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Sun L, Zhang C, Song P, Zhong X, Xie B, Huang Y, Hu Y, Xu X, Lei X. Hypertension and 28-day mortality in sepsis patients: An observational and mendelian randomization study. Heart Lung 2025; 70:147-156. [PMID: 39671847 DOI: 10.1016/j.hrtlng.2024.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 11/12/2024] [Accepted: 11/26/2024] [Indexed: 12/15/2024]
Abstract
BACKGROUND Predicting and reducing the 28-day mortality in sepsis remains a challenge in this research field. OBJECTIVE This study aimed to explore the association between hypertension and 28-day mortality in sepsis. METHODS This study is a cross-sectional approach with Mendelian Randomization (MR). We used GWAS data for hypertension as the exposure and 28-day mortality in sepsis as the outcome and employed the main inverse variance weighted method along with other supplementary MR techniques to verify the causal association between hypertension and 28-day mortality in sepsis. We used sensitivity analyses to ensure the robustness of the research findings. Finally, we utilized clinical data from the Medical Information Mart for Intensive Care-IV database to assess the risk association between hypertension and 28-day mortality in sepsis using difference analysis and multivariate logistic regression analysis. RESULTS According to MR, hypertension increased the 28-day mortality in sepsis in both two datasets (FinnGen: odds ratio [OR] = 1.61, 95 % confidence interval [CI] = 1.15-2.26, p = 0.006; Medical Research Council-Integrative Epidemiological Unit: OR = 160, 95 % CI = 2.76-9250, p = 0.014). In our observational study, we included a total of 2012 sepsis patients, of which 60.5 % were male, and the average age was 55.4 years. By applying univariate and multivariate logistic regression models (univariate analysis p = 0.02, multivariate analysis p = 0.02), we observed a significantly increased risk of 28-day mortality due to hypertension in sepsis patients. CONCLUSION This study confirmed the causal relationship between hypertension and the 28-day mortality in sepsis.
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Affiliation(s)
- Lichang Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Chongqing, China; Research Center for Medicine and Social Development, Chongqing, China; Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China; Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Cong Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Ping Song
- Big Data Center for Children's Medical Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Xiaoni Zhong
- Department of Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Biao Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Yingzhu Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Chongqing, China; Research Center for Medicine and Social Development, Chongqing, China; Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China; Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Yuanjia Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Chongqing, China; Research Center for Medicine and Social Development, Chongqing, China; Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China; Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Ximing Xu
- Big Data Center for Children's Medical Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
| | - Xun Lei
- Department of Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Chongqing, China; Research Center for Medicine and Social Development, Chongqing, China; Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China; Research Center for Public Health Security, Chongqing Medical University, Chongqing, China.
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Bezerra R, Feitosa AD, Silvestre OM, Fernandes-Silva MM, Amazonas RB, Teles F, Rodrigues CIS, Lima-Filho JL, Sposito AC, Nadruz W. Dialysis parameters associated with SARS-CoV-2 infection and prognosis in end-stage kidney disease. Ann Med 2024; 56:2343890. [PMID: 38738416 PMCID: PMC11095274 DOI: 10.1080/07853890.2024.2343890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND The Covid-19 pandemic has affected patients with end-stage kidney disease (ESKD). Whether dialysis parameters have a prognostic value in ESKD patients with Covid-19 remains unclear. MATERIALS AND METHODS We retrospectively evaluated clinical characteristics, blood pressure (BP) and dialysis parameters in ESKD patients undergoing maintenance outpatient hemodialysis, with (Covid-ESKD) and without (No-Covid-ESKD) Covid-19, at four Brazilian hemodialysis facilities. The Covid-ESKD (n = 107; 54% females; 60.8 ± 17.7 years) and No-Covid-ESKD (n = 107; 62% females; 58.4 ± 14.6 years) groups were matched by calendar time. The average BP and dialysis parameters were calculated during the pre-infection, acute infection, and post-infection periods. The main outcomes were Covid-19 hospitalization and all-cause mortality. RESULTS Covid-ESKD patients had greater intradialytic and postdialysis systolic BP and lower predialysis weight, postdialysis weight, ultrafiltration rate, and interdialytic weight gain during acute-illness compared to 1-week-before-illness, while these changes were not observed in No-Covid-ESKD patients. After 286 days of follow-up (range, 276-591), there were 18 Covid-19-related hospitalizations and 28 deaths among Covid-ESKD patients. Multivariable logistic regression analysis showed that increases in predialysis systolic BP from 1-week-before-illness to acute-illness (OR, 95%CI = 1.06, 1.02-1.10; p = .004) and Covid-19 vaccination (OR, 95%CI = 0.16, 0.04-0.69; p = .014) were associated with hospitalization in Covid-ESKD patients. Multivariable Cox-regression analysis showed that Covid-19-related hospitalization (HR, 95%CI = 5.17, 2.07-12.96; p < .001) and age (HR, 95%CI = 1.05, 1.01-1.08; p = .008) were independent predictors of all-cause mortality in Covid-ESKD patients. CONCLUSION Acute Covid-19 illness is associated with variations in dialysis parameters of volume status in patients with ESKD. Furthermore, increases in predialysis BP during acute Covid-19 illness are associated with an adverse prognosis in Covid-ESKD patients.
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Affiliation(s)
- Rodrigo Bezerra
- Keizo Asami Institute, Federal University of Pernambuco, Recife, PE, Brazil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil
| | - Audes D.M. Feitosa
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil
| | | | | | | | - Flavio Teles
- School of Medicine, Federal University of Alagoas, Maceio, AL, Brazil
| | - Cibele I. S. Rodrigues
- Department of Internal Medicine, Faculty of Medical Sciences and Health, Pontifical Catholic University of São Paulo, Sorocaba, SP, Brazil
| | - Jose L. Lima-Filho
- Keizo Asami Institute, Federal University of Pernambuco, Recife, PE, Brazil
| | - Andrei C. Sposito
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Wilson Nadruz
- Keizo Asami Institute, Federal University of Pernambuco, Recife, PE, Brazil
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
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Varatharajan S, Bohra GK, Bhatia PK, Khichar S, Meena M, Palanisamy N, Gaur A, Garg MK. Outcome of COVID-19 infection in patients on antihypertensives: A cross-sectional study. World J Crit Care Med 2024; 13:96882. [PMID: 39253317 PMCID: PMC11372513 DOI: 10.5492/wjccm.v13.i3.96882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/07/2024] [Accepted: 08/13/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND Patients with coronavirus disease 2019 (COVID-19) infection frequently have hypertension as a co-morbidity, which is linked to adverse outcomes. Antihypertensives may affect the outcome of COVID-19 infection. AIM To assess the effects of antihypertensive agents on the outcomes of COVID-19 infection. METHODS A total of 260 patients were included, and their demographic data and clinical profile were documented. The patients were categorized into nonhypertensive, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), calcium channel blocker (CCB), a combination of ACEI/ARB and CCB, and beta-blocker groups. Biochemical, hematological, and inflammatory markers were measured. The severity of infection, intensive care unit (ICU) intervention, and outcome were recorded. RESULTS The mean age of patients was approximately 60-years-old in all groups, except the nonhypertensive group. Men were predominant in all groups. Fever was the most common presenting symptom. Acute respiratory distress syndrome was the most common complication, and was mostly found in the CCB group. Critical cases, ICU intervention, and mortality were also higher in the CCB group. Multivariable logistic regression analysis revealed that age, duration of antihypertensive therapy, erythrocyte sedimentation rate, high-sensitivity C-reactive protein, and interleukin 6 were significantly associated with mortality. The duration of antihypertensive therapy exhibited a sensitivity of 70.8% and specificity of 55.7%, with a cut-off value of 4.5 years and an area under the curve of 0.670 (0.574-0.767; 95% confidence interval) for COVID-19 outcome. CONCLUSION The type of antihypertensive medication has no impact on the clinical sequence or mortality of patients with COVID-19 infection. However, the duration of antihypertensive therapy is associated with poor outcomes.
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Affiliation(s)
- Sakthivadivel Varatharajan
- Department of General Medicine, All India Institute of Medical Sciences - Bibinagar, Hyderabad 508126, Telangana, India
| | - Gopal K Bohra
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
| | - Pradeep K Bhatia
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
| | - Satyendra Khichar
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
| | - Mahadev Meena
- Department of General Medicine, All India Institute of Medical Sciences, Bhopal 462020, Madhya Pradesh, India
| | - Naveenraj Palanisamy
- Department of General Medicine, ESIC Medical College & Hospital, Chennai 600021, Tamilnadu, India
| | - Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences - Bibinagar, Hyderabad 508126, Telangana, India
| | - Mahendra K Garg
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
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Camacho-Moll ME, Mata-Tijerina VL, Gutiérrez-Salazar CC, Silva-Ramírez B, Peñuelas-Urquides K, González-Escalante L, Escobedo-Guajardo BL, Cruz-Luna JE, Corrales-Pérez R, Gómez-García S, Bermúdez-de León M. The impact of comorbidity status in COVID-19 vaccines effectiveness before and after SARS-CoV-2 omicron variant in northeastern Mexico: a retrospective multi-hospital study. Front Public Health 2024; 12:1402527. [PMID: 38932780 PMCID: PMC11199416 DOI: 10.3389/fpubh.2024.1402527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction The end of the coronavirus disease 2019 (COVID-19) pandemic has been declared by the World Health Organization on May 5, 2023. Several vaccines were developed, and new data is being published about their effectiveness. However, the clinical trials for the vaccines were performed before the Omicron variant appeared and there are population groups where vaccine effectiveness still needs to be tested. The overarching goal of the present study was to analyze the effects of COVID-19 vaccination before and after the Omicron variant in patients considering comorbidities in a population from Nuevo Leon, Mexico. Methods Epidemiological COVID-19 data from the Mexican Social Security Institute were collected from 67 hospitals located in northeastern Mexico, from July 2020 to May 2023, and a total of 669,393 cases were compiled, 255,819 reported a SARS-CoV-2 positive reverse transcription quantitative polymerase chain reaction (RT-qPCR) test or a positive COVID-19 antigen rapid test. Results Before Omicron (BO, 2020-2021), after 14 days of two doses of COVID-19 vaccine, BNT162b2 and ChAdOx1 vaccines were effective against infection in non-comorbid and all comorbid subgroups, whereas after Omicron (AO, 2022- 2023) there was no significant effectiveness against infection with none of the vaccines. Regarding hospitalization BO, BNT162b2, ChAdOx1, CoronaVac and mRNA-1273 significantly protected non-comorbid patients whereas BNT162b2, ChAdOx1, and mRNA-1273, protected all comorbid subgroups against hospitalization. AO, BNT162b2, ChAdOx1, CoronaVac and mRNA-1273 were effective against hospitalization in non-comorbid patients whereas for most comorbid subgroups BNT162b2, ChAdOx1 and CoronaVac were effective against hospitalization. Non-comorbid patients were protected against death as an outcome of COVID-19 during the BO period with most vaccines whereas a reduction in effectiveness was observed AO with mRNA-1273 vaccines in patients with hypertension, and diabetes mellitus. Discussion BO, COVID-19 vaccines were effective against infection, hospitalization, and death whereas AO, COVID-19 vaccines failed to protect the population from COVID-19 infection. A varying effectiveness against hospitalization and death is observed AO.
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Affiliation(s)
- Maria Elena Camacho-Moll
- Laboratory of Molecular Biology, Northeast Biomedical Research Center, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Viviana Leticia Mata-Tijerina
- Laboratory of Immunogenetics, Northeast Biomedical Research Center, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | | | - Beatriz Silva-Ramírez
- Laboratory of Immunogenetics, Northeast Biomedical Research Center, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Katia Peñuelas-Urquides
- Laboratory of Molecular Microbiology, Northeast Biomedical Research Center, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Laura González-Escalante
- Laboratory of Molecular Microbiology, Northeast Biomedical Research Center, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Brenda Leticia Escobedo-Guajardo
- Laboratory of Molecular Research of Diseases, Northeast Biomedical Research Center, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Jorge Eleazar Cruz-Luna
- Medical Epidemiological Assistance Coordination of the State of Nuevo Leon, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Roberto Corrales-Pérez
- Medical Epidemiological Assistance Coordination of the State of Nuevo Leon, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Salvador Gómez-García
- Medical Epidemiological Assistance Coordination of the State of Nuevo Leon, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
| | - Mario Bermúdez-de León
- Laboratory of Molecular Biology, Northeast Biomedical Research Center, Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico
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Fitri NK, Meliani M, Marpaung K, Cahyadi RAD, Permatasari R, Zainumi CM, Lubis IND. Community Actions and Insights in the Battle against COVID-19 at the Start of the Pandemic: A District Study Observation from Medan, Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:444. [PMID: 38673355 PMCID: PMC11050628 DOI: 10.3390/ijerph21040444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/26/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND As of 17 June 2020, the WHO confirmed 8,061,550 COVID-19 cases globally, with Indonesia reporting 40,400 cases and North Sumatra over 932 cases. The rising infection rates have led to increased deaths, highlighting the urgency for public understanding of virus transmission. Despite information dissemination efforts, North Sumatra has not seen a reduction in cases, emphasizing the need for a unified approach to combat the pandemic. OBJECTIVE This study aims to investigate the relationship between public perception and practices regarding COVID-19 prevention in Medan, North Sumatra. METHODS A cross-sectional study will be conducted using a combined questionnaire from two previous studies conducted at the start of the pandemic. RESULTS Among 200 participants, social media was the favored source for prevention information. Participants exhibited above-average knowledge (67.5%) but predominantly below-average attitudes toward prevention (64.5%). However, most residents practiced correct prevention measures (75.5%). CONCLUSIONS Despite possessing adequate knowledge, negative attitudes toward prevention suggest a need for educational interventions to address misconceptions and promote positive behaviors. Such interventions could enhance the community's response to COVID-19 transmission during the pandemic.
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Affiliation(s)
- Nadya Keumala Fitri
- Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia; (N.K.F.); (R.A.D.C.)
| | - Meliani Meliani
- Department of Clinical Pathology, Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia; (M.M.); (R.P.)
| | - Kartini Marpaung
- Department of Paediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia;
| | | | - Ranti Permatasari
- Department of Clinical Pathology, Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia; (M.M.); (R.P.)
| | - Cut Meliza Zainumi
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia;
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Sakurai K, Chubachi S, Asakura T, Namkoong H, Tanaka H, Azekawa S, Shimada T, Otake S, Nakagawara K, Fukushima T, Lee H, Watase M, Kusumoto T, Masaki K, Kamata H, Ishii M, Hasegawa N, Okada Y, Koike R, Kitagawa Y, Kimura A, Imoto S, Miyano S, Ogawa S, Kanai T, Fukunaga K. Prognostic significance of hypertension history and blood pressure on admission in Japanese patients with coronavirus disease 2019: integrative analysis from the Japan COVID-19 Task Force. Hypertens Res 2024; 47:639-648. [PMID: 37919428 DOI: 10.1038/s41440-023-01490-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023]
Abstract
The effect of preexisting hypertension on coronavirus disease 2019 (COVID-19) prognosis remains controversial. Additionally, no studies have compared the association between blood pressure (BP) indices on admission and COVID-19 outcomes using preexisting hypertension status. Therefore, this study aimed to investigate the association between preexisting hypertension and COVID-19 outcomes in Japanese patients with COVID-19 and assess the impact of BP indices on admission on clinical outcomes in patients with and without preexisting hypertension. Preexisting hypertension presence was confirmed based on the patient's clinical history. Critical outcomes were defined as high-flow oxygen use, non-invasive and invasive positive-pressure ventilation, extracorporeal membrane oxygenation, or death during hospitalization. Preexisting hypertension was observed in 64.6% of the patients. Multivariable logistic regression analysis of severe COVID-19 risk factors indicated that preexisting hypertension was independently associated with critical outcomes [adjusted odds ratio (OR): 1.35; 95% confidence interval (CI): 1.05-1.73]. Low or high BP and high pulse pressure on admission were associated with critical outcomes in patients without preexisting hypertension [OR for systolic BP < 100 mmHg: 2.13, 95% CI: 1.21-3.75; OR for high BP stage 2 (160-179 systolic and/or 100-109 mmHg diastolic BP): 2.13, 95% CI: 1.27-3.58; OR for pulse pressure ≥60 mmHg: 1.68, 95% CI: 1.14-2.48]. Preexisting hypertension is a risk factor for critical outcomes in Japanese patients with COVID-19. BP indices are useful biomarkers for predicting COVID-19 outcomes, particularly in patients without preexisting hypertension. Thus, hypertension history, systolic BP, and pulse pressure should be assessed to predict severe COVID-19 outcomes.
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Affiliation(s)
- Kaori Sakurai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
- Department of Clinical Medicine (Laboratory of Bioregulatory Medicine), Kitasato University School of Pharmacy, Tokyo, Japan.
- Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan.
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Hiromu Tanaka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shuhei Azekawa
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Shimada
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shiro Otake
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kensuke Nakagawara
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Fukushima
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ho Lee
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mayuko Watase
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuya Kusumoto
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsunori Masaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Genome Informatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Ryuji Koike
- Health Science Research and Development Center (HeRD), Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akinori Kimura
- Institute of Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seiya Imoto
- Division of Health Medical Intelligence, Human Genome Center, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
| | - Satoru Miyano
- M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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AlSereidi A, Salih SQM, Mohammed RT, Zaidan A, Albayati H, Pamucar D, Albahri A, Zaidan B, Shaalan K, Al-Obaidi J, Albahri O, Alamoodi A, Abdul Majid N, Garfan S, Al-Samarraay M, Jasim A, Baqer M. Novel Federated Decision Making for Distribution of Anti-SARS-CoV-2 Monoclonal Antibody to Eligible High-Risk Patients. INTERNATIONAL JOURNAL OF INFORMATION TECHNOLOGY & DECISION MAKING 2024; 23:197-268. [DOI: 10.1142/s021962202250050x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
Context: When the epidemic first broke out, no specific treatment was available for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The urgent need to end this unusual situation has resulted in many attempts to deal with SARS-CoV-2. In addition to several types of vaccinations that have been created, anti-SARS-CoV-2 monoclonal antibodies (mAbs) have added a new dimension to preventative and treatment efforts. This therapy also helps prevent severe symptoms for those at a high risk. Therefore, this is one of the most promising treatments for mild to moderate SARS-CoV-2 cases. However, the availability of anti-SARS-CoV-2 mAb therapy is limited and leads to two main challenges. The first is the privacy challenge of selecting eligible patients from the distribution hospital networking, which requires data sharing, and the second is the prioritization of all eligible patients amongst the distribution hospitals according to dose availability. To our knowledge, no research combined the federated fundamental approach with multicriteria decision-making methods for the treatment of SARS-COV-2, indicating a research gap. Objective: This paper presents a unique sequence processing methodology that distributes anti-SARS-CoV-2 mAbs to eligible high-risk patients with SARS-CoV-2 based on medical requirements by using a novel federated decision-making distributor. Method: This paper proposes a novel federated decision-making distributor (FDMD) of anti-SARS-CoV-2 mAbs for eligible high-risk patients. FDMD is implemented on augmented data of 49,152 cases of patients with SARS-CoV-2 with mild and moderate symptoms. For proof of concept, three hospitals with 16 patients each are enrolled. The proposed FDMD is constructed from the two sides of claim sequencing: central federated server (CFS) and local machine (LM). The CFS includes five sequential phases synchronised with the LMs, namely, the preliminary criteria setting phase that determines the high-risk criteria, calculates their weights using the newly formulated interval-valued spherical fuzzy and hesitant 2-tuple fuzzy-weighted zero-inconsistency (IVSH2-FWZIC), and allocates their values. The subsequent phases are federation, dose availability confirmation, global prioritization of eligible patients and alerting the hospitals with the patients most eligible for receiving the anti-SARS-CoV-2 mAbs according to dose availability. The LM independently performs all local prioritization processes without sharing patients’ data using the provided criteria settings and federated parameters from the CFS via the proposed Federated TOPSIS (F-TOPSIS). The sequential processing steps are coherently performed at both sides. Results and Discussion: (1) The proposed FDMD efficiently and independently identifies the high-risk patients most eligible for receiving anti-SARS-CoV-2 mAbs at each local distribution hospital. The final decision at the CFS relies on the indexed patients’ score and dose availability without sharing the patients’ data. (2) The IVSH2-FWZIC effectively weighs the high-risk criteria of patients with SARS-CoV-2. (3) The local and global prioritization ranks of the F-TOPSIS for eligible patients are subjected to a systematic ranking validated by high correlation results across nine scenarios by altering the weights of the criteria. (4) A comparative analysis of the experimental results with a prior study confirms the effectiveness of the proposed FDMD. Conclusion: The proposed FDMD has the benefits of centrally distributing anti-SARS-CoV-2 mAbs to high-risk patients prioritized based on their eligibility and dose availability, and simultaneously protecting their privacy and offering an effective cure to prevent progression to severe SARS-CoV-2 hospitalization or death.
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Affiliation(s)
- Abeer AlSereidi
- Faculty of Engineering & IT, The British university in Dubia, United Arab Emirates
| | | | - R. T. Mohammed
- Department of Computing Science, College of Science, Komar University of Science and Technology (KUST), Sulaymaniyah, Iraq
| | - A. A. Zaidan
- Faculty of Engineering & IT, The British university in Dubia, United Arab Emirates
| | - Hassan Albayati
- Department of Business Administration, College of Administrative Science, The University of Mashreq, 10021 Baghdad, Iraq
- Department of Computing, Faculty of Arts, Computing and Creative Industry, Universiti Pendidikan Sultan Idris, Tanjung Malim, Malaysia
| | - Dragan Pamucar
- University of Defence in Belgrade, Department of Logistic, Pavla Jurisica Sturma 33, 11000 Belgrade, Serbia
| | - A. S. Albahri
- Informatics Institute for Postgraduate Studies (IIPS), Iraqi Commission for Computers and Informatics (ICCI), Baghdad, Iraq
- University of Information Technology and Communications (UOITC), Baghdad, Iraq
| | - B. B. Zaidan
- Future Technology Research Center, National Yunlin University of Science and Technology, 123 University Road, Section 3, Douliou, Yunlin 64002, Taiwan
| | - Khaled Shaalan
- Faculty of Engineering & IT, The British university in Dubia, United Arab Emirates
| | - Jameel Al-Obaidi
- Department of Biology, Faculty of Science and Mathematics, Universiti Pendidikan Sultan Idris, Tanjong Malim 35900, Perak, Malaysia
| | - O. S. Albahri
- Computer Techniques Engineering Department Mazaya University College, Thi-Qar, Nassiriya, Iraq
| | - Abdulah Alamoodi
- Department of Computing, Faculty of Arts, Computing and Creative Industry, Universiti Pendidikan Sultan Idris, Tanjung Malim, Malaysia
| | - Nazia Abdul Majid
- Institute of Biological Sciences, Faculty of Science, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Salem Garfan
- Department of Computing, Faculty of Arts, Computing and Creative Industry, Universiti Pendidikan Sultan Idris, Tanjung Malim, Malaysia
| | - M. S. Al-Samarraay
- Department of Computing, Faculty of Arts, Computing and Creative Industry, Universiti Pendidikan Sultan Idris, Tanjung Malim, Malaysia
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Angeli F, Zappa M, Verdecchia P. Global burden of new-onset hypertension associated with severe acute respiratory syndrome coronavirus 2 infection. Eur J Intern Med 2024; 119:31-33. [PMID: 37852842 DOI: 10.1016/j.ejim.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 10/20/2023]
Abstract
Several reports documented a specific effect of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on blood pressure (BP), during and after the acute phase of infection. Clinical studies demonstrated that coronavirus disease 2019 (COVID-19) is associated with an increased risk of a persistent increase in BP requiring a new or intensified anti-hypertensive treatment during hospitalization. The picture is further complicated by the evidence from large databases showing an increased risk of new-onset hypertension in COVID-19 survivors on the long term. To further elucidate the epidemiological burden of this phenomenon, we performed a pooled analysis of 4 studies reporting crude incidence rates of new-onset hypertension among COVID-19 patients and contemporary controls. Overall, COVID-19 was associated with a 65% increased risk of new-onset hypertension when compared with controls (p<0.0001); furthermore, incidence of new-onset hypertension was 9% and 5% among COVID-19 patients and controls, respectively. In both the acute phase and recovery from infection, the interaction between spike proteins of SARS-CoV-2 and angiotensin converting enzyme 2 (ACE2) receptors remain the most plausible mechanism explaining the raise in BP (ranking new onset hypertension as one of the most prevalent cardiovascular sequelae of COVID-19). In this area of research, it is worth to mention that new variants of SARS-CoV-2 exhibit specific mutations in the spike protein that promotes entry into viral cells via ACE2. Thus, the enhanced spike affinity for ACE2 of new variants has the potential to increase the risk of new-onset hypertension when compared with the original Wuhan strain.
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Technological Innovation (DiMIT), University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Italy.
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
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9
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Ghazanfar A, Abbas M, Hussain MW, Kayal M. Risk stratification of renal transplant recipients using routine parameters: Implication of learning from SARS-CoV-2 into transplant follow-up program. World J Transplant 2023; 13:344-356. [PMID: 38174144 PMCID: PMC10758680 DOI: 10.5500/wjt.v13.i6.344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/21/2023] [Accepted: 11/13/2023] [Indexed: 12/15/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is a global pandemic that is associated with a high risk of morbidity and mortality among recipients of solid organ transplantation. In the course of acute SARS-CoV-2 infection, various laboratory markers have been identified as predictors for high risk of mortality. AIM To risk stratify renal transplant recipients (RTxR) using general demographic parameters, comorbidities and routine laboratory markers for the severity of the disease and its outcomes. We believe that learning about these routinely moni tored parameters can help us plan better strategies for the RTxR follow-up program. METHODS This present study includes RTxR who acquired SARS-CoV-2 infection from March 2020 to February 2021. We recorded the basic demographics, comorbidities and routine laboratory markers. We investigated the impact of SARS-CoV-2 infection on RTxRs and risk-stratified the progression of disease severity and outcomes in terms of recovery or mortality. RESULTS From 505 RTxRs in our renal transplant follow-up program, 29 (7.75%) RTxRs had PCR-positive SARS-CoV-2 infection. We recorded 8 deaths from SARS-CoV-2 infection giving an overall mortality rate of 1.6% but a significant 27.6% mortality in SARS-CoV-2 positive recipients. Age more than 68 years, non-Caucasian ethnicity and male gender were associated with a significant drop in survival probability; P ≤ 0.001. < 0.001 and < 0.0001 respectively. 87.5% of the deceased were diabetic; P ≤ 0.0.0001. Estimated glomerular filtration rate of less than 26 mL/min/1.73 m2, serum albumin less than 20 g/L, Hemoglobin less than 9.6 g/L and serum calcium less than 1.70 mmol/L were all associated with significantly increased risk of mortality; P = 0.0128, < 0.001, < 0.0001 and 0.0061 respectively. CONCLUSION This study has identified some routinely used modifiable parameters in predicting a higher risk of mortality and morbidity. This knowledge can be used in RTxR follow-up programs by addressing these parameters early to help reduce the morbidity and mortality in RTxRs.
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Affiliation(s)
- Abbas Ghazanfar
- Renal and Transplant Unit, St Georges University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Madiha Abbas
- Department of Anesthesia and Intensive Care Medicine, Epsom and St Helier University Hospitals NHS Trust, London KT8 7EG, United Kingdom
| | - Md Walid Hussain
- Department of Renal and Transplant Surgery, St Georges University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Malik Kayal
- Department of Renal and Transplant Surgery, St Georges University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
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10
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Jackson SL, Woodruff RC, Nagavedu K, Fearrington J, Rolka DB, Twentyman E, Carton TW, Puro J, Denson JL, Kappelman MD, Paranjape A, Thacker D, Weiner MG, Goodman AB, Lekiachvili A, Boehmer TK, Block JP. Association Between Hypertension and Diabetes Control and COVID-19 Severity: National Patient-Centered Clinical Research Network, United States, March 2020 to February 2022. J Am Heart Assoc 2023; 12:e030240. [PMID: 37850404 PMCID: PMC10727406 DOI: 10.1161/jaha.122.030240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/15/2023] [Indexed: 10/19/2023]
Abstract
Background Hypertension and diabetes are associated with increased COVID-19 severity. The association between level of control of these conditions and COVID-19 severity is less well understood. Methods and Results This retrospective cohort study identified adults with COVID-19, March 2020 to February 2022, in 43 US health systems in the National Patient-Centered Clinical Research Network. Hypertension control was categorized as blood pressure (BP) <130/80, 130 to 139/80 to 89, 140 to 159/90 to 99, or ≥160/100 mm Hg, and diabetes control as glycated hemoglobin <7%, 7% to <9%, ≥9%. Adjusted, pooled logistic regression assessed associations between hypertension and diabetes control and severe COVID-19 outcomes. Among 1 494 837 adults with COVID-19, 43% had hypertension and 12% had diabetes. Among patients with hypertension, the highest baseline BP was associated with greater odds of hospitalization (adjusted odds ratio [aOR], 1.30 [95% CI, 1.23-1.37] for BP ≥160/100 versus BP <130/80), critical care (aOR, 1.30 [95% CI, 1.21-1.40]), and mechanical ventilation (aOR, 1.32 [95% CI, 1.17-1.50]) but not mortality (aOR, 1.08 [95% CI, 0.98-1.12]). Among patients with diabetes, the highest glycated hemoglobin was associated with greater odds of hospitalization (aOR, 1.61 [95% CI, 1.47-1.76] for glycated hemoglobin ≥9% versus <7%), critical care (aOR, 1.42 [95% CI, 1.31-1.54]), mechanical ventilation (aOR, 1.12 [95% CI, 1.02-1.23]), and mortality (aOR, 1.18 [95% CI, 1.09-1.27]). Black and Hispanic adults were more likely than White adults to experience severe COVID-19 outcomes, independent of comorbidity score and control of hypertension or diabetes. Conclusions Among 1.5 million patients with COVID-19, higher BP and glycated hemoglobin were associated with more severe COVID-19 outcomes. Findings suggest that adults with poorest control of hypertension or diabetes might benefit from efforts to prevent and initiate early treatment of COVID-19.
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Affiliation(s)
- Sandra L. Jackson
- Division for Heart Disease and Stroke PreventionNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaGA
| | - Rebecca C. Woodruff
- Division for Heart Disease and Stroke PreventionNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaGA
| | - Kshema Nagavedu
- Department of Population MedicineHarvard Pilgrim Health Care Institute, Harvard Medical SchoolBostonMA
| | - Julia Fearrington
- Department of Population MedicineHarvard Pilgrim Health Care Institute, Harvard Medical SchoolBostonMA
| | - Deborah B. Rolka
- Division of Diabetes TranslationNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaGA
| | - Evelyn Twentyman
- Office of the DirectorNational Center for Immunizations and Respiratory Diseases, Centers for Disease Control and PreventionAtlantaGA
| | | | | | - Joshua L. Denson
- Section of Pulmonary, Critical Care, and Environmental MedicineTulane University School of MedicineNew OrleansLA
| | - Michael D. Kappelman
- Department of Pediatrics, UNC School of MedicineThe University of North Carolina at Chapel HillChapel HillNC
| | | | | | - Mark G. Weiner
- Department of Population Health SciencesWeill Cornell MedicineNew YorkNY
| | - Alyson B. Goodman
- Division of Nutrition, Physical Activity, and ObesityNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaGA
| | - Akaki Lekiachvili
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaGA
| | - Tegan K. Boehmer
- Office of Public Health Data, Surveillance, and TechnologyCenters for Disease Control and PreventionAtlantaGA
| | - Jason P. Block
- Division of Chronic Disease Research Across the Lifecourse (CoRAL)Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical SchoolBostonMA
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11
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Mnguni AT, Schietekat D, Ebrahim N, Sonday N, Boliter N, Schrueder N, Gabriels S, Cois A, Tamuzi JL, Tembo Y, Davies MA, English R, Nyasulu PS. The interface between SARS-CoV-2 and non-communicable diseases (NCDs) in a high HIV/TB burden district level hospital setting, Cape Town, South Africa. PLoS One 2023; 18:e0277995. [PMID: 37796879 PMCID: PMC10553288 DOI: 10.1371/journal.pone.0277995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/22/2022] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND COVID-19 experiences on noncommunicable diseases (NCDs) from district-level hospital settings during waves I and II are scarcely documented. The aim of this study is to investigate the NCDs associated with COVID-19 severity and mortality in a district-level hospital with a high HIV/TB burden. METHODS This was a retrospective observational study that compared COVID-19 waves I and II at Khayelitsha District Hospital in Cape Town, South Africa. COVID-19 adult patients with a confirmed SARS-CoV-2 polymerase chain reaction (PCR) or positive antigen test were included. In order to compare the inter wave period, clinical and laboratory parameters on hospital admission of noncommunicable diseases, the Student t-test or Mann-Whitney U for continuous data and the X2 test or Fishers' Exact test for categorical data were used. The role of the NCD subpopulation on COVID-19 mortality was determined using latent class analysis (LCA). FINDINGS Among 560 patients admitted with COVID-19, patients admitted during wave II were significantly older than those admitted during wave I. The most prevalent comorbidity patterns were hypertension (87%), diabetes mellitus (65%), HIV/AIDS (30%), obesity (19%), Chronic Kidney Disease (CKD) (13%), Congestive Cardiac Failure (CCF) (8.8%), Chronic Obstructive Pulmonary Disease (COPD) (3%), cerebrovascular accidents (CVA)/stroke (3%), with similar prevalence in both waves except HIV status [(23% vs 34% waves II and I, respectively), p = 0.022], obesity [(52% vs 2.5%, waves II and I, respectively), p <0.001], previous stroke [(1% vs 4.1%, waves II and I, respectively), p = 0.046]. In terms of clinical and laboratory findings, our study found that wave I patients had higher haemoglobin and HIV viral loads. Wave II, on the other hand, had statistically significant higher chest radiography abnormalities, fraction of inspired oxygen (FiO2), and uraemia. The adjusted odds ratio for death vs discharge between waves I and II was similar (0.94, 95%CI: 0.84-1.05). Wave I had a longer average survival time (8.0 vs 6.1 days) and a shorter average length of stay among patients discharged alive (9.2 vs 10.7 days). LCA revealed that the cardiovascular phenotype had the highest mortality, followed by diabetes and CKD phenotypes. Only Diabetes and hypertension phenotypes had the lowest mortality. CONCLUSION Even though clinical and laboratory characteristics differed significantly between the two waves, mortality remained constant. According to LCA, the cardiovascular, diabetes, and CKD phenotypes had the highest death probability.
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Affiliation(s)
- Ayanda Trevor Mnguni
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Khayelitsha District Hospital, Cape Town, South Africa
| | | | | | | | | | - Neshaad Schrueder
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Shiraaz Gabriels
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Annibale Cois
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jacques L. Tamuzi
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Yamanya Tembo
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Health Impact Assessment Directorate, Western Cape Government, Cape Town, South Africa
| | - Rene English
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter S. Nyasulu
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine and Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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12
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Ghorbanali Z, Zare-Mirakabad F, Salehi N, Akbari M, Masoudi-Nejad A. DrugRep-HeSiaGraph: when heterogenous siamese neural network meets knowledge graphs for drug repurposing. BMC Bioinformatics 2023; 24:374. [PMID: 37789314 PMCID: PMC10548718 DOI: 10.1186/s12859-023-05479-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Drug repurposing is an approach that holds promise for identifying new therapeutic uses for existing drugs. Recently, knowledge graphs have emerged as significant tools for addressing the challenges of drug repurposing. However, there are still major issues with constructing and embedding knowledge graphs. RESULTS This study proposes a two-step method called DrugRep-HeSiaGraph to address these challenges. The method integrates the drug-disease knowledge graph with the application of a heterogeneous siamese neural network. In the first step, a drug-disease knowledge graph named DDKG-V1 is constructed by defining new relationship types, and then numerical vector representations for the nodes are created using the distributional learning method. In the second step, a heterogeneous siamese neural network called HeSiaNet is applied to enrich the embedding of drugs and diseases by bringing them closer in a new unified latent space. Then, it predicts potential drug candidates for diseases. DrugRep-HeSiaGraph achieves impressive performance metrics, including an AUC-ROC of 91.16%, an AUC-PR of 90.32%, an accuracy of 84.63%, a BS of 0.119, and an MCC of 69.31%. CONCLUSION We demonstrate the effectiveness of the proposed method in identifying potential drugs for COVID-19 as a case study. In addition, this study shows the role of dipeptidyl peptidase 4 (DPP-4) as a potential receptor for SARS-CoV-2 and the effectiveness of DPP-4 inhibitors in facing COVID-19. This highlights the practical application of the model in addressing real-world challenges in the field of drug repurposing. The code and data for DrugRep-HeSiaGraph are publicly available at https://github.com/CBRC-lab/DrugRep-HeSiaGraph .
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Affiliation(s)
- Zahra Ghorbanali
- Computational Biology Research Center (CBRC), Department of Mathematics and Computer Science, Amirkabir University of Technology, Tehran, Iran
| | - Fatemeh Zare-Mirakabad
- Computational Biology Research Center (CBRC), Department of Mathematics and Computer Science, Amirkabir University of Technology, Tehran, Iran.
| | - Najmeh Salehi
- School of Biological Science, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Mohammad Akbari
- Computational Biology Research Center (CBRC), Department of Mathematics and Computer Science, Amirkabir University of Technology, Tehran, Iran
| | - Ali Masoudi-Nejad
- Laboratory of Systems Biology and Bioinformatics (LBB), Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
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13
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Beaney T, Wang W, Schlaich MP, Schutte AE, Stergiou GS, Alcocer L, Alsaid J, Diaz AB, Hernandez-Hernandez R, Ishaq M, Jozwiak J, Khan N, Kiru G, McCardle H, Odili AN, Pyun WB, Romero CA, Wang J, Poulter NR. Global blood pressure screening during the COVID-19 pandemic: results from the May Measurement Month 2021 campaign. J Hypertens 2023; 41:1446-1455. [PMID: 37337866 PMCID: PMC10399936 DOI: 10.1097/hjh.0000000000003488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/20/2023] [Accepted: 05/10/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Raised blood pressure (BP) remains the biggest risk factor contributing to the global burden of disease and mortality, despite the COVID-19 pandemic. May Measurement Month (MMM), an annual global screening campaign aims to highlight the importance of BP measurement by evaluating global awareness, treatment and control rates among adults with hypertension. In 2021, we assessed the global burden of these rates during the COVID-19 pandemic. METHODS Screening sites were set up in 54 countries between May and November 2021 and screenees were recruited by convenience sampling. Three sitting BPs were measured, and a questionnaire completed including demographic, lifestyle and clinical data. Hypertension was defined as a systolic BP at least 140 mmHg and/or a diastolic BP at least 90 mmHg (using the mean of the second and third readings) or taking antihypertensive medication. Multiple imputation was used to impute the average BP when readings were missing. RESULTS Of the 642 057 screenees, 225 882 (35.2%) were classified as hypertensive, of whom 56.8% were aware, and 50.3% were on antihypertensive medication. Of those on treatment, 53.9% had controlled BP (<140/90 mmHg). Awareness, treatment and control rates were lower than those reported in MMM campaigns before the COVID-19 pandemic. Minimal changes were apparent among those testing positive for, or being vaccinated against COVID-19. Of those on antihypertensive medication, 94.7% reported no change in their treatment because of the COVID-19 pandemic. CONCLUSION The high yield of untreated or inadequately treated hypertension in MMM 2021 confirms the need for systematic BP screening where it does not currently exist.
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Affiliation(s)
- Thomas Beaney
- Imperial Clinical Trials Unit, and
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Wei Wang
- Imperial Clinical Trials Unit, and
| | - Markus P. Schlaich
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital Unit – University of Western Australia, Perth, Western Australia
| | - Aletta E. Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, Australia
- Hypertension in Africa Research Team/SAMRC Unit for Hypertension and CVD, North-West University, Potchefstroom, South Africa
| | - George S. Stergiou
- School of Medicine, Hypertension Center STRIDE-7 National and Kapodistrian University of Athens Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Luis Alcocer
- Instituto Mexicano de Salud Cardiovascular, Tuxpan 16, Roma Sur, Cuauhtemoc, Mexico
| | - Jafar Alsaid
- University of Queensland, Brisbane, Queensland, Australia
- Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Alejandro Bimbo Diaz
- Department of Neuroscience and Behavioral Medicine, University of Santo Tomas Hospital, Manila, Philippines
| | - Rafael Hernandez-Hernandez
- Hypertension and Cardiovascular Risk Factors Clinic, Dean of Health Sciences, Universidad Centro Occidental Lisandro Alvarado, Barquisimeto, Venezuela
| | - Mohammad Ishaq
- Karachi Institute of Heart Diseases, AGA Khan University Hospital, Karachi, Pakistan
| | - Jacek Jozwiak
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Opole, Opole, Poland
| | - Nadia Khan
- Department of Medicine, Center for Health Evaluation and Outcomes Sciences, University of British Colombia, Vancouver, Canada
| | | | | | - Augustine Nonso Odili
- Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Cesar A. Romero
- Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jiguang Wang
- Rujin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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14
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Rangelov B, Young A, Lilaonitkul W, Aslani S, Taylor P, Guðmundsson E, Yang Q, Hu Y, Hurst JR, Hawkes DJ, Jacob J. Delineating COVID-19 subgroups using routine clinical data identifies distinct in-hospital outcomes. Sci Rep 2023; 13:9986. [PMID: 37339958 PMCID: PMC10282086 DOI: 10.1038/s41598-023-32469-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/28/2023] [Indexed: 06/22/2023] Open
Abstract
The COVID-19 pandemic has been a great challenge to healthcare systems worldwide. It highlighted the need for robust predictive models which can be readily deployed to uncover heterogeneities in disease course, aid decision-making and prioritise treatment. We adapted an unsupervised data-driven model-SuStaIn, to be utilised for short-term infectious disease like COVID-19, based on 11 commonly recorded clinical measures. We used 1344 patients from the National COVID-19 Chest Imaging Database (NCCID), hospitalised for RT-PCR confirmed COVID-19 disease, splitting them equally into a training and an independent validation cohort. We discovered three COVID-19 subtypes (General Haemodynamic, Renal and Immunological) and introduced disease severity stages, both of which were predictive of distinct risks of in-hospital mortality or escalation of treatment, when analysed using Cox Proportional Hazards models. A low-risk Normal-appearing subtype was also discovered. The model and our full pipeline are available online and can be adapted for future outbreaks of COVID-19 or other infectious disease.
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Affiliation(s)
- Bojidar Rangelov
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK.
| | - Alexandra Young
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK
- Department of Neuroimaging, King's College London, London, UK
| | | | - Shahab Aslani
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK
| | - Paul Taylor
- Institute of Health Informatics, University College London, London, UK
| | - Eyjólfur Guðmundsson
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK
| | - Qianye Yang
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Yipeng Hu
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - David J Hawkes
- Centre for Medical Image Computing, University College London, London, UK
| | - Joseph Jacob
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK
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15
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Camacho Moll ME, Mata Tijerina VL, Silva Ramírez B, Peñuelas Urquides K, González Escalante LA, Escobedo Guajardo BL, Cruz Luna JE, Corrales Pérez R, Gómez García S, Bermúdez de León M. Sex, Age, and Comorbidities Are Associated with SARS-CoV-2 Infection, COVID-19 Severity, and Fatal Outcome in a Mexican Population: A Retrospective Multi-Hospital Study. J Clin Med 2023; 12:jcm12072676. [PMID: 37048758 PMCID: PMC10095205 DOI: 10.3390/jcm12072676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
People with comorbidities and the male sex are at a higher risk of developing severe COVID-19. In the present study, we aim to investigate the associated factors for infection, severity, and death due to COVID-19 in a population from Nuevo León, México. Epidemiological COVID-19 data were collected from 65 hospitals from December 2020 to May 2022. A total of 75,232 cases were compiled from which 25,722 cases were positive for SARS-CoV-2. Male sex, older age, diabetes, obesity, and hypertension were associated with infection. In addition to the above-mentioned factors, renal disease, cardiovascular disease, and immunosuppression were found to be associated with increased COVID-19 severity. These factors, as well as neurological diseases, are also associated with death due to COVID-19. When comparing the different variants of SARs-CoV-2, the variant B1.1.519 increased the probability of death by 2.23 times compared to the AY.20 variant. Male sex, older age, diabetes, obesity, and hypertension are associated with SARS-CoV-2 infection, severity, and death. Along with the aforementioned comorbidities, renal disease, cardiovascular disease, and immunosuppression are also associated with severity and death. Another factor associated with death is the presence of neurological disease. The SARS-CoV-2 B1.1.519 variant increases the odds of death compared to the SARS-CoV-2 AY.20 variant.
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Affiliation(s)
- Maria Elena Camacho Moll
- Laboratory of Molecular Biology, Northeast Biomedical Research Centre, Mexican Social Security Institute, Monterrey 64720, Mexico
| | - Viviana Leticia Mata Tijerina
- Laboratory of Immunogenetics, Northeast Biomedical Research Centre, Mexican Social Security Institute, Monterrey 64720, Mexico
| | - Beatriz Silva Ramírez
- Laboratory of Immunogenetics, Northeast Biomedical Research Centre, Mexican Social Security Institute, Monterrey 64720, Mexico
| | - Katia Peñuelas Urquides
- Laboratory of Molecular Microbiology, Northeast Biomedical Research Centre, Mexican Social Security Institute, Monterrey 64720, Mexico
| | - Laura Adiene González Escalante
- Laboratory of Molecular Microbiology, Northeast Biomedical Research Centre, Mexican Social Security Institute, Monterrey 64720, Mexico
| | - Brenda Leticia Escobedo Guajardo
- Laboratory of Molecular Research of Diseases, Northeast Biomedical Research Centre, Mexican Social Security Institute, Monterrey 64720, Mexico
| | - Jorge Eleazar Cruz Luna
- Medical Epidemiological Assistance Coordination of the State of Nuevo León, Mexican Social Security Institute, Monterrey 64000, Mexico
| | - Roberto Corrales Pérez
- Medical Epidemiological Assistance Coordination of the State of Nuevo León, Mexican Social Security Institute, Monterrey 64000, Mexico
| | - Salvador Gómez García
- Medical Epidemiological Assistance Coordination of the State of Nuevo León, Mexican Social Security Institute, Monterrey 64000, Mexico
| | - Mario Bermúdez de León
- Laboratory of Molecular Biology, Northeast Biomedical Research Centre, Mexican Social Security Institute, Monterrey 64720, Mexico
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16
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Amado LA, Coelho WLDCNP, Alves ADR, Carneiro VCDS, Moreira ODC, de Paula VS, Lemos AS, Duarte LA, Gutman EG, Fontes-Dantas FL, Gonçalves JPDC, Ramos CHF, Ramos Filho CHF, Cavalcanti MG, Amaro MP, Kader RL, Medronho RDA, Sarmento DJDS, Alves-Leon SV. Clinical Profile and Risk Factors for Severe COVID-19 in Hospitalized Patients from Rio de Janeiro, Brazil: Comparison between the First and Second Pandemic Waves. J Clin Med 2023; 12:2568. [PMID: 37048652 PMCID: PMC10094970 DOI: 10.3390/jcm12072568] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 03/30/2023] Open
Abstract
Since COVID-19 was declared a pandemic, Brazil has become one of the countries most affected by this disease. A year into the pandemic, a second wave of COVID-19 emerged, with a rapid spread of a new SARS-CoV-2 lineage of concern. Several vaccines have been granted emergency-use authorization, leading to a decrease in mortality and severe cases in many countries. However, the emergence of SARS-CoV-2 variants raises the alert for potential new waves of transmission and an increase in pathogenicity. We compared the demographic and clinical data of critically ill patients infected with COVID-19 hospitalized in Rio de Janeiro during the first and second waves between July 2020 and October 2021. In total, 106 participants were included in this study; among them, 88% had at least one comorbidity, and 37% developed severe disease. Disease severity was associated with older age, pre-existing neurological comorbidities, higher viral load, and dyspnea. Laboratory biomarkers related to white blood cells, coagulation, cellular injury, inflammation, renal, and liver injuries were significantly associated with severe COVID-19. During the second wave of the pandemic, the necessity of invasive respiratory support was higher, and more individuals with COVID-19 developed acute hepatitis, suggesting that the progression of the second wave resulted in an increase in severe cases. These results can contribute to understanding the behavior of the COVID-19 pandemic in Brazil and may be helpful in predicting disease severity, which is a pivotal for guiding clinical care, improving patient outcomes, and defining public policies.
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Affiliation(s)
- Luciane Almeida Amado
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro 21040-900, Brazil
| | | | - Arthur Daniel Rocha Alves
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Vanessa Cristine de Souza Carneiro
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro 21040-900, Brazil
- Laboratory of Molecular Virology, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Otacilio da Cruz Moreira
- Laboratory of Molecular Virology, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro 21040-900, Brazil
- Real Time PCR Platform RPT09A, Laboratory of Molecular Biology and Endemic Diseases, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Vanessa Salete de Paula
- Laboratory of Molecular Virology, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Andreza Salvio Lemos
- Laboratory of Translacional Neurosciences, Biomedical Institute, Federal University of the State of Rio de Janeiro-UNIRIO, Rio de Janeiro 22290-240, Brazil
| | - Larissa Araujo Duarte
- Laboratory of Translacional Neurosciences, Biomedical Institute, Federal University of the State of Rio de Janeiro-UNIRIO, Rio de Janeiro 22290-240, Brazil
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Elisa Gouvea Gutman
- Laboratory of Translacional Neurosciences, Biomedical Institute, Federal University of the State of Rio de Janeiro-UNIRIO, Rio de Janeiro 22290-240, Brazil
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Fabricia Lima Fontes-Dantas
- Laboratory of Translacional Neurosciences, Biomedical Institute, Federal University of the State of Rio de Janeiro-UNIRIO, Rio de Janeiro 22290-240, Brazil
- Department of Pharmacology and Psychobiology, Roberto Alcântara Gomes Institute Biology (IBRAG), Rio de Janeiro State University (UERJ), Rio de Janeiro 20551-030, Brazil
| | - João Paulo da Costa Gonçalves
- Laboratory of Translacional Neurosciences, Biomedical Institute, Federal University of the State of Rio de Janeiro-UNIRIO, Rio de Janeiro 22290-240, Brazil
| | - Carlos Henrique Ferreira Ramos
- Unit of Intensive Treatment, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | | | - Marta Guimarães Cavalcanti
- Epidemiology and Evaluation Service, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Marisa Pimentel Amaro
- Post-Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Rafael Lopes Kader
- Post-Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | | | | | - Soniza Vieira Alves-Leon
- Laboratory of Translacional Neurosciences, Biomedical Institute, Federal University of the State of Rio de Janeiro-UNIRIO, Rio de Janeiro 22290-240, Brazil
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
- Department of Neurology, Reference and Research Center for Multiple Sclerosis and Other Central Nervous System Idiopathic Demyelinating Inflammatory Diseases, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
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17
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Nag S, Mandal S, Mukherjee O, Mukherjee S, Kundu R. DPP-4 Inhibitors as a savior for COVID-19 patients with diabetes. Future Virol 2023:10.2217/fvl-2022-0112. [PMID: 37064327 PMCID: PMC10096336 DOI: 10.2217/fvl-2022-0112] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 03/01/2023] [Indexed: 04/18/2023]
Abstract
Diabetic patients are at particular risk of severe COVID-19. Human dipeptidyl peptidase-4 (DPP-4) is a membrane-bound aminopeptidase that regulates insulin release by inactivating incretin. DPP-4 inhibitors (DPP-4is) are therefore used as oral anti-diabetic drugs to restore normal insulin levels. These molecules also have anti-inflammatory and anti-hypertension effects. Recent studies on the interactions of SARS-CoV-2 spike glycoprotein and DPP-4 predict a possible entry route for SARS-CoV-2. Therefore, DPP-4is could be effective at reducing the virus-induced 'cytokine storm', thereby ceasing inflammatory injury to vital organs. Moreover, DPP-4is may interfere with viral entry into host cells. Herein, we have reviewed the efficacy of DPP-4is as potential repurposed drugs to reduce the severity of SARS-CoV-2 infection in patients with diabetes.
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Affiliation(s)
- Snehasish Nag
- Department of Zoology, Cell Signaling Laboratory, Visva-Bharati University, Santiniketan, West Bengal, 731 235, India
| | - Samanwita Mandal
- Department of Zoology, Cell Signaling Laboratory, Visva-Bharati University, Santiniketan, West Bengal, 731 235, India
| | - Oindrila Mukherjee
- Department of Zoology, Cell Signaling Laboratory, Visva-Bharati University, Santiniketan, West Bengal, 731 235, India
| | - Suprabhat Mukherjee
- Department of Animal Science, Integrative Biochemistry & Immunology Laboratory, Kazi Nazrul University, Asansol, West Bengal, 713 340, India
- Author for correspondence:
| | - Rakesh Kundu
- Department of Zoology, Cell Signaling Laboratory, Visva-Bharati University, Santiniketan, West Bengal, 731 235, India
- Author for correspondence:
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18
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Angeli F, Zappa M, Reboldi G, Gentile G, Trapasso M, Spanevello A, Verdecchia P. The spike effect of acute respiratory syndrome coronavirus 2 and coronavirus disease 2019 vaccines on blood pressure. Eur J Intern Med 2023; 109:12-21. [PMID: 36528504 PMCID: PMC9744686 DOI: 10.1016/j.ejim.2022.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/14/2022]
Abstract
Among the various comorbidities potentially worsening the clinical outcome in patients hospitalized for the acute respiratory syndrome coronavirus-2 (SARS-CoV-2), hypertension is one of the most prevalent. However, the basic mechanisms underlying the development of severe forms of coronavirus disease 2019 (COVID-19) among hypertensive patients remain undefined and the direct association of hypertension with outcome in COVID-19 is still a field of debate. Experimental and clinical data suggest that SARS-CoV-2 infection promotes a rise in blood pressure (BP) during the acute phase of infection. Acute increase in BP and high in-hospital BP variability may be tied with acute organ damage and a worse outcome in patients hospitalized for COVID-19. In this context, the failure of the counter-regulatory renin-angiotensin-system (RAS) axis is a potentially relevant mechanism involved in the raise in BP. It is well recognized that the efficient binding of the Spike (S) protein to angiotensin converting enzyme 2 (ACE2) receptors mediates the virus entry into cells. Internalization of ACE2, downregulation and malfunction predominantly due to viral occupation, dysregulates the protective RAS axis with increased generation and activity of angiotensin (Ang) II and reduced formation of Ang1,7. Thus, the imbalance between Ang II and Ang1-7 can directly contribute to excessively rise BP in the acute phase of SARS-CoV-2 infection. A similar mechanism has been postulated to explain the raise in BP following COVID-19 vaccination ("Spike Effect" similar to that observed during the infection of SARS-CoV-2). S proteins produced upon vaccination have the native-like mimicry of SARS-CoV-2 S protein's receptor binding functionality and prefusion structure and free-floating S proteins released by the destroyed cells previously targeted by vaccines may interact with ACE2 of other cells, thereby promoting ACE2 internalization and degradation, and loss of ACE2 activities.
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, 21100, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049, Italy.
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, 21100, Italy
| | - Gianpaolo Reboldi
- Department of Medicine, and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, Perugia, 06100, Italy
| | - Giorgio Gentile
- College of Medicine and Health. University of Exeter, Exeter, United Kingdom and Department of Nephrology, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - Monica Trapasso
- Dipartimento di Igiene e Prevenzione Sanitaria, PSAL, Sede Territoriale di Varese, ATS Insubria, Varese, 21100, Italy
| | - Antonio Spanevello
- Department of Medicine and Surgery, University of Insubria, Varese, 21100, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049, Italy
| | - Paolo Verdecchia
- Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, and Fondazione Umbra Cuore e Ipertensione-ONLUS, Perugia, 06100, Italy
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19
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COVID-19 pandemic and hypertension: an updated report from the Japanese Society of Hypertension project team on COVID-19. Hypertens Res 2023; 46:589-600. [PMID: 36550205 PMCID: PMC9780104 DOI: 10.1038/s41440-022-01134-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/19/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
The number of reported cases with coronavirus disease 2019 (COVID-19) has exceeded 620 million worldwide, still having a profound impact on people's health and daily lives since its occurrence and outbreak in December 2019. From the early phase of the COVID-19 pandemic, there has been a concern that the rapid spread of this communicable disease can negatively influence non-communicable diseases. Accumulating data indicate that the restriction on the access to medical care, psychological distress, and life-style changes triggered by the pandemic have indeed affected blood pressure control in hypertensive patients. Since our previous report in 2020 that summarized the findings of the literature related to COVID-19 and hypertension, there has been a considerable progress in our understanding of the association between these two disorders; nonetheless, there are remaining challenges and emerging questions in the field. In this article, we aim to summarize the latest information on the impact of the pandemic on blood pressure control, the use of the renin-angiotensin system inhibitors in patients with COVID-19, and the blood pressure changes as one of the possible post-acute sequelae of COVID-19 (also known as long COVID). We also summarize the evidence of telemedicine and COVID-19 vaccination in hypertensive subjects, based on data available as of June 2022.
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20
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Espiritu AI, Sucaldito MSFP, Ona DID, Apor ADAO, Sy MCC, Anlacan VMM, Jamora RDG. Clinical outcomes in COVID-19 among patients with hypertension in the Philippine CORONA Study. Eur J Med Res 2023; 28:62. [PMID: 36732874 PMCID: PMC9894742 DOI: 10.1186/s40001-022-00969-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/21/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To describe the association between hypertension and clinical outcomes in a cohort of patients with coronavirus disease 2019 (COVID-19). DESIGN Retrospective cohort study. SETTING Thirty-seven (37) hospitals in the Philippines. PATIENTS 10,881 patients admitted for COVID-19 from February to December 2020. MEASUREMENTS AND MAIN RESULTS Among the 10,881 patients included in the Philippine CORONA Study, 3647 (33.5%) had hypertension. On regression analysis adjusted for confounders (age group, sex, smoking history, diabetes, chronic cardiac disease, chronic kidney disease, chronic respiratory disease, chronic neurologic disease, chronic liver disease, HIV/AIDS, and malignancy), patients with hypertension had significantly greater odds of in-hospital mortality (OR 1.33, 95% CI 1.17-1.52), respiratory failure (OR 1.99, 95% CI 1.75-2.28), ICU admission (OR 2.16, 95% CI 1.90-2.45) and severe/critical disease (OR 1.57, 95% CI 1.41-1.75), compared to patients without hypertension. The time-to-event analysis with confounder adjustment also showed that hypertension was significantly associated with shorter time-to-event outcomes of in-hospital mortality (HR 1.13, 95% CI 1.01-1.26), respiratory failure (HR 1.86, 95% CI 1.65-2.10), and ICU admission (HR 1.99, 95% CI 1.76-2.23). CONCLUSIONS Our analysis of nationwide data confirmed previous findings that hypertension is an independent risk factor for worse clinical outcomes among patients hospitalized for COVID-19, with increased odds of in-hospital mortality, respiratory failure, ICU admission, and severe/critical COVID-19. More specific studies should be done to elucidate the impact of hypertension characteristics, such as chronicity, severity, drug therapy, and level of control on these clinical outcomes.
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Affiliation(s)
- Adrian I. Espiritu
- grid.11159.3d0000 0000 9650 2179Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines ,grid.11159.3d0000 0000 9650 2179Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines ,grid.17063.330000 0001 2157 2938Department of Medicine (Division of Neurology) and Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Ma. Sergia Fatima P. Sucaldito
- grid.11159.3d0000 0000 9650 2179Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Deborah Ignacia D. Ona
- grid.11159.3d0000 0000 9650 2179Division of Hypertension, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Almira Doreen Abigail O. Apor
- grid.11159.3d0000 0000 9650 2179Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Marie Charmaine C. Sy
- grid.11159.3d0000 0000 9650 2179Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Veeda Michelle M. Anlacan
- grid.11159.3d0000 0000 9650 2179Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Roland Dominic G. Jamora
- grid.11159.3d0000 0000 9650 2179Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines ,grid.416846.90000 0004 0571 4942Institute for Neurosciences, St. Luke’s Medical Center, Quezon City, Philippines ,grid.416846.90000 0004 0571 4942Institute for Neurosciences, St. Luke’s Medical Center, Global City, Philippines
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21
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Oliveira KB, de Melo IS, da Silva BRM, Oliveira KLDS, Sabino-Silva R, Anhezini L, Katayama PL, Santos VR, Shetty AK, de Castro OW. SARS-CoV-2 and Hypertension: Evidence Supporting Invasion into the Brain Via Baroreflex Circuitry and the Role of Imbalanced Renin-Angiotensin-Aldosterone-System. Neurosci Insights 2023; 18:26331055231151926. [PMID: 36756280 PMCID: PMC9900164 DOI: 10.1177/26331055231151926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/04/2023] [Indexed: 02/05/2023] Open
Abstract
Hypertension is considered one of the most critical risk factors for COVID-19. Evidence suggests that SARS-CoV-2 infection produces intense effects on the cardiovascular system by weakening the wall of large vessels via vasa-vasorum. In this commentary, we propose that SARS-CoV-2 invades carotid and aortic baroreceptors, leading to infection of the nucleus tractus solitari (NTS) and paraventricular hypothalamic nucleus (PVN), and such dysregulation of NTS and PVN following infection causes blood pressure alteration at the central level. We additionally explored the hypothesis that SARS-CoV-2 favors the internalization of membrane ACE2 receptors generating an imbalance of the renin-angiotensin-aldosterone system (RAAS), increasing the activity of angiotensin II (ANG-II), disintegrin, and metalloproteinase 17 domain (ADAM17/TACE), eventually modulating the integration of afferents reaching the NTS from baroreceptors and promoting increased blood pressure. These mechanisms are related to the increased sympathetic activity, which leads to transient or permanent hypertension associated with SARS-CoV-2 invasion, contributing to the high number of deaths by cardiovascular implications.
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Affiliation(s)
- Kellysson Bruno Oliveira
- Department of Physiology, Institute of
Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceió,
Alagoas, Brazil
| | - Igor Santana de Melo
- Department of Physiology, Institute of
Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceió,
Alagoas, Brazil
| | - Bianca Rodrigues Melo da Silva
- Department of Physiology, Institute of
Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceió,
Alagoas, Brazil
| | - Keylla Lavínia da Silva Oliveira
- Department of Physiology, Institute of
Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceió,
Alagoas, Brazil
| | - Robinson Sabino-Silva
- Department of Physiology, Institute of
Biomedical Sciences, Federal University of Uberlandia (UFU), Uberlândia, Minas
Gerais, Brazil
| | - Lucas Anhezini
- Department of Histology, Institute of
Biological Sciences and Health, Federal University of Alagoas, Maceió, Alagoas,
Brazil
| | - Pedro Lourenco Katayama
- Department of Physiology and Pathology,
Dentistry School of Araraquara, São Paulo State University, Araraquara, São Paulo,
Brazil
| | - Victor Rodrigues Santos
- Department of Morphology, Institute of
Biological Science, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas
Gerais, Brazil
| | - Ashok K Shetty
- Institute for Regenerative Medicine,
Department of Cell Biology and Genetics, Texas A&M University School of
Medicine, College Station, TX, USA
| | - Olagide Wagner de Castro
- Department of Physiology, Institute of
Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceió,
Alagoas, Brazil,Olagide Wagner de Castro, Institute of
Biological Sciences and Health, Federal University of Alagoas (UFAL), Av.
Lourival de Melo Mota, km 14, Campus A. C. Simões, Cidade Universitária, Maceió,
Alagoas CEP 57072-970, Brazil.
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22
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Therapeutic target and clinical impact of day-to-day blood pressure variability in hypertensive patients with covid-19. Hypertens Res 2023; 46:165-174. [PMID: 36280737 PMCID: PMC9589643 DOI: 10.1038/s41440-022-01077-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 02/03/2023]
Abstract
Blood pressure variability (BPV) is essential in hypertensive patients and is frequently associated with organ damage. As of today, hypertension is still the most common comorbidity in COVID-19, but the impact of BPV and the therapeutic target of BPV on outcomes in COVID-19 patients with hypertension remain unclear. Therefore, this study investigated the relationship between BPV and severity of COVID-19, in-hospital mortality, hypertensive status, and efficacy of antihypertensives in suppressing hypertensive covid-19 patient BPV. This cohort retrospective study enrolled 351 patients hospitalized with COVID-19. Subjects were classified according to the severity of COVID-19, the presence of hypertension, and their BPV status. During hospitalization, mean arterial pressure (MAP) was measured at 6 a.m. and 6 p.m., and BPV was calculated as the coefficient of variation of MAP (MAPCV). MAPCV values above the median were defined as high BPV. In addition, we compared the hypertensive status, COVID-19 severity, in-hospital mortality, and antihypertensive agents between the BPV groups. The mean age was 53.85 ± 18.84 years old. Hypertension was significantly associated with high BPV with prevalence ratio (PR) = 1.38 (95% CI = 1.13-1.70; p = 0.003) or severe COVID-19 (PR = 1.39; 95% CI = 1.09-1.76; p = 0.005). In laboratory findings, high BPV group had lower Albumin, higher WBC, serum Cr, CRP, and creatinine to albumin ratio. High BPV status also significantly increased risk of mortality (HR = 2.30; 95% CI = 1.73-3.86; p < 0.001). Patients with a combination of severe COVID-19 status, hypertension, and high BPV status had the highest risk of in-hospital mortality (HR = 3.51; 95% CI = 2.32-4.97; p < 0.001) compared to other combination status groups. In COVID-19 patients with hypertension, combination therapy with calcium channel blockers (CCB) as well as CCB monotherapy significantly develop low BPV (PR = 2.002; 95 CI% = 1.33-3.07; p = 0.004) and low mortality (HR = 0.17; 95% CI = 0.05-0.56; p = 0.004). Hypertensive status and severe COVID-19 were significantly associated with high BPV, and these factors increased in-hospital mortality. CCBs might be antihypertensive agents that potentially effectively suppressing BPV and mortality in COVID-19 patients.
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23
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Comparative Analysis of the Efficiency of Medicinal Plants for the Treatment and Prevention of COVID-19. Int J Biomater 2022; 2022:5943649. [DOI: 10.1155/2022/5943649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/30/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has once again prompted people to resort to the remedies of folk and alternative medicine. Medicinal plants, because of their chemical composition, pharmacological properties, and the action of biologically active substances, can stop and relieve the symptoms of the disease. The purpose of the work is a comparative flora analysis of medicinal plants to identify the most prospective plant and further production of a remedy for the avoidance, treatment, and rehabilitation of COVID-19. The search for prospective medicinal plants was performed by analyzing the literature in online databases: Web of Science, Scopus, Google Scholar, and PubMed, including official WHO media sites. According to recent studies related to COVID-19, a significant number of medicinal plants with anti-inflammatory, antiviral, and immunostimulatory effects have been identified. A comparative study of nine medicinal plants was conducted to determine the most suitable medicinal plant to treat coronavirus infection. According to the results of the comparative analysis, Chamaenerion angustifolium Seg. showed itself as the most prospective medicinal plant with the greatest pharmacological effect compared with other types of medicinal plants. Its therapeutic properties allow physiological relief of 18 symptoms of coronavirus infection. It is advisable to conduct further clinical trials for the treatment and rehabilitation of COVID-19 using preparations from this plant.
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24
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Shaw KA, Bertrand L, Deprez D, Ko J, Zello GA, Chilibeck PD. The impact of the COVID-19 pandemic on the diet, training habits and fitness of Masters cyclists. Nutr Health 2022; 28:669-675. [PMID: 33759633 PMCID: PMC9716051 DOI: 10.1177/02601060211002350] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background: The number of Masters-level athletes (≥ 35 years of age) taking part in cycling has increased in the past years which may have beneficial effects on their health. The restrictions brought on by the COVID-19 pandemic has the potential to negatively impact the diet, training and fitness of these individuals due to restrictions in place to slow the spread of the virus. Aim: To investigate how the COVID-19 pandemic impacted the diet, training and fitness of Masters-level cyclists. Methods: 32 Masters cyclists (12 males, 20 females; mean age 47 ± 10 years) completed two incremental exercise tests one month apart during the pandemic to assess sport-specific fitness. Participants also completed online questionnaires to report their sedentary behavior and dietary intake before and during the pandemic, and their training volume and intensity for a specified week in February (before the pandemic) and each of March, April and May (during the pandemic). Results: No differences were seen in fitness (p = 0.6), training volume (p = 0.24) or intensity (p = 0.79) and sedentary behavior (p = 0.14) during the pandemic. Energy intake was unchanged (p = 1.0) during the pandemic, but participants consumed lower amounts of key nutrients such as fiber, vitamin A, omega-3 fatty acids and potassium (p < 0.05) while consuming more alcohol (p = 0.008) and vitamin C (p = 0.03). Conclusions: Our data shows that the COVID-19 pandemic has undesirable effects on nutrient and alcohol intake of Masters cyclists without impacting their training regimes, which may have adverse effects on their overall health and fitness in the long term.
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Affiliation(s)
- Keely A Shaw
- College of Kinesiology, University of
Saskatchewan, Canada
| | | | - Dalton Deprez
- College of Kinesiology, University of
Saskatchewan, Canada
| | - Jongbum Ko
- College of Kinesiology, University of
Saskatchewan, Canada
| | - Gordon A Zello
- College of Pharmacy and Nutrition, University of
Saskatchewan, Canada
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25
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da Luz Pádua Guimarães MC, Coelho JC, dos Santos J, de Oliveira Higa CB, Flórido CF, Lee RJW, Paes GS, da Silva GV, Drager LF, Pierin AMG. Adherence to antihypertensive treatment during the COVID-19 pandemic: findings from a cross-sectional study. Clin Hypertens 2022; 28:35. [PMID: 36451199 PMCID: PMC9713116 DOI: 10.1186/s40885-022-00219-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 07/17/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Nonadherence to antihypertensive treatment is one of the main causes of the lack of blood pressure (BP) control. The coronavirus disease (COVID-19) pandemic imposes substantial social restriction impairing the medical care routine, which may influence adherence to the antihypertensive treatment. To assess the rate of nonadherence to antihypertensive drug treatment during the COVID-19 pandemic. METHODS This is a cross-sectional study evaluating hypertensive adult patients from a tertiary outpatient clinic. From March to August 2020, patients were interviewed by telephone during the social distancing period of the COVID-19 pandemic. We evaluated biosocial data, habits, attitudes, and treatment adherence using the 4-item Morisky Green Levine Scale during the social distancing. Uncontrolled BP was defined by BP ≥ 140/90 mmHg. Clinical and prescription variables for drug treatment were obtained from the electronic medical record. We performed a multivariate analysis to determine the predictors of nonadherence to BP treatment. RESULTS We studied 281 patients (age 66 ± 14 years, 60.5% white, 62.3% women, mean education of 9.0 ± 4 years of study). We found that 41.3% of the individuals reported poor adherence to antihypertensive drug treatment and 48.4% had uncontrolled BP. Subsample data identified that adherence was worse during the pandemic than in the previous period. The variables that were independently associated with the nonadherence during the pandemic period were black skin color (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.46-4.68), and intermittent lack of access to antihypertensive medication during the pandemic (OR, 2.56; 95% CI, 1.11-5.89). CONCLUSIONS Beyond traditional variables associated with poor adherence, the lack of availability of antihypertensive medications during the study underscore the potential role of pandemic on hypertension burden.
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Affiliation(s)
| | - Juliana Chaves Coelho
- grid.11899.380000 0004 1937 0722University of São Paulo Nursing School, São Paulo, Brazil ,grid.414374.1Beneficência Portuguesa Hospital in São Paulo, São Paulo, Brazil
| | - Juliano dos Santos
- grid.11899.380000 0004 1937 0722University of São Paulo Nursing School, São Paulo, Brazil ,Cancer Hospital III, National Cancer Institute of Brazil, Rio de Janeiro, Brazil
| | | | - Carime Farah Flórido
- grid.11899.380000 0004 1937 0722University of São Paulo Nursing School, São Paulo, Brazil
| | - Renata Jae Won Lee
- grid.11899.380000 0004 1937 0722University of São Paulo Nursing School, São Paulo, Brazil
| | - Grazielli Soares Paes
- grid.11899.380000 0004 1937 0722University of São Paulo Nursing School, São Paulo, Brazil
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Wojciechowska W, Terlecki M, Klocek M, Pac A, Olszanecka A, Stolarz-Skrzypek K, Jastrzębski M, Jankowski P, Ostrowska A, Drożdż T, Prejbisz A, Dobrowolski P, Januszewicz A, Krzanowski M, Małecki MT, Grodzicki T, Kreutz R, Rajzer M. Impact of Arterial Hypertension and Use of Antihypertensive Pharmacotherapy on Mortality in Patients Hospitalized due to COVID-19: The CRACoV-HHS Study. Hypertension 2022; 79:2601-2610. [PMID: 36082666 PMCID: PMC9553221 DOI: 10.1161/hypertensionaha.122.19575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiovascular diseases including arterial hypertension are common comorbidities among patients hospitalized due to COVID-19. We assessed the influence of preexisting hypertension and its pharmacological treatment on in-hospital mortality in patients hospitalized with COVID-19.
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Affiliation(s)
- Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland. (W.W., M.T., M. Klocek, A. Olszanecka, K.S.S., M.J., P.J., A. Ostrowska, T.D., M.R.)
| | - Michał Terlecki
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland. (W.W., M.T., M. Klocek, A. Olszanecka, K.S.S., M.J., P.J., A. Ostrowska, T.D., M.R.)
| | - Marek Klocek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland. (W.W., M.T., M. Klocek, A. Olszanecka, K.S.S., M.J., P.J., A. Ostrowska, T.D., M.R.)
| | - Agnieszka Pac
- Department of Epidemiology, Jagiellonian University Medical College, Krakow, Poland. (A.P.)
| | - Agnieszka Olszanecka
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland. (W.W., M.T., M. Klocek, A. Olszanecka, K.S.S., M.J., P.J., A. Ostrowska, T.D., M.R.)
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland. (W.W., M.T., M. Klocek, A. Olszanecka, K.S.S., M.J., P.J., A. Ostrowska, T.D., M.R.)
| | - Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland. (W.W., M.T., M. Klocek, A. Olszanecka, K.S.S., M.J., P.J., A. Ostrowska, T.D., M.R.)
| | - Piotr Jankowski
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland. (W.W., M.T., M. Klocek, A. Olszanecka, K.S.S., M.J., P.J., A. Ostrowska, T.D., M.R.)
| | - Aleksandra Ostrowska
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland. (W.W., M.T., M. Klocek, A. Olszanecka, K.S.S., M.J., P.J., A. Ostrowska, T.D., M.R.)
| | - Tomasz Drożdż
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland. (W.W., M.T., M. Klocek, A. Olszanecka, K.S.S., M.J., P.J., A. Ostrowska, T.D., M.R.)
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A.P., P.D., A.J.)
| | - Piotr Dobrowolski
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A.P., P.D., A.J.)
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A.P., P.D., A.J.)
| | - Marcin Krzanowski
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland. (M. Krzanowski)
| | - Maciej T Małecki
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland. (M.T.M.)
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland. (T.G.)
| | - Reinhold Kreutz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany (R.K.)
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland. (W.W., M.T., M. Klocek, A. Olszanecka, K.S.S., M.J., P.J., A. Ostrowska, T.D., M.R.)
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Maranduca MA, Tanase DM, Cozma CT, Dima N, Clim A, Pinzariu AC, Serban DN, Serban IL. The Impact of Angiotensin-Converting Enzyme-2/Angiotensin 1-7 Axis in Establishing Severe COVID-19 Consequences. Pharmaceutics 2022; 14:pharmaceutics14091906. [PMID: 36145655 PMCID: PMC9505151 DOI: 10.3390/pharmaceutics14091906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/24/2022] [Accepted: 09/03/2022] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has put a tremendous stress on the medical community over the last two years. Managing the infection proved a lot more difficult after several research communities started to recognize the long-term effects of this disease. The cellular receptor for the virus was identified as angiotensin-converting enzyme-2 (ACE2), a molecule responsible for a wide array of processes, broadly variable amongst different organs. Angiotensin (Ang) 1-7 is the product of Ang II, a decaying reaction catalysed by ACE2. The effects observed after altering the level of ACE2 are essentially related to the variation of Ang 1-7. The renin-angiotensin-aldosterone system (RAAS) is comprised of two main branches, with ACE2 representing a crucial component of the protective part of the complex. The ACE2/Ang (1-7) axis is well represented in the testis, heart, brain, kidney, and intestine. Infection with the novel SARS-CoV-2 virus determines downregulation of ACE2 and interrupts the equilibrium between ACE and ACE2 in these organs. In this review, we highlight the link between the local effects of RAAS and the consequences of COVID-19 infection as they arise from observational studies.
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Affiliation(s)
- Minela Aida Maranduca
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700115 Iasi, Romania
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Daniela Maria Tanase
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700115 Iasi, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristian Tudor Cozma
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence:
| | - Nicoleta Dima
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700115 Iasi, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andreea Clim
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alin Constantin Pinzariu
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dragomir Nicolae Serban
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ionela Lacramioara Serban
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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Relationship between Metabolic Syndrome Components and COVID-19 Disease Severity in Hospitalized Patients: A Pilot Study. CANADIAN JOURNAL OF INFECTIOUS DISEASES AND MEDICAL MICROBIOLOGY 2022; 2022:9682032. [PMID: 36061633 PMCID: PMC9433267 DOI: 10.1155/2022/9682032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/23/2022] [Accepted: 07/22/2022] [Indexed: 01/08/2023]
Abstract
Background Preliminary data suggest that patients with comorbidities are more susceptible to severe COVID-19 infection. However, data regarding the presence of metabolic syndrome (MetS) in patients with COVID-19 are scarce. Aim In the present study, we aim to investigate the association between MetS components and disease severity in hospitalized COVID-19 patients. Methods We conducted a prospective observational study of 90 hospitalized patients with COVID-19 pneumonia at a tertiary hospital. The study population consisted of inpatients who tested positive by the reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2. Patients with critical COVID-19 disease on admission were excluded. Adult Treatment Panel III of the National Cholesterol Education Program (NCEP-ATP III) criteria were used to define MetS. Laboratory analysis and thorax CT were performed on admission. Results 90 patients, 60 moderate and 30 severe COVID-19 patients, included in the study. The percentage of MetS cases was higher among severe COVID-19 patients (p=0.018). Of the MetS criteria fasting blood glucose (p=0.004), triglycerides (p=0.007) were significantly higher in patients with severe COVID-19 disease with no statistical significance found in waist circumference (WC) (p=0.348), systolic blood pressure (p=0.429), and HDL-C levels (p=0.263) between two groups. Body mass index (BMI) values were similar in both severe and moderate cases (p=0.854). In logistic regression analysis, serum triglycerides (p=0.024), HDL-C (p=0.006), and WC (p=0.004) were found as independent prognostic factor for severe COVID-19 infection. Conclusion Severe COVID-19 patients have higher rates of MetS. Serum triglycerides, HDL-C, and WC have an impact on disease severity in COVID-19.
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Batmunkh MU, Ravjir O, Lkhagvasuren E, Dambaa N, Boldoo T, Ganbold S, Ganbaatar K, Tserendorj C, Togoo K, Bat-Erdene A, Narmandakh Z, Soodoi C, Damdinbazar O, Tsolmon B, Gunchin B, Sandag T. Sex-adjusted approach to baseline variables demonstrated some improved predictive capabilities for disease severity and survival in patients with Coronavirus Disease 19. INFORMATICS IN MEDICINE UNLOCKED 2022; 31:100982. [PMID: 35706828 PMCID: PMC9186409 DOI: 10.1016/j.imu.2022.100982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The study was focused on comparing crude and sex-adjusted hazard ratio calculated by the baseline variables which may have contributed to the severity of the disease course and fatal outcomes in Coronavirus Disease-19 (COVID-19) patients. METHOD The study enrolled 150 eligible adult patients with confirmed SARS-CoV-2 infection. There were 61 (40.7%) male patients, and 89 (59.3%) female patients. Baseline information of patients was collected from patient medical records and surveys that the patients had completed on admission to the hospital. RESULTS Considerable number of baseline variables stratified according to disease severity and outcomes showed different optimal cut-points (OCP) in men and women. Sex-adjusted baseline data categories such as age; BMI; systolic and diastolic blood pressure; peripheral RBC and platelet counts; haematocrit; percentage of neutrophils, lymphocytes, monocytes, and their ratio; percentage of eosinophils; titre of plasma IL-6, IL-8, IL-10, and IL-17; and CXCL10; and ratio of pro- and anti-inflammatory cytokines demonstrated significant impacts on the development of the severe stage and fatal outcomes by the mean hazard ratio in the Kaplan-Meier and Cox regression models. CONCLUSION This study confirmed some improved predictive capabilities of the sex-adjusted approach in the analysis of the baseline predictive variables for severity and outcome of the COVID-19.
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Affiliation(s)
- Munkh-Undrakh Batmunkh
- Mongolian National University of Medical Sciences, Jamyan Street 3, Sukhbaatar District, Ulaanbaatar, 14210, Mongolia
| | - Oyungerel Ravjir
- Mongolian National University of Medical Sciences, Jamyan Street 3, Sukhbaatar District, Ulaanbaatar, 14210, Mongolia
| | - Enkhsaikhan Lkhagvasuren
- Mongolian National University of Medical Sciences, Jamyan Street 3, Sukhbaatar District, Ulaanbaatar, 14210, Mongolia
| | - Naranzul Dambaa
- National Centre for Communicable Diseases, Horoo 14, 13th Horoolol, Nam Yan Ju Street, Bayanzurkh District, Ulaanbaata, 13335, Mongolia
| | - Tsolmon Boldoo
- National Centre for Communicable Diseases, Horoo 14, 13th Horoolol, Nam Yan Ju Street, Bayanzurkh District, Ulaanbaata, 13335, Mongolia
| | - Sarangua Ganbold
- National Centre for Communicable Diseases, Horoo 14, 13th Horoolol, Nam Yan Ju Street, Bayanzurkh District, Ulaanbaata, 13335, Mongolia
| | - Khorolgarav Ganbaatar
- Mongolian National University of Medical Sciences, Jamyan Street 3, Sukhbaatar District, Ulaanbaatar, 14210, Mongolia
| | - Chinbayar Tserendorj
- National Centre for Communicable Diseases, Horoo 14, 13th Horoolol, Nam Yan Ju Street, Bayanzurkh District, Ulaanbaata, 13335, Mongolia
| | - Khongorzul Togoo
- Mongolian National University of Medical Sciences, Jamyan Street 3, Sukhbaatar District, Ulaanbaatar, 14210, Mongolia
| | - Ariunzaya Bat-Erdene
- Mongolian National University of Medical Sciences, Jamyan Street 3, Sukhbaatar District, Ulaanbaatar, 14210, Mongolia
| | - Zolmunkh Narmandakh
- Mongolian National University of Medical Sciences, Jamyan Street 3, Sukhbaatar District, Ulaanbaatar, 14210, Mongolia
| | - Chimidtseren Soodoi
- Mongolian National University of Medical Sciences, Jamyan Street 3, Sukhbaatar District, Ulaanbaatar, 14210, Mongolia
| | - Otgonbayar Damdinbazar
- Mongolian National University of Medical Sciences, Jamyan Street 3, Sukhbaatar District, Ulaanbaatar, 14210, Mongolia
| | - Bilegtsaikhan Tsolmon
- National Centre for Communicable Diseases, Horoo 14, 13th Horoolol, Nam Yan Ju Street, Bayanzurkh District, Ulaanbaata, 13335, Mongolia
| | - Batbaatar Gunchin
- Mongolian National University of Medical Sciences, Jamyan Street 3, Sukhbaatar District, Ulaanbaatar, 14210, Mongolia
| | - Tsogtsaikhan Sandag
- Mongolian National University of Medical Sciences, Jamyan Street 3, Sukhbaatar District, Ulaanbaatar, 14210, Mongolia
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Loader J, Taylor FC, Lampa E, Sundström J. Renin-Angiotensin Aldosterone System Inhibitors and COVID-19: A Systematic Review and Meta-Analysis Revealing Critical Bias Across a Body of Observational Research. J Am Heart Assoc 2022; 11:e025289. [PMID: 35624081 PMCID: PMC9238740 DOI: 10.1161/jaha.122.025289] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/07/2022] [Indexed: 12/18/2022]
Abstract
Background Renin-angiotensin aldosterone system (RAAS) inhibitor-COVID-19 studies, observational in design, appear to use biased methods that can distort the interaction between RAAS inhibitor use and COVID-19 risk. This study assessed the extent of bias in that research and reevaluated RAAS inhibitor-COVID-19 associations in studies without critical risk of bias. Methods and Results Searches were performed in MEDLINE, EMBASE, and CINAHL databases (December 1, 2019 to October 21, 2021) identifying studies that compared the risk of infection and/or severe COVID-19 outcomes between those using or not using RAAS inhibitors (ie, angiotensin-converting enzyme inhibitors or angiotensin II type-I receptor blockers). Weighted hazard ratios (HR) and 95% CIs were extracted and pooled in fixed-effects meta-analyses, only from studies without critical risk of bias that assessed severe COVID-19 outcomes. Of 169 relevant studies, 164 had critical risks of bias and were excluded. Ultimately, only two studies presented data relevant to the meta-analysis. In 1 351 633 people with uncomplicated hypertension using a RAAS inhibitor, calcium channel blocker, or thiazide diuretic in monotherapy, the risk of hospitalization (angiotensin-converting enzyme inhibitor: HR, 0.76; 95% CI, 0.66-0.87; P<0.001; angiotensin II type-I receptor blockers: HR, 0.86; 95% CI, 0.77-0.97; P=0.015) and intubation or death (angiotensin-converting enzyme inhibitor: HR, 0.64; 95% CI, 0.48-0.85; P=0.002; angiotensin II type-I receptor blockers: HR, 0.74; 95% CI, 0.58-0.95; P=0.019) with COVID-19 was lower in those using a RAAS inhibitor. However, these protective effects are probably not clinically relevant. Conclusions This study reveals the critical risk of bias that exists across almost an entire body of COVID-19 research, raising an important question: Were research methods and/or peer-review processes temporarily weakened during the surge of COVID-19 research or is this lack of rigor a systemic problem that also exists outside pandemic-based research? Registration URL: www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021237859.
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Affiliation(s)
- Jordan Loader
- Department of Medical SciencesUppsala UniversityUppsalaSweden
- Inserm U1300 – HP2CHU Grenoble AlpesGrenobleFrance
| | - Frances C. Taylor
- Baker Heart and Diabetes InstituteMelbourneVictoriaAustralia
- Mary MacKillop Institute for Health Research, Australian Catholic UniversityMelbourneVictoriaAustralia
| | - Erik Lampa
- Department of Medical SciencesUppsala UniversityUppsalaSweden
| | - Johan Sundström
- Department of Medical SciencesUppsala UniversityUppsalaSweden
- The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
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Dai LS, Zhu MP, Li YM, Zhou HM, Liao HL, Cheng PP, Xia XY, Yao XY, Zhang HJ, Liu XQ, Huang W, Wan L, Xu XY, Wang FR, Xu CQ. Hypertension Exacerbates Severity and Outcomes of COVID-19 in Elderly Patients: A Retrospective Observational Study. Curr Med Sci 2022; 42:561-568. [PMID: 35678917 PMCID: PMC9178941 DOI: 10.1007/s11596-022-2539-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/07/2021] [Indexed: 02/08/2023]
Abstract
Objective To evaluate the impact of hypertension on the clinical outcome of COVID-19 patients aged 60 years old and older. Methods This single-center retrospective cohort study enrolled consecutive COVID-19 patients aged 60 years old and older, who were admitted to Liyuan Hospital from January 1, 2020 to April 25, 2020. All included patients were divided into two groups: hypertension and nonhypertension group. The baseline demographic characteristics, laboratory test results, chest computed tomography (CT) images and clinical outcomes were collected and analyzed. The prognostic value of hypertension was determined using binary logistic regression. Results Among the 232 patients included in the analysis, 105 (45.3%) patients had comorbid hypertension. Compared to the nonhypertension group, patients in the hypertension group had higher neutrophil-to-lymphocyte ratios, red cell distribution widths, lactate dehydrogenase, high-sensitivity C-reactive protein, D-dimer and severity of lung lesion, and lower lymphocyte counts (all P<0.05). Furthermore, the hypertension group had a higher proportion of intensive care unit admissions [24 (22.9%) vs. 14 (11.0%), P=0.02) and deaths [16 (15.2%) vs. 3 (2.4%), P<0.001] and a significantly lower probability of survival (P<0.001) than the nonhypertension group. Hypertension (OR: 4.540, 95% CI: 1.203–17.129, P=0.026) was independently correlated with all-cause in-hospital death in elderly patients with COVID-19. Conclusion The elderly COVID-19 patients with hypertension tend to have worse conditions at baseline than those without hypertension. Hypertension may be an independent prognostic factor of poor clinical outcome in elderly COVID-19 patients.
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Park K, Byeon J, Yang Y, Cho H. Healthcare utilisation for elderly people at the onset of the COVID-19 pandemic in South Korea. BMC Geriatr 2022; 22:395. [PMID: 35524173 PMCID: PMC9072758 DOI: 10.1186/s12877-022-03085-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 04/25/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND At the onset of the coronavirus disease 2019 (COVID-19) pandemic, health care systems were severely disrupted in many countries and in particular, elderly people vulnerable to COVID-19 may have been reluctant to receive their medical treatment. METHODS We conducted interrupted time series analyses (ITSA) using nationwide medical claim data between January 2020 and July 2020, with focus on different disease categories for the patients of 65 to 84-year-olds, i.e., acute upper respiratory infections (AURIs) vs. chronic diseases. RESULTS AURIs and chronic diseases showed a sharp contrast with respect to the change in healthcare service utilisation. First, the utilisation rate for chronic diseases changed little whereas for AURIs it dropped by 20.4% year-over-year (yoy) at the onset of the pandemic (week 6, 2020). Second, as social distancing relaxed (week 17, 2020), the AURIs patients trended up and even reached to 7.8% above yoy whereas no significant change found for chronic diseases. CONCLUSIONS The uninterrupted treatment for chronic diseases in contrast to the AURIs implies that the governmental and public responses to the pandemic outbreak worked for efficient healthcare provision to patients in needs of regular check-ups and treatment in the middle of an infectious disease crisis.
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Affiliation(s)
- K. Park
- Health Insurance Research Institute, National Health Insurance Service, Wonju, 26464 South Korea
| | - J. Byeon
- Health Insurance Research Institute, National Health Insurance Service, Wonju, 26464 South Korea
| | - Y. Yang
- Health Insurance Research Institute, National Health Insurance Service, Wonju, 26464 South Korea
| | - H. Cho
- Health Insurance Research Institute, National Health Insurance Service, Wonju, 26464 South Korea
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Glycated Albumin and Glycated Albumin/HbA1c Predict the Progression of Coronavirus Disease 2019 from Mild to Severe Disease in Korean Patients with Type 2 Diabetes. J Clin Med 2022; 11:jcm11092327. [PMID: 35566453 PMCID: PMC9105907 DOI: 10.3390/jcm11092327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 12/15/2022] Open
Abstract
Hyperglycemia is among the main risk factors for severe COVID-19. We evaluated the association of glycated albumin (GA) and GA/HbA1c ratio with progression of COVID-19 from mild to severe disease in patients with type 2 diabetes mellitus (T2DM). Our retrospective study included 129 patients aged over 18 years with COVID-19 and T2DM who did not have any need of oxygen supplement. Of these, 59 patients whose COVID-19 was aggravated and required oxygen supplementation eventually were classified as having severe disease. Clinical and laboratory data were compared between mild and severe cases. The median of GA (18.4% vs. 20.95%, p = 0.0013) and GA/HbA1c (2.55 vs. 2.68, p = 0.0145) were higher in severe disease than in mild disease and positively correlated with C-reactive protein (Kendal Tau coefficient 0.200 and 0.126, respectively; all p < 0.05). Multiple logistic regression analysis showed that GA (odds ratio (OR), 1.151; 95% confidence interval (CI), 1.024−1.294) and GA/HbA1c (OR, 8.330; 95% CI, 1.786−38.842) increased the risk of severe disease. Patients with GA 20% or higher were 4.03 times more likely to progress from mild to severe disease. GA and GA/HbA1c ratio predicted progression of COVID-19 from mild to severe disease in patients with T2DM.
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Ribeiro AC, Uehara SCDSA. Systemic arterial hypertension as a risk factor for the severe form of covid-19: scoping review. Rev Saude Publica 2022; 56:20. [PMID: 35416846 PMCID: PMC8973022 DOI: 10.11606/s1518-8787.2022056004311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/10/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Identify whether systemic arterial hypertension is a risk factor for the severe form of covid-19. METHODS This is a scoping review, searches were performed on the Lilacs, PubMed, SciELO and Web of Science databases. RESULTS Thirteen articles were selected. The studies presented systemic arterial hypertension as the most common chronic disease in subjects diagnosed with covid-19. Hypertensive subjects were older, and men were more likely to develop severe covid-19. Hypertensive subjects without antihypertensive treatment were associated with a higher risk of mortality. CONCLUSIONS subjects with chronic diseases tend to have a different clinical profile. Blood pressure should be controlled in hypertensive subjects that should be continuously monitored during the covid-19 infection.
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Affiliation(s)
- Ana Cristina Ribeiro
- Universidade Federal de São CarlosDepartamento de EnfermagemSão CarlosSPBrasilUniversidade Federal de São Carlos. Departamento de Enfermagem. São Carlos, SP, Brasil
| | - Sílvia Carla da Silva André Uehara
- Universidade Federal de São CarlosDepartamento de EnfermagemSão CarlosSPBrasilUniversidade Federal de São Carlos. Departamento de Enfermagem. São Carlos, SP, Brasil
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Yang K, Holt M, Fan M, Lam V, Yang Y, Ha T, Williams DL, Li C, Wang X. Cardiovascular Dysfunction in COVID-19: Association Between Endothelial Cell Injury and Lactate. Front Immunol 2022; 13:868679. [PMID: 35401579 PMCID: PMC8984030 DOI: 10.3389/fimmu.2022.868679] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/01/2022] [Indexed: 12/27/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), an infectious respiratory disease propagated by a new virus known as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), has resulted in global healthcare crises. Emerging evidence from patients with COVID-19 suggests that endothelial cell damage plays a central role in COVID-19 pathogenesis and could be a major contributor to the severity and mortality of COVID-19. Like other infectious diseases, the pathogenesis of COVID-19 is closely associated with metabolic processes. Lactate, a potential biomarker in COVID-19, has recently been shown to mediate endothelial barrier dysfunction. In this review, we provide an overview of cardiovascular injuries and metabolic alterations caused by SARS-CoV-2 infection. We also propose that lactate plays a potential role in COVID-19-driven endothelial cell injury.
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Affiliation(s)
- Kun Yang
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Center of Excellence in Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Matthew Holt
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Min Fan
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Center of Excellence in Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Victor Lam
- College of Arts and Science, New York University, New York City, NY, United States
| | - Yong Yang
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Tuanzhu Ha
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Center of Excellence in Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - David L. Williams
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Center of Excellence in Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Chuanfu Li
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Center of Excellence in Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Xiaohui Wang
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Center of Excellence in Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
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Saylik F, Akbulut T, Kaya S. Reply to Letter: “Impact of Hypertension on the Prognosis of COVID-19 Disease and Uncertainties that Need to be Clarified”. Angiology 2022; 73:487-488. [PMID: 35090347 PMCID: PMC8801340 DOI: 10.1177/00033197221075397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Safak Kaya
- Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
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Ghamari SH, Abbasi-Kangevari M, Zamani N, Hassanian-Moghaddam H, Kolahi AA. Priorities Towards Fair Allocation of Ventilators During COVID-19 Pandemic: A Delphi Study. Front Med (Lausanne) 2022; 8:769508. [PMID: 35141240 PMCID: PMC8818721 DOI: 10.3389/fmed.2021.769508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/31/2021] [Indexed: 11/29/2022] Open
Abstract
Background COVID-19 pandemic has resulted in severe shortage in vital resources, including invasive mechanical ventilators. The current imbalance between demand and supply of mechanical ventilators has called for investigations on the fair allocation of mechanical ventilators. Objective To determine the priorities of the medical experts towards the fair allocation of ventilators during the COVID-19 pandemic. Methods This study was conducted from May 28 to Aug 20, 2020. The questionnaire was sent to 50 medical specialists as the Delphi panel. Participants were asked to rate each prioritising factor: “−1” for low priority, “+1” for high priority, and “Zero” for equal priority. Results Among 38 experts who responded to the email, the responses of 35 were analysed. 31 (88.6%) participants recommended that pregnant women be considered high priority in allocating ventilators, 27 (77.1%) mothers of children <5 years, 26 (74.3%) patients under 80-years, and 23 (65.7%) front-line-healthcare-workers. In contrast, 28 (80.0) participants recommended that patients who are terminally ill should be considered as a low priority, 27 (77.1%) patients with active-malignancy, 25 (71.4%) neurodegenerative diseases, and 16 (45.7%) patients aged >80. The panel did not reach a consensus regarding the role of patients' laboratory profiles, underlying diseases, or drug abuse in the prioritisation of ventilators. Conclusions The panel considered pregnant mothers, mothers of children under 5 years, age groups younger than 80, and front-line healthcare workers to have high priority in allocating mechanical ventilators.
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Nozari F, Hamidizadeh N. The Effects of Different Classes of Antihypertensive Drugs on Patients with COVID-19 and Hypertension: A Mini-Review. Int J Hypertens 2022; 2022:5937802. [PMID: 35075396 PMCID: PMC8783136 DOI: 10.1155/2022/5937802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/04/2021] [Accepted: 01/06/2022] [Indexed: 12/22/2022] Open
Abstract
Hypertension is a major risk factor for cardiovascular disease. Previous studies showed that patients with hypertension are at an increased risk of developing severe COVID-19 infection. Therefore, proper blood pressure control in hypertensive patients with COVID-19 is of great importance. In this review, we discussed the effects of different classes of antihypertensive drugs on patients with hypertension and COVID-19.
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Affiliation(s)
- Farnoosh Nozari
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Hamidizadeh
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Renin Angiotensin System Blockers and Risk of Mortality in Hypertensive Patients Hospitalized for COVID-19: An Italian Registry. J Cardiovasc Dev Dis 2022; 9:jcdd9010015. [PMID: 35050225 PMCID: PMC8781822 DOI: 10.3390/jcdd9010015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 02/07/2023] Open
Abstract
Background: It is uncertain whether exposure to renin–angiotensin system (RAS) modifiers affects the severity of the new coronavirus disease 2019 (COVID-19) because most of the available studies are retrospective. Methods: We tested the prognostic value of exposure to RAS modifiers (either angiotensin-converting enzyme inhibitors [ACE-Is] or angiotensin receptor blockers [ARBs]) in a prospective study of hypertensive patients with COVID-19. We analyzed data from 566 patients (mean age 75 years, 54% males, 162 ACE-Is users, and 147 ARBs users) hospitalized in five Italian hospitals. The study used systematic prospective data collection according to a pre-specified protocol. All-cause mortality during hospitalization was the primary outcome. Results: Sixty-six patients died during hospitalization. Exposure to RAS modifiers was associated with a significant reduction in the risk of in-hospital mortality when compared to other BP-lowering strategies (odds ratio [OR]: 0.54, 95% confidence interval [CI]: 0.32 to 0.90, p = 0.019). Exposure to ACE-Is was not significantly associated with a reduced risk of in-hospital mortality when compared with patients not treated with RAS modifiers (OR: 0.66, 95% CI: 0.36 to 1.20, p = 0.172). Conversely, ARBs users showed a 59% lower risk of death (OR: 0.41, 95% CI: 0.20 to 0.84, p = 0.016) even after allowance for several prognostic markers, including age, oxygen saturation, occurrence of severe hypotension during hospitalization, and lymphocyte count (adjusted OR: 0.37, 95% CI: 0.17 to 0.80, p = 0.012). The discontinuation of RAS modifiers during hospitalization did not exert a significant effect (p = 0.515). Conclusions: This prospective study indicates that exposure to ARBs reduces mortality in hospitalized patients with COVID-19.
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How to deal with hypertension in the COVID-19 era-the impact "ON" and "OF" hypertension. Hypertens Res 2022; 45:548-550. [PMID: 34921300 PMCID: PMC8680064 DOI: 10.1038/s41440-021-00822-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/08/2022]
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The effect of resistant hypertension on in-hospital mortality in patients hospitalized with COVID-19. J Hum Hypertens 2022; 36:846-851. [PMID: 34354253 PMCID: PMC8341552 DOI: 10.1038/s41371-021-00591-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/20/2021] [Accepted: 07/29/2021] [Indexed: 12/22/2022]
Abstract
Hypertension is a major concomitant disease in hospitalized patients with COVID-19 (Coronavirus disease 2019) infection. The adverse effect of hypertension on prognosis in COVID-19 is known. Nevertheless, it is not known how COVID-19 progresses in resistant hypertensive patients. In this study, we aimed to examine the effect of resistant hypertension (ResHT) on in-hospital mortality in patients hospitalized with COVID-19. In our single-center retrospective study, included 1897 COVID-19 patients. The patients were divided into three groups according to the non-hypertensive (n = 1211), regulated HT (RegHT) (n = 574), and ResHT (n = 112). These three groups were compared according to demographic features, clinical signs, laboratory findings, and follow-up times. The median age of the study population was 62 (50-72 IQR) and 1000 (52.7%) of patients were male. The total mortality of the study population was 18.7% (n = 356). Mortality rates were similar in the hypertensive patient group (27.5% for the RegHT and 32.1% for ResHT, p = 0.321). In a multivariable analysis, ResHT was independently associated with a significantly increased risk of in-hospital mortality of COVID-19, while no significant increased risk was observed with RegHT [respectively, Odds Ratio (OR) = 2.013, Confidence Interval (CI) 1.085-3.734, p = 0.026 and OR = 1.194, CI 0.795-1.794, p = 0.394]. Also, age, male gender, chronic renal failure, lymphocyte, procalcitonin, creatinine, and admission SpO2 levels were determined as independent predictors of in-hospital mortality. In our study, it was found that ResHT was an independent predictor of mortality in patients hospitalized with COVID-19; however, this situation was not found in RegHT.
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Tadic M, Cuspidi C. Resistant hypertension and COVID-19: tip of the iceberg? J Hum Hypertens 2022; 36:693-694. [PMID: 34508157 PMCID: PMC8429887 DOI: 10.1038/s41371-021-00607-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/24/2021] [Accepted: 09/03/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081, Ulm, Germany.
| | - Cesare Cuspidi
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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Rais N, Ahmad R, Ved A, Parveen K, Ishrat T, Prakash O, Shadab M, Bari DG, Siddiqui NA. Diabetes Mellitus during the Pandemic Covid-19: Prevalence, Pathophysiology, Mechanism, and Management: An updated overview. Curr Diabetes Rev 2022; 18:e120721194712. [PMID: 34931983 DOI: 10.2174/1573399817666210712160651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/27/2021] [Accepted: 05/23/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is among the most frequently reported comorbidities in patients tainted with the pandemic coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With a high pervasiveness of diabetes mellitus, there is an urgency to understand the special aspects of COVID-19 in hyperglycemic patients. Diabetic patients are at higher risk than the general population of viral or bacterial infections, thus require special attention since diabetes is linked with severe, critical, and lethal modes of COVID-19. OBJECTIVE The objective of this study was to focus on epidemiology, pathophysiology, mechanism, and management of DM with COVID-19. METHODS The search was carried out on databases portals such as Pubmed, EMBASE, Google Scholar, and CINAHL with the keywords, i.e., COVID-19, coronavirus, SARS-CoV-2, diabetes, covid-19, etc. Result: DM and COVID-19 disease conditions can impact each other in terms of clinical progression and outcome. Available laboratory/clinical observations suggest that hyperglycemia-induced immune dysfunction, inflated lactate grades, and cytokines storm may play critical roles in the seriousness of COVID-19 in patients with diabetes; however, the exact mechanisms linking diabetes and COVID-19 remain to be further clarified. CONCLUSION Standards to constrain the disease spread at the individual and community level are the key to extenuate the speedily rising pandemic, while definitive treatment, like plasma therapy, chemoprophylaxis, or vaccine for COVID-19, has yet to be discovered.
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Affiliation(s)
- Nadeem Rais
- Department of Pharmacy, Bhagwant University, Ajmer, Rajasthan, 305004, India
| | - Rizwan Ahmad
- Department of Pharmacy, Vivek College of Technical Education, Bijnor, Uttar Pradesh, 246701, India
| | - Akash Ved
- Goel Institute of Pharmaceutical Sciences, Lucknow, Uttar Pradesh, 226028, India
| | - Kehkashan Parveen
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, Uttar Pradesh, 202002, India
| | - Tauheed Ishrat
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, TN, 38163, USA
| | - Om Prakash
- Goel Institute of Pharmacy and Sciences, Faizabad Road, Lucknow, Uttar Pradesh, 226028, India
| | - Mohd Shadab
- Arabian Gulf University, Manama, 26671, Bahrain
| | | | - Nasir Ali Siddiqui
- Department of Pharmacognosy, King Saud University, Riyadh, 2457-11451, KSA
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Feitosa FGAM, Feitosa ADM, Paiva AMG, Mota-Gomes MA, Barroso WS, Miranda RD, Barbosa ECD, Brandão AA, Lima-Filho JL, Sposito AC, Coca A, Nadruz W. Impact of the COVID-19 pandemic on blood pressure control: a nationwide home blood pressure monitoring study. Hypertens Res 2021; 45:364-368. [PMID: 34857897 PMCID: PMC8636576 DOI: 10.1038/s41440-021-00784-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/15/2021] [Accepted: 09/30/2021] [Indexed: 01/08/2023]
Abstract
There are concerns that hypertension control may decrease during the COVID-19 pandemic. This study evaluated the impact of the COVID-19 pandemic on office blood pressure (OBP) and home blood pressure monitoring (HBPM) control in a large Brazilian nationwide sample. The results of an adjusted spline analysis evaluating the trajectory of OBP and HBPM control from 01/Jan/2019 to 31/Dec/2020 among independent participants who were untreated (n = 24,227) or treated (n = 27,699) with antihypertensive medications showed a modest and transient improvement in OBP control among treated individuals, which was restricted to the early months following the COVID-19 pandemic outbreak. Furthermore, slight reductions in OBP and HBPM values were detected in the early months following the COVID-19 pandemic outbreak among treated (n = 987) participants for whom blood pressure measurements before and during the pandemic were available, but not among untreated (n = 495) participants. In conclusion, we found no major adverse influence of the COVID-19 pandemic on OBP and HBPM control in a large nationwide sample.
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Affiliation(s)
- Fabiana G A M Feitosa
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil.,Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil.,University Hospital Oswaldo Cruz, University of Pernambuco, Recife, PE, Brazil
| | - Audes D M Feitosa
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil.,Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil.,UNICAP Clinical Research Institute, Recife, PE, Brazil
| | | | | | - Weimar S Barroso
- Hypertension League, Federal University of Goiás, Goiânia, GO, Brazil
| | - Roberto D Miranda
- Cardiovascular Section, Geriatrics Division, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Eduardo C D Barbosa
- Department of Hypertension and Cardiometabolism, São Francisco Hospital - Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Andréa A Brandão
- School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - José L Lima-Filho
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil
| | - Andrei C Sposito
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP Paulo, Brazil
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Wilson Nadruz
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil. .,Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP Paulo, Brazil.
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Risk of hospitalization and mortality associated with uncontrolled blood pressure in patients with hypertension and COVID-19. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2021; 11:200117. [PMID: 34778888 PMCID: PMC8576055 DOI: 10.1016/j.ijcrp.2021.200117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/05/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The role of uncontrolled blood pressure (BP) in COVID-19 severity among patients with hypertension is unclear. We evaluated the association between uncontrolled BP and the risk of hospitalization and/or mortality in patients with hypertension from a large US integrated healthcare system. METHODS We identified patients with hypertension and a positive RT-PCR test result or a diagnosis of COVID-19 between March 1 - September 1, 2020 from Kaiser Permanente Southern California. BP categories was defined using the most recent outpatient BP measurement during 12 months prior to COVID-19 infection. The primary outcome of interest was all-cause hospitalization or mortality within 30 days from COVID-19 infection. RESULTS Among 12,548 patients with hypertension and COVID-19 (mean age = 60 years, 47% male), 63% had uncontrolled BP (≥130/80 mm Hg) prior to COVID-19. Twenty-one percent were hospitalized or died within 30 days of COVID-19 infection. Uncontrolled BP was not associated with higher hospitalization or mortality (adjusted rate ratios for BP ≥ 160/100 mm Hg vs < 130/80 mm Hg = 1.00 [95% CI: 0.87, 1.14]; BP 140-159/90-99 mm Hg vs < 130/80 mm Hg = 1.02 [95% CI: 0.93, 1.11]). These findings were consistent across different age groups, treatment for antihypertensive medications, as well as atherosclerotic cardiovascular disease risk. CONCLUSION Among patients with hypertension, uncontrolled BP prior to COVID-19 infection did not appear to be an important risk factor for 30-day mortality or hospitalization.
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Agarwal N, Biswas B, Singh C, Nair R, Mounica G, H H, Jha AR, Das KM. Early Determinants of Length of Hospital Stay: A Case Control Survival Analysis among COVID-19 Patients admitted in a Tertiary Healthcare Facility of East India. J Prim Care Community Health 2021; 12:21501327211054281. [PMID: 34704488 PMCID: PMC8554553 DOI: 10.1177/21501327211054281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Length of hospital stay (LOS) for a disease is a vital estimate for healthcare logistics planning. The study aimed to illustrate the effect of factors elicited on arrival on LOS of the COVID-19 patients. MATERIALS AND METHODS It was a retrospective, record based, unmatched, case control study using hospital records of 334 COVID-19 patients admitted in an East Indian tertiary healthcare facility during May to October 2020. Discharge from the hospital (cases/survivors) was considered as an event while death (control/non-survivors) as right censoring in the case-control survival analysis using cox proportional hazard model. RESULTS Overall, we found the median LOS for the survivors to be 8 days [interquartile range (IQR): 7-10 days] while the same for the non-survivors was 6 days [IQR: 2-11 days]. In the multivariable cox-proportional hazard model; travel distance (>16 km) [adjusted hazard ratio (aHR): 0.69, 95% CI: (0.50-0.95)], mode of transport to the hospital (ambulance) [aHR: 0.62, 95% CI: (0.45-0.85)], breathlessness (yes) [aHR: 0.56, 95% CI: (0.40-0.77)], number of co-morbidities (1-2) [aHR: 0.66, 95% CI: (0.47-0.93)] (≥3) [aHR: 0.16, 95% CI: (0.04-0.65)], COPD/asthma (yes) [ [aHR: 0.11, 95% CI: (0.01-0.79)], DBP (<60/≥90) [aHR: 0.55, 95% CI: (0.35-0.86)] and qSOFA score (≥2) [aHR: 0.33, 95% CI: (0.12-0.92)] were the significant attributes affecting LOS of the COVID-19 patients. CONCLUSION Factors elicited on arrival were found to be significantly associated with LOS. A scoring system inculcating these factors may be developed to predict LOS of the COVID-19 patients.
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Affiliation(s)
- Neeraj Agarwal
- All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Bijit Biswas
- All India Institute of Medical Sciences, Patna, Bihar, India
| | | | - Rathish Nair
- All India Institute of Medical Sciences, Patna, Bihar, India
| | - Gera Mounica
- All India Institute of Medical Sciences, Patna, Bihar, India
| | - Haripriya H
- All India Institute of Medical Sciences, Patna, Bihar, India
| | - Amit Ranjan Jha
- All India Institute of Medical Sciences, Patna, Bihar, India
| | - Kumar M Das
- All India Institute of Medical Sciences, Patna, Bihar, India
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Angeli F, Verdecchia P, Reboldi G. Pharmacotherapy for hypertensive urgency and emergency in COVID-19 patients. Expert Opin Pharmacother 2021; 23:235-242. [PMID: 34634987 PMCID: PMC8544668 DOI: 10.1080/14656566.2021.1990264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction Hypertension is a common chronic disorder in patients hospitalized for coronavirus disease 2019 (COVID-19). Furthermore, an exaggerated cardiovascular response with persistently raised blood pressure during hospitalization seems independently associated with in-hospital all-cause mortality, intensive care unit admission and heart failure. However, the real burden of elevated blood pressure during the acute phase of COVID-19 remains undefined. Areas covered The authors review the available evidence on the pharmacotherapy for the treatment of acute elevations in blood pressure (including hypertensive urgency and emergency) in COVID-19 patients. Expert opinion Acute elevations in blood pressure and unstable in-hospital blood pressure may be associated with organ damage and worse outcome in patients with COVID-19. In this setting, hypertensive emergencies require immediate reduction in blood pressure through intravenous treatment according to specific features and goals. Conversely, hypertensive urgencies usually require solely oral treatment. Diuretics, beta-blockers, renin-angiotensin-aldosterone system inhibitors, and calcium channel blockers may be of benefit in treating COVID-19 patients with elevated blood pressure values.
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Surgery, University of Insubria - Varese and Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS, Tradat, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore E Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria Della Misericordia, Perugia, Italy
| | - Gianpaolo Reboldi
- Department of Medicine, and Centro Di Ricerca Clinica E Traslazionale (CERICLET), University of Perugia, Perugia, Italy
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Touyz RM, Boyd MO, Guzik T, Padmanabhan S, McCallum L, Delles C, Mark PB, Petrie JR, Rios F, Montezano AC, Sykes R, Berry C. Cardiovascular and Renal Risk Factors and Complications Associated With COVID-19. CJC Open 2021; 3:1257-1272. [PMID: 34151246 PMCID: PMC8205551 DOI: 10.1016/j.cjco.2021.05.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/28/2021] [Indexed: 01/08/2023] Open
Abstract
The current COVID-19 pandemic, caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus, represents the largest medical challenge in decades. It has exposed unexpected cardiovascular vulnerabilities at all stages of the disease (pre-infection, acute phase, and subsequent chronic phase). The major cardiometabolic drivers identified as having epidemiologic and mechanistic associations with COVID-19 are abnormal adiposity, dysglycemia, dyslipidemia, and hypertension. Hypertension is of particular interest, because components of the renin-angiotensin system (RAS), which are critically involved in the pathophysiology of hypertension, are also implicated in COVID-19. Specifically, angiotensin-converting enzyme-2 (ACE2), a multifunctional protein of the RAS, which is part of the protective axis of the RAS, is also the receptor through which SARS-CoV-2 enters host cells, causing viral infection. Cardiovascular and cardiometabolic comorbidities not only predispose people to COVID-19, but also are complications of SARS-CoV-2 infection. In addition, increasing evidence indicates that acute kidney injury is common in COVID-19, occurs early and in temporal association with respiratory failure, and is associated with poor prognosis, especially in the presence of cardiovascular risk factors. Here, we discuss cardiovascular and kidney disease in the context of COVID-19 and provide recent advances on putative pathophysiological mechanisms linking cardiovascular disease and COVID-19, focusing on the RAS and ACE2, as well as the immune system and inflammation. We provide up-to-date information on the relationships among hypertension, diabetes, and COVID-19 and emphasize the major cardiovascular diseases associated with COVID-19. We also briefly discuss emerging cardiovascular complications associated with long COVID-19, notably postural tachycardia syndrome (POTS).
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Affiliation(s)
- Rhian M. Touyz
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Marcus O.E. Boyd
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Tomasz Guzik
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Linsay McCallum
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Patrick B. Mark
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - John R. Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Francisco Rios
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Augusto C. Montezano
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Robert Sykes
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
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Nguyen NTV, Chau HN, Le NH, Nguyen HH, Nguyen HA. Impact of Novel Guidelines on Multifactorial Control and Its Association with Mortality in Adult Patients with Hypertension and Newly Diagnosed Type 2 Diabetes: A 4-Year Prospective Multicenter Study. Int J Endocrinol 2021; 2021:9977840. [PMID: 34621312 PMCID: PMC8492251 DOI: 10.1155/2021/9977840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022] Open
Abstract
METHODS This prospective, observational study involved adult hypertensive patients with newly diagnosed type 2 diabetes mellitus at two university hospitals in Vietnam. The median time of follow-up was 4 years (August 2016-August 2020). The primary outcome was time to all-cause mortality. RESULTS 246 patients were included with a mean age of 64.5 ± 10.4. 58.5% were females. 64.2% were categorized as high risk. At baseline, ischemic heart disease, dyslipidemia, and chronic kidney disease (CKD) were present in 54.9%, 67.1%, and 41.1% of patients. Renin-angiotensin-aldosterone inhibitor, metformin, and statin were prescribed in 89.8%, 66.3%, and 67.1%. Among three risk factors, LDL-c control was the hardest to achieve, increasing from 5.7% to 8.5%. In contrast, blood pressure control decreased from 56.1% in 2016 to 30.2% in 2020, when the second wave of COVID-19 hit our nation. While contemporary targets resulted in persistently low simultaneous control at 1.2%, significant improvement was observed with conventional criteria (blood pressure < 140/90 mmHg, HbA1c < 7%, LDL-c < 70 mg/dl), increasing from 14.6% to 33.7%. During follow-up, the mortality rate was 24.4 events per 1000 patient-years, exclusively in patients with early newly diagnosed diabetes. Improving control overtime, not at baseline, was associated with less mortality. Conversely, age >75 years (HR = 2.6) and CKD (HR = 4.9) were associated with increased mortality. CONCLUSION These findings demonstrated real-world difficulties in managing hypertension and newly diagnosed diabetes, especially with stringent criteria from novel guidelines. High-risk profile, high mortality, and poor simultaneous control warrant more aggressive cardiorenal protection, focusing more on aging CKD patients with early newly diagnosed diabetes.
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Affiliation(s)
- Ngoc-Thanh-Van Nguyen
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700 000, Vietnam
- Cardiology Department, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 700 000, Vietnam
- Outpatient Department, University Medical Center, Ho Chi Minh City 700 000, Vietnam
| | - Hoa Ngoc Chau
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700 000, Vietnam
- Cardiology Department, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 700 000, Vietnam
- Outpatient Department, University Medical Center, Ho Chi Minh City 700 000, Vietnam
| | - Nam Hoai Le
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700 000, Vietnam
- Outpatient Department, University Medical Center, Ho Chi Minh City 700 000, Vietnam
| | - Hai Hoang Nguyen
- Cardiology Department, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 700 000, Vietnam
| | - Hoai-An Nguyen
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700 000, Vietnam
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Hassan TA, Sáenz JE, Ducinskiene D, Cook JP, Imperato JS, Zou KH. New Strategies to Improve Patient Adherence to Medications for Noncommunicable Diseases During and After the COVID-19 Era Identified via a Literature Review. J Multidiscip Healthc 2021; 14:2453-2465. [PMID: 34522102 PMCID: PMC8434910 DOI: 10.2147/jmdh.s313626] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/28/2021] [Indexed: 12/21/2022] Open
Abstract
Noncommunicable diseases (NCDs) place a huge burden on healthcare systems and society as a whole. Relatively early in the coronavirus disease 2019 (COVID-19) pandemic, clinicians became aware that in individuals infected with COVID-19, those with preexisting NCDs such as diabetes mellitus and cardiovascular disease (CVD) were at a greater risk of poor outcomes and mortality than those without. The importance of adherence to medications and lifestyle changes to control and prevent NCDs has been a major focus for many years, but with limited success - the proportion of patients adherent and persistent to their medications remains very low. There are many facets to adherence and persistence. Recent evidence suggests that a patient-centric approach is important, and ensuring that a patient is both motivated and empowered is critical to improving adherence/persistence. The COVID-19 pandemic has brought many changes to the way in which patients with NCDs are managed, with telemedicine and ehealth becoming more common. Changes have also occurred in the way in which patients can gain access to medications during the pandemic. The potential for these changes forms the basis of improving the management of patients with NCDs both during and after the pandemic. Over the coming months, a huge amount of work will be put into initiatives to promote adherence to COVID-19 vaccination programs. Those at highest risk of severe COVID-19, such as people aged 80 years and older, are likely to receive the vaccine first in some parts of world. Finally, social determinants of health are critical elements that can impact not just the likelihood of having an NCD or becoming infected with COVID-19, but also access to healthcare, and a patient's adherence and persistence with their treatments.
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Affiliation(s)
- Tarek A Hassan
- Global Medical and Clinical, Viatris, Canonsburg, PA, USA
| | | | | | - Joseph P Cook
- Global Medical and Clinical, Viatris, Canonsburg, PA, USA
| | | | - Kelly H Zou
- Global Medical and Clinical, Viatris, Canonsburg, PA, USA
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