CI: 4,138-36,845 p = 0.001), total leukocytes> 11,000 cells / mm3 (adjusted OR = 2,649, 95% CI: 0.879-7.981 p = 0.083), glucose> 126 mg / dL (adjusted OR = 3.716, 95% CI: 1.247-11.074 p = 0.018) and creatinine> 1.1 mg / dL (adjusted OR = 2.566, 95% CI: 0.889- 7.403, p = 0.081) This score was called COVEB (COVID, Age, Basic analytical profile) with an AUC 0.874 (95% CI: 0.816-0.933, p <0.001; Cut-off point = 1 (sensitivity = 89.66 % (95% CI: 72.6% -97.8%), specificity = 75.59% (95% CI: 67.2% -82.8%). A score <1 has a negative predictive value = 100% (95% CI: 93.51% -100%) and a positive predictive value = 18.59% (95% CI: 12.82% -25.59%). CONCLUSIONS: Clinical severity scales, kidney function biomarkers, white blood cell count parameters, the total neutrophils / total lymphocytes ratio and procalcitonin are early risk factors for mortality. The variables age, glucose, creatinine and total leukocytes stand out as the best predictors of mortality. A COVEB score <1 indicates with a 100% probability that the patient with suspected COVID-19 will not die in the next 30 days.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/mortalidad , Neumonía Viral/sangre , Neumonía Viral/mortalidad , Factores de Edad , Anciano , Análisis de Varianza , Área Bajo la Curva , Biomarcadores/sangre , Glucemia/análisis , Infecciones por Coronavirus/diagnóstico , Creatinina/sangre , Estudios Transversales , Servicio de Urgencia en Hospital , Femenino , Humanos , Hipertensión/mortalidad , Recuento de Leucocitos , Masculino , Oportunidad Relativa , Pandemias , Neumonía Viral/diagnóstico , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Medición de Riesgo/métodos , Sensibilidad y Especificidad
2.
Cardiovasc Diabetol ; 19(1): 114, 2020 07 20.
Artículo en Inglés | MEDLINE | ID: mdl-32690029

RESUMEN

In the pandemic "Corona Virus Disease 2019" (COVID-19) people with diabetes have a high risk to require ICU admission. The management of diabetes in Intensive Care Unit is always challenging, however, when diabetes is present in COVID-19 the situation seems even more complicated. An optimal glycemic control, avoiding acute hyperglycemia, hypoglycemia and glycemic variability may significantly improve the outcome. In this case, intravenous insulin infusion with continuous glucose monitoring should be the choice. No evidence suggests stopping angiotensin-converting-enzyme inhibitors, angiotensin-renin-blockers or statins, even it has been suggested that they may increase the expression of Angiotensin-Converting-Enzyme-2 (ACE2) receptor, which is used by "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to penetrate into the cells. A real issue is the usefulness of several biomarkers, which have been suggested to be measured during the COVID-19. N-Terminal-pro-Brain Natriuretic-Peptide, D-dimer and hs-Troponin are often increased in diabetes. Their meaning in the case of diabetes and COVID-19 should be therefore very carefully evaluated. Even though we understand that in such a critical situation some of these requests are not so easy to implement, we believe that the best possible action to prevent a worse outcome is essential in any medical act.


Asunto(s)
Betacoronavirus/patogenicidad , Glucemia/efectos de los fármacos , Infecciones por Coronavirus/terapia , Diabetes Mellitus/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Unidades de Cuidados Intensivos , Neumonía Viral/terapia , Antihipertensivos/uso terapéutico , Biomarcadores/sangre , Glucemia/metabolismo , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Dislipidemias/tratamiento farmacológico , Dislipidemias/mortalidad , Interacciones Huésped-Patógeno , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipertensión/tratamiento farmacológico , Hipertensión/mortalidad , Hipoglucemiantes/efectos adversos , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/virología , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento
3.
Artículo en Inglés | MEDLINE | ID: mdl-32609257

RESUMEN

Age, sex and presence of comorbidities are risk factors associated with COVID-19. Hypertension, diabetes and heart disease are the most common comorbidities in patients with COVID-19. The objective of this study was to estimate the prevalence of patients with comorbidities who died of COVID-19 in Brazil. Searches of data were carried out on the official pages of the 26 State health departments and the federal district. The random-effect method was used to calculate the prevalence of patients with comorbidities who died. From the beginning of the pandemic in Brazil until May 20, 2020, 276,703 cases of COVID-19 were notified in Brazil, 6.4% died, 58.6% of whom were male. The prevalence of comorbidities among deaths was 83% (95% CI: 79 - 87), with heart disease and diabetes being the most prevalent. To our knowledge, this study represents the first large analysis of cases of patients with confirmed COVID-19 in Brazil. There is a high prevalence of comorbidities (83%) among patients who died from COVID-19 in Brazil, with heart disease being the most prevalent. This is important considering the possible secondary effects produced by drugs such as hydroxychloroquine.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Cardiopatías/mortalidad , Pandemias/estadística & datos numéricos , Neumonía Viral/mortalidad , Brasil/epidemiología , Enfermedad Crónica , Comorbilidad , Diabetes Mellitus/mortalidad , Femenino , Humanos , Hipertensión/mortalidad , Enfermedades del Sistema Inmune/mortalidad , Unidades de Cuidados Intensivos/estadística & datos numéricos , Enfermedades Renales/mortalidad , Enfermedades Pulmonares/mortalidad , Masculino , Obesidad/mortalidad , Neumonía/mortalidad , Prevalencia , Factores de Riesgo , Distribución por Sexo , Factores Sexuales , Accidente Cerebrovascular/mortalidad
4.
Eur Heart J ; 41(22): 2058-2066, 2020 06 07.
Artículo en Inglés | MEDLINE | ID: mdl-32498076

RESUMEN

AIMS: It remains unknown whether the treatment of hypertension influences the mortality of patients diagnosed with coronavirus disease 2019 (COVID-19). METHODS AND RESULTS: This is a retrospective observational study of all patients admitted with COVID-19 to Huo Shen Shan Hospital. The hospital was dedicated solely to the treatment of COVID-19 in Wuhan, China. Hypertension and the treatments were stratified according to the medical history or medications administrated prior to the infection. Among 2877 hospitalized patients, 29.5% (850/2877) had a history of hypertension. After adjustment for confounders, patients with hypertension had a two-fold increase in the relative risk of mortality as compared with patients without hypertension [4.0% vs. 1.1%, adjusted hazard ratio (HR) 2.12, 95% confidence interval (CI) 1.17-3.82, P = 0.013]. Patients with a history of hypertension but without antihypertensive treatment (n = 140) were associated with a significantly higher risk of mortality compared with those with antihypertensive treatments (n = 730) (7.9% vs. 3.2%, adjusted HR 2.17, 95% CI 1.03-4.57, P = 0.041). The mortality rates were similar between the renin-angiotensin-aldosterone system (RAAS) inhibitor (4/183) and non-RAAS inhibitor (19/527) cohorts (2.2% vs. 3.6%, adjusted HR 0.85, 95% CI 0.28-2.58, P = 0.774). However, in a study-level meta-analysis of four studies, the result showed that patients with RAAS inhibitor use tend to have a lower risk of mortality (relative risk 0.65, 95% CI 0.45-0.94, P = 0.20). CONCLUSION: While hypertension and the discontinuation of antihypertensive treatment are suspected to be related to increased risk of mortality, in this retrospective observational analysis, we did not detect any harm of RAAS inhibitors in patients infected with COVID-19. However, the results should be considered as exploratory and interpreted cautiously.


Asunto(s)
Antihipertensivos/uso terapéutico , Betacoronavirus , Infecciones por Coronavirus/mortalidad , Hipertensión/tratamiento farmacológico , Neumonía Viral/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , China/epidemiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/complicaciones , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Estudios Retrospectivos
5.
Infez Med ; 28(2): 238-242, 2020 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-32487789

RESUMEN

The present study is aimed to assess the risk factors for mortality in the first 107 rRT-PCR confirmed cases of SARS-CoV-2 infections in Bolivia. For this observational, retrospective and cross-sectional study, the epidemiological data records were collected from the Hospitals and the Ministry of Health of Bolivia, obtaining the clinical and epidemiological data of the COVID-19 cases that were laboratory-diagnosed during March 2-29, 2020. Samples were tested by rRT-PCR to SARS-CoV-2 at the Laboratory of the National Center of Tropical Diseases (CENETROP), following the protocol Charite, Berlin, Germany. The odds ratio (OR) with respective 95% confidence interval (95%CI) for mortality as dependent variable was calculated. When we comparatively analyzed survivors and non-survivors in this first group of 107 cases in Bolivia, we found that at bivariate analyses, age (±60 years old), hypertension, chronic heart failure, diabetes, and obesity, as well as the requirement of ICU, were significantly exposure variables associated with death. At the multivariate analysis (logistic regression), two variables remained significantly associated, age, ±60 years-old (OR=9.4, 95%CI 1.8-104.1) and hypertension (OR=3.3, 95%CI 1.3-6.3). As expected, age and comorbidities, particularly hypertension, were independent risk factors for mortality in Bolivia in the first 107 cases group. More further studies are required to better define risk factors and preventive measures related to COVID-19 in this and other Latin American countries.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Adolescente , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Bolivia/epidemiología , Niño , Intervalos de Confianza , Infecciones por Coronavirus/epidemiología , Estudios Transversales , Complicaciones de la Diabetes/mortalidad , Femenino , Insuficiencia Cardíaca/mortalidad , Humanos , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Obesidad/mortalidad , Oportunidad Relativa , Pandemias , Neumonía Viral/epidemiología , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Adulto Joven
6.
Cochrane Database Syst Rev ; 6: CD012572, 2020 06 10.
Artículo en Inglés | MEDLINE | ID: mdl-32519776

RESUMEN

BACKGROUND: Hypertension is an important risk factor for subsequent cardiovascular events, including ischaemic and haemorrhagic stroke, myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death. Overall, the use of antihypertensive medications has led to reduction in cardiovascular disease, morbidity rates and mortality rates. However, the use of antihypertensive medications is also associated with harms, especially in older people, including the development of adverse drug reactions, drug-drug interactions and can contribute to increasing medication-related burden. As such, discontinuation of antihypertensives may be considered and appropriate in some older people. OBJECTIVES: To investigate whether withdrawal of antihypertensive medications is feasible, and evaluate the effects of withdrawal of antihypertensive medications on mortality, cardiovascular outcomes, hypertension and quality of life in older people. SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to April 2019: the Cochrane Hypertension Specialised Register, CENTRAL (2019, Issue 3), Ovid MEDLINE, Ovid Embase, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also conducted reference checking, citation searches and, when appropriate, contacted study authors to identify any additional studies. The searches had no language restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of withdrawal versus continuation of antihypertensive medications used for hypertension or primary prevention of cardiovascular disease in older adults (defined as 50 years and over). Participants were eligible if they lived in the community, residential aged care facilities, or were based in hospital settings. We sought to include trials looking at the complete withdrawal of the antihypertensive medication, and those focusing on a dose reduction of the antihypertensive medicine. DATA COLLECTION AND ANALYSIS: We compared the intervention of discontinuing or reducing antihypertensive medication to usual treatment using mean differences (MD) and 95% confidence intervals (95% CIs) for continuous variables and we used Peto odds ratios (ORs) and 95% CI for binary variables. Our primary outcomes included: mortality, myocardial infarction, development of adverse drug reactions or adverse drug withdrawal reactions. Secondary outcomes included: blood pressure, hospitalisation, stroke, success of withdrawing from antihypertensives, quality of life, and falls. Two authors independently, and in duplicate, conducted all stages of study selection, data extraction and quality assessment. MAIN RESULTS: Six RCTs met the inclusion criteria and were included in the review (1073 participants). Study duration and follow-up ranged from 4 weeks to 56 weeks. Meta-analysis of studies showed that, in the discontinuation group compared to continuation, the odds for all-cause mortality were 2.08 (95% CI 0.79 to 5.46; low certainty of evidence), for myocardial infarction 1.86 (95% CI 0.19 to 17.98; very low certainty of evidence) and for stroke 1.44 (95% CI 0.25 to 8.35; low certainty of evidence). Blood pressure was higher in the discontinuation group than the continuation group (systolic blood pressure: MD = 9.75 mmHg, 95% CI 7.33 to 12.18; and diastolic blood pressure: MD = 3.5 mmHg, 95% CI 1.82 to 5.18; low certainty of evidence). For the development of adverse events, meta-analysis was not possible; antihypertensive discontinuation did not appear to increase the risk of adverse events and may lead to resolution of adverse drug reactions, although eligible studies had limited reporting of adverse effects of drug withdrawal (very low certainty of evidence). One study reported hospitalisation with an odds ratio of 0.83 for discontinuation compared to continuation (95% CI 0.33 to 2.10; low certainty of evidence). No studies were identified which reported falls. Between 10.5% and 33.3% of participants in the discontinuation group compared to 9% to 15% in the continuation group experienced raised blood pressure or other clinical criteria (as pre-defined by the studies) that would require restarting of therapy/removal from the study. The sources of bias included selective reporting (reporting bias), lack of blinding of outcome assessment (detection bias), incomplete outcome data (attrition bias), and lack of blinding of participants and personnel (performance bias). AUTHORS' CONCLUSIONS: There is no evidence of an effect of discontinuing compared with continuing antihypertensives used for hypertension or primary prevention of cardiovascular disease in older adults on all-cause mortality and myocardial infarction. The evidence was low to very low certainty mainly due to small studies and low event rates. These limitations mean that we cannot make any firm conclusions about the effect of deprescribing antihypertensives on these outcomes. Future research should focus on populations with the greatest uncertainty of the benefit:risk ratio for use of antihypertensive medications, such as those with frailty, older age groups and those taking polypharmacy, and measure clinically important outcomes such as falls, quality of life and adverse drug events.


Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Privación de Tratamiento , Anciano , Anciano de 80 o más Años , Antihipertensivos/efectos adversos , Sesgo , Presión Sanguínea , Causas de Muerte , Intervalos de Confianza , Hospitalización/estadística & datos numéricos , Humanos , Hipertensión/complicaciones , Hipertensión/mortalidad , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Infarto del Miocardio/prevención & control , Oportunidad Relativa , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/prevención & control , Incertidumbre
7.
Clin Immunol ; 217: 108509, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32535188

RESUMEN

BACKGROUND: National health-system hospitals of Lombardy faced a heavy burden of admissions for acute respiratory distress syndromes associated with coronavirus disease (COVID-19). Data on patients of European origin affected by COVID-19 are limited. METHODS: All consecutive patients aged ≥18 years, coming from North-East of Milan's province and admitted at San Raffaele Hospital with COVID-19, between February 25th and March 24th, were reported, all patients were followed for at least one month. Clinical and radiological features at admission and predictors of clinical outcomes were evaluated. RESULTS: Of the 500 patients admitted to the Emergency Unit, 410 patients were hospitalized and analyzed: median age was 65 (IQR 56-75) years, and the majority of patients were males (72.9%). Median (IQR) days from COVID-19 symptoms onset was 8 (5-11) days. At hospital admission, fever (≥ 37.5 °C) was present in 67.5% of patients. Median oxygen saturation (SpO2) was 93% (range 60-99), with median PaO2/FiO2 ratio, 267 (IQR 184-314). Median Radiographic Assessment of Lung Edema (RALE) score was 9 (IQR 4-16). More than half of the patients (56.3%) had comorbidities, with hypertension, coronary heart disease, diabetes and chronic kidney failure being the most common. The probability of overall survival at day 28 was 66%. Multivariable analysis showed older age, coronary artery disease, cancer, low lymphocyte count and high RALE score as factors independently associated with an increased risk of mortality. CONCLUSION: In a large cohort of COVID-19 patients of European origin, main risk factors for mortality were older age, comorbidities, low lymphocyte count and high RALE.


Asunto(s)
Enfermedad Coronaria/diagnóstico , Infecciones por Coronavirus/diagnóstico , Diabetes Mellitus/diagnóstico , Hipertensión/diagnóstico , Fallo Renal Crónico/diagnóstico , Neumonía Viral/diagnóstico , Edema Pulmonar/diagnóstico , Síndrome Respiratorio Agudo Grave/diagnóstico , Factores de Edad , Anciano , Betacoronavirus/inmunología , Betacoronavirus/patogenicidad , Comorbilidad , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/inmunología , Enfermedad Coronaria/mortalidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/mortalidad , Diabetes Mellitus/epidemiología , Diabetes Mellitus/inmunología , Diabetes Mellitus/mortalidad , Femenino , Hospitalización , Humanos , Hipertensión/epidemiología , Hipertensión/inmunología , Hipertensión/mortalidad , Periodo de Incubación de Enfermedades Infecciosas , Italia/epidemiología , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/inmunología , Fallo Renal Crónico/mortalidad , Recuento de Linfocitos , Linfocitos/inmunología , Linfocitos/patología , Linfocitos/virología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Neumonía Viral/mortalidad , Edema Pulmonar/epidemiología , Edema Pulmonar/inmunología , Edema Pulmonar/mortalidad , Factores de Riesgo , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/inmunología , Síndrome Respiratorio Agudo Grave/mortalidad , Índice de Severidad de la Enfermedad , Análisis de Supervivencia
8.
J Clin Virol ; 128: 104431, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32442756

RESUMEN

BACKGROUND: Despite the death rate of COVID-19 is less than 3%, the fatality rate of severe/critical cases is high, according to World Health Organization (WHO). Thus, screening the severe/critical cases before symptom occurs effectively saves medical resources. METHODS AND MATERIALS: In this study, all 336 cases of patients infected COVID-19 in Shanghai to March 12th, were retrospectively enrolled, and divided in to training and test datasets. In addition, 220 clinical and laboratory observations/records were also collected. Clinical indicators were associated with severe/critical symptoms were identified and a model for severe/critical symptom prediction was developed. RESULTS: Totally, 36 clinical indicators significantly associated with severe/critical symptom were identified. The clinical indicators are mainly thyroxine, immune related cells and products. Support Vector Machine (SVM) and optimized combination of age, GSH, CD3 ratio and total protein has a good performance in discriminating the mild and severe/critical cases. The area under receiving operating curve (AUROC) reached 0.9996 and 0.9757 in the training and testing dataset, respectively. When the using cut-off value as 0.0667, the recall rate was 93.33 % and 100 % in the training and testing datasets, separately. Cox multivariate regression and survival analyses revealed that the model significantly discriminated the severe/critical cases and used the information of the selected clinical indicators. CONCLUSION: The model was robust and effective in predicting the severe/critical COVID cases.


Asunto(s)
Enfermedad Coronaria/diagnóstico , Infecciones por Coronavirus/diagnóstico , Complicaciones de la Diabetes/diagnóstico , Diabetes Mellitus/diagnóstico , Brotes de Enfermedades , Hipertensión/diagnóstico , Neumonía Viral/diagnóstico , Adulto , Factores de Edad , Anciano , Área Bajo la Curva , Betacoronavirus , Biomarcadores/sangre , Complejo CD3/sangre , Estudios de Cohortes , Enfermedad Coronaria/sangre , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/mortalidad , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Complicaciones de la Diabetes/sangre , Complicaciones de la Diabetes/mortalidad , Diabetes Mellitus/sangre , Diabetes Mellitus/mortalidad , Femenino , Glutatión/sangre , Humanos , Hipertensión/sangre , Hipertensión/complicaciones , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Pronóstico , Curva ROC , Índice de Severidad de la Enfermedad , Máquina de Vectores de Soporte , Análisis de Supervivencia , Tiroxina/sangre
9.
Clin Ther ; 42(6): 964-972, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32362344

RESUMEN

PURPOSE: The purpose of this study was to determine the risk factors associated with pneumonia, acute respiratory distress syndrome (ARDS), and clinical outcome among patients with novel coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional multicenter clinical study. A total of 95 patients infected with COVID-19 were enrolled. The COVID-19 diagnostic standard was polymerase chain reaction detection of target genes of 2019 novel coronavirus (2019-nCoV). Clinical, laboratory, and radiologic results, as well as treatment outcome data, were obtained. ARDS was defined as an oxygenation index (arterial partial pressure of oxygen/fraction of inspired oxygen) ≤300 mm Hg. FINDINGS: Multivariate analysis showed that older age (odds ratio [OR], 1.078; p = 0.008) and high body mass index (OR, 1.327; p = 0.024) were independent risk factors associated with patients with pneumonia. For patients with ARDS, multivariate analysis showed that only high systolic blood pressure (OR, 1.046; p = 0.025) and high lactate dehydrogenase level (OR, 1.010; p = 0.021) were independent risk factors associated with ARDS. A total of 70 patients underwent CT imaging repeatedly after treatment. Patients were divided in a disease exacerbation group (n = 19) and a disease relief group (n = 51). High body mass index (OR, 1.285; p = 0.017) and tobacco smoking (OR, 16.13; p = 0.032) were independent risk factors associated with disease exacerbation after treatment. IMPLICATIONS: These study results help in the risk stratification of patients with 2019-nCoV infection. Patients with risk factors should be given timely intervention to avoid disease progression.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/diagnóstico , Hipertensión/sangre , L-Lactato Deshidrogenasa/sangre , Neumonía Viral/sangre , Neumonía Viral/diagnóstico , Anciano , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Estudios Transversales , Humanos , Hipertensión/mortalidad , Hipertensión/fisiopatología , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Pronóstico , Resultado del Tratamiento
11.
Diabetes Care ; 43(7): 1382-1391, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32409504

RESUMEN

OBJECTIVE: Diabetes is common in COVID-19 patients and associated with unfavorable outcomes. We aimed to describe the characteristics and outcomes and to analyze the risk factors for in-hospital mortality of COVID-19 patients with diabetes. RESEARCH DESIGN AND METHODS: This two-center retrospective study was performed at two tertiary hospitals in Wuhan, China. Confirmed COVID-19 patients with diabetes (N = 153) who were discharged or died from 1 January 2020 to 8 March 2020 were identified. One sex- and age-matched COVID-19 patient without diabetes was randomly selected for each patient with diabetes. Demographic, clinical, and laboratory data were abstracted. Cox proportional hazards regression analyses were performed to identify the risk factors associated with the mortality in these patients. RESULTS: Of 1,561 COVID-19 patients, 153 (9.8%) had diabetes, with a median age of 64.0 (interquartile range 56.0-72.0) years. A higher proportion of intensive care unit admission (17.6% vs. 7.8%, P = 0.01) and more fatal cases (20.3% vs. 10.5%, P = 0.017) were identified in COVID-19 patients with diabetes than in the matched patients. Multivariable Cox regression analyses of these 306 patients showed that hypertension (hazard ratio [HR] 2.50, 95% CI 1.30-4.78), cardiovascular disease (HR 2.24, 95% CI 1.19-4.23), and chronic pulmonary disease (HR 2.51, 95% CI 1.07-5.90) were independently associated with in-hospital death. Diabetes (HR 1.58, 95% CI 0.84-2.99) was not statistically significantly associated with in-hospital death after adjustment. Among patients with diabetes, nonsurvivors were older (76.0 vs. 63.0 years), most were male (71.0% vs. 29.0%), and they were more likely to have underlying hypertension (83.9% vs. 50.0%) and cardiovascular disease (45.2% vs. 14.8%) (all P values <0.05). Age ≥70 years (HR 2.39, 95% CI 1.03-5.56) and hypertension (HR 3.10, 95% CI 1.14-8.44) were independent risk factors for in-hospital death of patients with diabetes. CONCLUSIONS: COVID-19 patients with diabetes had worse outcomes compared with the sex- and age-matched patients without diabetes. Older age and comorbid hypertension independently contributed to in-hospital death of patients with diabetes.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Diabetes Mellitus Tipo 2/mortalidad , Mortalidad Hospitalaria , Neumonía Viral/mortalidad , Anciano , Comorbilidad , Infecciones por Coronavirus/fisiopatología , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Hospitalización , Humanos , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/fisiopatología , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo
12.
BMC Public Health ; 20(1): 406, 2020 Mar 29.
Artículo en Inglés | MEDLINE | ID: mdl-32223743

RESUMEN

BACKGROUND: Hypertension is highly prevalent and is the primary risk factor for cardiovascular disease (CVD) and chronic kidney disease (CKD). While declining in some developed countries, it is increasing rapidly in some developing countries. Sichuan province is the largest and underdeveloped region in southwest China, with 486 thousand square kilometers, more than 80 million residents, unbalanced economic development, and high prevalence, low awareness, low treatment and low control rate of hypertension. We forecasted the death burden due to high systolic blood pressure (SBP) in Sichuan from 1990 to 2030, to raise the awareness of public and government of the importance and benefits of hypertension control. METHODS: We conducted secondary analysis based on data of Global Burden of Disease (GBD) 1990-2015, and predicted the population SBP level, population attributable fraction, and death burden for people aged 30-69 under different scenarios in 2030. RESULTS: Comparing with natural trend, if the prevalence of high SBP can be reduced relatively by 25% by 2030, the deaths of non-communicable chronic diseases (NCDs), CVD and CKD would be reduced by 27.1 thousand, 26.2 thousand and 0.8 thousand for people aged 30-69; the mortality would be reduced by 10.8, 32.8 and 16.0%; and the premature mortality would be reduced by 9.9, 32.0 and 16.0%, respectively. CONCLUSIONS: Controlling or decreasing the prevalence of high SBP can significantly reduce the deaths, death rate and premature mortality of NCDs, CVD and CKD for the 30-69 years old population in Sichuan. There would be huge benefits for the governments to take cost-effective measures to control or reduce the prevalence of hypertension.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Hipertensión/mortalidad , Mortalidad Prematura/tendencias , Enfermedades no Transmisibles/mortalidad , Insuficiencia Renal Crónica/mortalidad , Adulto , Anciano , Enfermedades Cardiovasculares/etiología , China/epidemiología , Femenino , Predicción , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/etiología , Factores de Riesgo
13.
Niger Postgrad Med J ; 27(2): 83-86, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32295937

RESUMEN

Objectives: Diabetes mellitus (DM) is a global health problem with associated high morbidity and mortality. This study was a retrospective review of post-mortem examination findings of hospitalised patients with DM for causes of death. Materials and Methods: A retrospective, cross-sectional autopsy review of all the patients with DM in our hospital between January 2008 and December 2017 was conducted. The causes of death were classified into cardiovascular, cerebrovascular, acute diabetic emergencies, infection, cancers and unnatural deaths. The demographic data and clinicopathological parameters were extracted, and the data were analysed using the SPSS software version 23. Results: A total of 1092 cases of autopsy were done within the study period, of which 91 cases were on patients with diabetes accounting for 8.3%. Infections with sepsis were the major cause of death, accounting for 51.6% followed by cardiovascular diseases (16.5%), cancers (14.3%), acute diabetic emergencies (6.6%) and cerebrovascular accidents (6.6%), with renal complications and road traffic accidents accounting for 2.2% each. Patients' age ranged from 31 to 84 years, with a modal age of 57 years. There was a male predominance with a male-to-female ratio of 1.5:1. Systemic hypertension co-morbidity was statistically significantly more common in patients aged 60 and above (P = 0.035). The most common lesion observed in the kidneys was benign nephrosclerosis (43.2%). Conclusions: This study suggests that majority of our patients with diabetes mellitus die from infections with attendant sepsis. Older patients appear to have co-morbid systemic hypertension. Patient education on infection prevention and prompt treatment might be life-saving.


Asunto(s)
Autopsia/estadística & datos numéricos , Complicaciones de la Diabetes/mortalidad , Diabetes Mellitus Tipo 2/mortalidad , Hipertensión/mortalidad , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Trastornos Cerebrovasculares/mortalidad , Comorbilidad , Estudios Transversales , Femenino , Humanos , Hipertensión/complicaciones , Masculino , Enfermedades Metabólicas/mortalidad , Persona de Mediana Edad , Nigeria/epidemiología , Enfermedades Respiratorias/mortalidad , Estudios Retrospectivos , Sepsis/epidemiología , Caracteres Sexuales , Distribución por Sexo , Centros de Atención Terciaria
14.
Nat Med ; 26(4): 542-548, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32251405

RESUMEN

While polygenic risk scores (PRSs) are poised to be translated into clinical practice through prediction of inborn health risks1, a strategy to utilize genetics to prioritize modifiable risk factors driving heath outcome is warranted2. To this end, we investigated the association of the genetic susceptibility to complex traits with human lifespan in collaboration with three worldwide biobanks (ntotal = 675,898; BioBank Japan (n = 179,066), UK Biobank (n = 361,194) and FinnGen (n = 135,638)). In contrast to observational studies, in which discerning the cause-and-effect can be difficult, PRSs could help to identify the driver biomarkers affecting human lifespan. A high systolic blood pressure PRS was trans-ethnically associated with a shorter lifespan (hazard ratio = 1.03[1.02-1.04], Pmeta = 3.9 × 10-13) and parental lifespan (hazard ratio = 1.06[1.06-1.07], P = 2.0 × 10-86). The obesity PRS showed distinct effects on lifespan in Japanese and European individuals (Pheterogeneity = 9.5 × 10-8 for BMI). The causal effect of blood pressure and obesity on lifespan was further supported by Mendelian randomization studies. Beyond genotype-phenotype associations, our trans-biobank study offers a new value of PRSs in prioritization of risk factors that could be potential targets of medical treatment to improve population health.


Asunto(s)
Bancos de Muestras Biológicas/estadística & datos numéricos , Marcadores Genéticos , Estudio de Asociación del Genoma Completo/métodos , Longevidad/genética , Herencia Multifactorial/genética , Adulto , Factores de Edad , Anciano , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/mortalidad , Femenino , Finlandia/epidemiología , Marcadores Genéticos/genética , Predisposición Genética a la Enfermedad/epidemiología , Estudio de Asociación del Genoma Completo/estadística & datos numéricos , Humanos , Hipertensión/genética , Hipertensión/mortalidad , Japón/epidemiología , Masculino , Persona de Mediana Edad , Obesidad/genética , Obesidad/mortalidad , Polimorfismo de Nucleótido Simple , Factores de Riesgo , Reino Unido/epidemiología
15.
High Blood Press Cardiovasc Prev ; 27(2): 129-132, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32200502

RESUMEN

Acute elevations in blood pressure (BP), usually defined as ≥ 180/110 mmHg, may present with highly heterogeneous profiles ranging from absence of symptoms to life-threatening target organ damage. In most recent years the diagnostic approach and the treatment of hypertension have gained interest by patients and physicians. The GEAR project (Gestione delle Emergenze e urgenze in ARea critica, management of hypertensive emergencies and hypertensive urgencies in the emergency setting) was proposed by the group of Young Investigators of the Italian Society of Hypertension as a survey aimed to evaluate the awareness, diagnosis and treatment of hypertensive emergencies and urgencies in Italy.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Antihipertensivos/efectos adversos , Urgencias Médicas , Encuestas de Atención de la Salud , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Hipertensión/fisiopatología , Italia/epidemiología , Proyectos de Investigación , Factores de Riesgo , Resultado del Tratamiento
16.
Ann Hematol ; 99(6): 1369-1376, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32173768

RESUMEN

Allogeneic hematopoietic transplantation (allo-HCT) is still associated with significant morbidity and mortality, and risk stratification is critical. In this study, we analyzed the relationship between blood pressure control early after allo-HCT and survival outcomes. All patients who survived longer than 28 days after allo-HCT at our center between June 2007 and June 2018 (n = 353) were included, and the average systolic blood pressure (asBP) from 1 to 28 days after allo-HCT was calculated. According to the results of a ROC curve analysis, an asBP of 131 mmHg was defined as a cut-off value between high and low asBP groups. Non-relapse mortality (NRM) and OS were significantly inferior in the high asBP group (2-year-NRM 28.0% vs 11.1%, P < 0.001; 2-year-OS 46.7% vs 65.7%, P = 0.001). In addition, baseline asBP before commencement of the conditioning regimen and elevation of asBP (asBP - baseline asBP) were both associated with inferior NRM. While these results were also observed in the younger patients (≤ 50 years), no relationship was observed in the older patients (> 50 years). High blood pressure within 28 days after allo-HCT was associated with inferior survival outcomes, especially in patients younger than 50 years.


Asunto(s)
Presión Sanguínea/fisiología , Trasplante de Células Madre Hematopoyéticas/mortalidad , Trasplante de Células Madre Hematopoyéticas/tendencias , Hipertensión/mortalidad , Acondicionamiento Pretrasplante/mortalidad , Acondicionamiento Pretrasplante/tendencias , Adolescente , Adulto , Anciano , Estudios de Cohortes , Femenino , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Hipertensión/etiología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Acondicionamiento Pretrasplante/métodos , Trasplante Homólogo/métodos , Trasplante Homólogo/tendencias , Resultado del Tratamiento , Adulto Joven
18.
Sci Rep ; 10(1): 1425, 2020 01 29.
Artículo en Inglés | MEDLINE | ID: mdl-31996724

RESUMEN

Mortality of primary hypertension is high worldwide. Whether untraditional factors exist in modern life and affect the mortality is not well studied. The aim of the study was to evaluate the risk factors for fatality rate of hypertensive men in downtown area. A cross-sectional study was performed on hypertensive men, who were hospitalized into our hospital and lived in eligible urban areas. The characteristics of the patients and factors for the fatality were analyzed and of the risks or the contributors on the status were investigated. 14354 patients were identified. Mean age was 68.9 ± 12.4 year old (y) and dead ones was 75.9 ± 9.5 y. The overall hospitalized fatality was 5.9%, which was increased with age: fatality with 0.7%, 2.2%, 2.9%, 7.1%, 11.1% and 16.6% was for age group ≦ 49 y, 50-59 y, 60-69 y, 70-79 y, 80-89 y and ≧ 90 y respectively. The increased fatality was significantly positively correlated with the incidence of pneumonia, P < 0.05, r = 0.99. Pneumonia was prone to involve in men with older age and severer organ damage by hypertension. Similar to traditional risks such as coronary heart disease and stroke, pneumonia and lung cancer were also significantly associated with the fatality. Odds ratio (95% CI) for pneumonia and lung cancer were 6.18 (4.35-8.78) and 1.55 (1.14-2.11). The study provides evidence that pneumonia and lung cancer are highly associated with fatality of hypertensive men in downtown area, indicating that in order to reduce the fatality of hypertension, these lung diseases should be prevented and treated intensively in modern life.


Asunto(s)
Hipertensión/epidemiología , Neoplasias Pulmonares/epidemiología , Neumonía/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , China/epidemiología , Estudios Transversales , Hospitalización , Humanos , Hipertensión/mortalidad , Incidencia , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Neumonía/mortalidad , Factores de Riesgo , Análisis de Supervivencia , Población Urbana
20.
High Blood Press Cardiovasc Prev ; 27(1): 9-17, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31975151

RESUMEN

The presence of hypertensive mediated organ damage is related to increased vascular risk and mortality and its prevention should be a therapeutic target and a surrogate marker of in/adequate blood pressure control. In old adult hypertensive patients the therapeutic target should be to prevent major cardiovascular events, but in young hypertensive subjects the focus should be pointed on preventing the development of hypertensive mediated organ damage, since most of the hard events are preceded by functional and structural tissues injury. Hypertension Guidelines of the European Society of Cardiology and European Society of Hypertension recognizes that some variables like electrocardiographic or echocardiographic left ventricle hypertrophy, chronic kidney disease or advance retinopathy, all considered as hypertensive mediated organ damage, may be modifiers of cardiovascular risk estimated by the SCORE system, and for that reason they should be screened in hypertensive patients. It is well known the problem of limited health systems financial resources in many low and even median income countries which precludes the possibilities of generalizing the search for hypertension mediated organ damage in all hypertensive patients. In these scenario the recommendation to perform a detailed screening should be critically evaluated. Some questions remained unanswered: the screening generalization of hypertensive mediated organ damage should modify the cardiovascular risk score of the patients, if its presence could modify the therapeutic approach, and as a consequence, if the treatment adjustment should prolong life expectancy and ameliorate the quality of life.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Cardiopatías/prevención & control , Hipertensión/tratamiento farmacológico , Enfermedades Renales/prevención & control , Enfermedades Vasculares/prevención & control , Antihipertensivos/efectos adversos , Diagnóstico Precoz , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Cardiopatías/fisiopatología , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Hipertensión/fisiopatología , Enfermedades Renales/diagnóstico , Enfermedades Renales/mortalidad , Enfermedades Renales/fisiopatología , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/mortalidad , Enfermedades Vasculares/fisiopatología
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