COVID-19: Special Populations and Risk Factors

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: closed (20 April 2022) | Viewed by 71590

Special Issue Editor


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Guest Editor
1. Department of Internal Medicine, General University Hospital of Alicante, Alicante, Spain
2. Department of Clinical Medicine, School of Medicine, University Miguel Hernández of Elche, Alicante, Spain
Interests: internal medicine; infectious diseases; ageing; global health; COVID-19

Special Issue Information

Dear Colleagues,

Since December 2019, severe acute coronavirus syndrome 2 (SARS-CoV-2), responsible for COVID-19, has spread from Wuhan City (China) to other parts of the world. By 7 January 2021, 87.7 million cases had been diagnosed, leading to at least 1.8 million deaths.  In this current pandemic, special populations at a high risk of adverse outcome have been identified.

For this Special Issue, we invite researchers to contribute with articles describing the clinical features of the disease as well as the prognostic factors in special populations, such as very old patients, immunosuppressed patients, transplantation, health professional, nursing home residents, neoplasms and so on. We welcome papers addressing the relationship between risk factors of adverse outcome (fatality, complications, poor prognosis, acute severe respiratory distress, or acute respiratory failure) in special population and conditions affected by SARS-Cov2. We would appreciate research (original articles and reviews) examining the relation of adverse outcomes in special populations hospitalized with COVID-19

Dr. Jose-Manuel Ramos-Rincon
Guest Editor

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Keywords

  • COVID-19
  • SARS-CoV-2
  • hospitalized patients
  • special population
  • very old patients
  • long term care resident
  • younger people
  • health professional
  • immunosuppression
  • immunosuppressed patients
  • transplantation
  • autoimmune diseases
  • diabetes mellitus
  • hypertension
  • heart failure
  • neoplasms
  • epidemiology
  • risk factors
  • mortality
  • poor outcome
  • adverse outcome
  • causes of mortality
  • severity of COVID-19
  • acute severe respiratory distress
  • acute respiratory failure
  • readmission

Published Papers (23 papers)

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12 pages, 303 KiB  
Article
Remdesivir in Very Old Patients (≥80 Years) Hospitalized with COVID-19: Real World Data from the SEMI-COVID-19 Registry
by Jose-Manuel Ramos-Rincon, María-Dolores López-Carmona, Lidia Cobos-Palacios, Almudena López-Sampalo, Manuel Rubio-Rivas, María-Dolores Martín-Escalante, Santiago de-Cossio-Tejido, María-Luisa Taboada-Martínez, Antonio Muiño-Miguez, Maria Areses-Manrique, Carmen Martinez-Cilleros, Carlota Tuñón-de-Almeida, Lucy Abella-Vázquez, Angel-Luís Martínez-Gonzalez, Luis-Felipe Díez-García, Carlos-Jorge Ripper, Victor Asensi, Angeles Martinez-Pascual, Pablo Guisado-Vasco, Carlos Lumbreras-Bermejo, Ricardo Gómez-Huelgas and on behalf of the SEMI-COVID-19 Networkadd Show full author list remove Hide full author list
J. Clin. Med. 2022, 11(13), 3769; https://doi.org/10.3390/jcm11133769 - 29 Jun 2022
Cited by 12 | Viewed by 3020
Abstract
(1) Background: Large cohort studies of patients with COVID-19 treated with remdesivir have reported improved clinical outcomes, but data on older patients are scarce. Objective: This work aims to assess the potential benefit of remdesivir in unvaccinated very old patients hospitalized with COVID-19; [...] Read more.
(1) Background: Large cohort studies of patients with COVID-19 treated with remdesivir have reported improved clinical outcomes, but data on older patients are scarce. Objective: This work aims to assess the potential benefit of remdesivir in unvaccinated very old patients hospitalized with COVID-19; (2) Methods: This is a retrospective analysis of patients ≥ 80 years hospitalized in Spain between 15 July and 31 December 2020 (SEMI-COVID-19 Registry). Differences in 30-day all-cause mortality were adjusted using a multivariable regression analysis. (3) Results: Of the 4331 patients admitted, 1312 (30.3%) were ≥80 years. Very old patients treated with remdesivir (n: 140, 10.7%) had a lower mortality rate than those not treated with remdesivir (OR (95% CI): 0.45 (0.29–0.69)). After multivariable adjustment by age, sex, and variables associated with lower mortality (place of COVID-19 acquisition; degree of dependence; comorbidities; dementia; duration of symptoms; admission qSOFA; chest X-ray; D-dimer; and treatment with corticosteroids, tocilizumab, beta-lactams, macrolides, and high-flow nasal canula oxygen), the use of remdesivir remained associated with a lower 30-day all-cause mortality rate (adjusted OR (95% CI): 0.40 (0.22–0.61) (p < 0.001)). (4) Conclusions: Remdesivir may reduce mortality in very old patients hospitalized with COVID-19. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
18 pages, 3088 KiB  
Article
Differential Immune Checkpoint and Ig-like V-Type Receptor Profiles in COVID-19: Associations with Severity and Treatment
by Roberto Lozano-Rodríguez, Verónica Terrón-Arcos, Raúl López, Juan Martín-Gutiérrez, Alejandro Martín-Quirós, Charbel Maroun-Eid, Elena Muñoz del Val, Carlos Cañada-Illana, Alejandro Pascual Iglesias, Jaime Valentín Quiroga, Karla Montalbán-Hernández, José Carlos Casalvilla-Dueñas, Miguel A. García-Garrido, Álvaro del Balzo-Castillo, María A. Peinado-Quesada, Laura Gómez-Lage, Carmen Herrero-Benito, Ray G. Butler, José Avendaño-Ortiz and Eduardo López-Collazo
J. Clin. Med. 2022, 11(12), 3287; https://doi.org/10.3390/jcm11123287 - 8 Jun 2022
Cited by 1 | Viewed by 2214
Abstract
Identifying patients’ immune system status has become critical to managing SARS-CoV-2 infection and avoiding the appearance of secondary infections during a hospital stay. Despite the high volume of research, robust severity and outcome markers are still lacking in COVID-19. We recruited 87 COVID-19 [...] Read more.
Identifying patients’ immune system status has become critical to managing SARS-CoV-2 infection and avoiding the appearance of secondary infections during a hospital stay. Despite the high volume of research, robust severity and outcome markers are still lacking in COVID-19. We recruited 87 COVID-19 patients and analyzed, by unbiased automated software, 356 parameters at baseline emergency department admission including: high depth immune phenotyping and immune checkpoint expression by spectral flow cytometry, cytokines and other soluble molecules in plasma as well as routine clinical variables. We identified 69 baseline alterations in the expression of immune checkpoints, Ig-like V type receptors and other immune population markers associated with severity (O2 requirement). Thirty-four changes in these markers/populations were associated with secondary infection appearance. In addition, through a longitudinal sample collection, we described the changes which take place in the immune system of COVID-19 patients during secondary infections and in response to corticosteroid treatment. Our study provides information about immune checkpoint molecules and other less-studied receptors with Ig-like V-type domains such as CD108, CD226, HVEM (CD270), B7H3 (CD276), B7H5 (VISTA) and GITR (CD357), defining these as novel interesting molecules in severe and corticosteroids-treated acute infections. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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12 pages, 2225 KiB  
Article
Characterization and Outcomes of SARS-CoV-2 Infection in Overweight and Obese Patients: A Dynamic Comparison of COVID-19 Pandemic Waves
by Roxana Manuela Fericean, Cosmin Citu, Diana Manolescu, Ovidiu Rosca, Felix Bratosin, Emanuela Tudorache and Cristian Oancea
J. Clin. Med. 2022, 11(10), 2916; https://doi.org/10.3390/jcm11102916 - 21 May 2022
Cited by 13 | Viewed by 2038
Abstract
There are few data on the dynamics of SARS-CoV-2 viral manifestations in obese and overweight persons during each of the five waves that occurred in Romania during the last two years. As such, the purpose of this research was to characterize the variance [...] Read more.
There are few data on the dynamics of SARS-CoV-2 viral manifestations in obese and overweight persons during each of the five waves that occurred in Romania during the last two years. As such, the purpose of this research was to characterize the variance in case severity, symptomatology, ICU hospitalizations, and mortality among overweight and obese individuals infected with the SARS-CoV-2 virus. We included 250 overweight and obese patients admitted to hospital with COVID-19, where 50 patients were selected from each of the five pandemic waves that existed in Romania until March 2022. A total of 113 patients with normal body mass index were included in the study. They were matched with overweight and obese patients by age, gender, and cardiovascular comorbidities to avoid the effect of confounding factors. Between the five waves of the COVID-19 pandemic in Romania, the present investigation found substantial changes in overweight and obese patient features. Obesity increases the risk of hospitalization, severe complications, and mortality from COVID-19. However, this unique demographic is disproportionately affected by obesity-related comorbidities, which contribute to these adverse outcomes. We advocate for the development of new guiding principles for the formulation of healthcare strategies aimed at high-prevalence special populations such as overweight and obese individuals, while also promoting pandemic containment and avoiding the recurrence of pandemic waves with the same guidelines that proved detrimental in terms of economic and human life loss. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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9 pages, 710 KiB  
Article
Evaluating Ocular Symptoms and Tear Film Cytokine Profiles in Symptomatic COVID-19 Patients
by Anna Niedźwiedź, Miłosz Kawa, Ewa Pius-Sadowska, Agnieszka Kuligowska, Alicja Ziontkowska, Dawid Wrzałek, Miłosz Parczewski, Krzysztof Safranow, Krzysztof Kozłowski, Bogusław Machaliński and Anna Machalińska
J. Clin. Med. 2022, 11(9), 2647; https://doi.org/10.3390/jcm11092647 - 8 May 2022
Cited by 6 | Viewed by 1939
Abstract
Background: This study investigated the presence and duration of ophthalmic symptoms in the early phase of COVID-19 to assess the corresponding local immune response on the ocular surface. Methods: The study included data from 180 COVID-19 patients and 160 age-matched healthy controls. The [...] Read more.
Background: This study investigated the presence and duration of ophthalmic symptoms in the early phase of COVID-19 to assess the corresponding local immune response on the ocular surface. Methods: The study included data from 180 COVID-19 patients and 160 age-matched healthy controls. The main finding was the occurrence of ophthalmological manifestations at the time of admission to the hospital and during the preceding 7 days. Tear film concentrations of TNF-α, IL-1b, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12 p70, GM-CSF, and IFN-γ were determined by a magnetic bead assay. Results: Among the COVID-19 patients, 12.64% had at least one ocular symptom at the time of admission, and 24.14% had symptoms within the preceding 7 days (p < 0.001 vs. controls). We found that the COVID-19 patients complained more frequently about eye tearing (p = 0.04) and eye pain (p = 0.01) than controls. A multivariate analysis of the patients and controls adjusted for age and sex revealed that COVID-19 was an independent factor associated with higher VEGF and IL-10 tear film concentrations (β = +0.13, p = 0.047 and β = +0.34, p < 0.001, respectively) and lower IL-1β, IL-8, and GM-CSF levels (β = −0.25, p < 0.001; β = −0.18, p = 0.004; and β = −0.82, p = 0.0 respectively). Conclusions: SARS-CoV-2 does not attract a strong local response of the conjunctival immune system; therefore, ophthalmic symptoms may not constitute a substantial element in the clinical picture of novel COVID-19 infection. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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16 pages, 323 KiB  
Article
Ethnicity and Clinical Outcomes in Patients Hospitalized for COVID-19 in Spain: Results from the Multicenter SEMI-COVID-19 Registry
by Jose-Manuel Ramos-Rincon, Lidia Cobos-Palacios, Almudena López-Sampalo, Michele Ricci, Manuel Rubio-Rivas, Francisco Martos-Pérez, Antonio Lalueza-Blanco, Sergio Moragón-Ledesma, Eva-María Fonseca-Aizpuru, Gema-María García-García, Jose-Luis Beato-Perez, Claudia Josa-Laorden, Francisco Arnalich-Fernández, Sonia Molinos-Castro, José-David Torres-Peña, Arturo Artero, Juan-Antonio Vargas-Núñez, Manuel Mendez-Bailon, Jose Loureiro-Amigo, María-Soledad Hernández-Garrido, Jorge Peris-García, Manuel-Lorenzo López-Reboiro, Bosco Barón-Franco, Jose-Manuel Casas-Rojo, Ricardo Gómez-Huelgas and on behalf of the SEMI-COVID-19 Networkadd Show full author list remove Hide full author list
J. Clin. Med. 2022, 11(7), 1949; https://doi.org/10.3390/jcm11071949 - 31 Mar 2022
Cited by 4 | Viewed by 2462
Abstract
(1) Background: This work aims to analyze clinical outcomes according to ethnic groups in patients hospitalized for COVID-19 in Spain. (2) Methods: This nationwide, retrospective, multicenter, observational study analyzed hospitalized patients with confirmed COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry) from 1 March [...] Read more.
(1) Background: This work aims to analyze clinical outcomes according to ethnic groups in patients hospitalized for COVID-19 in Spain. (2) Methods: This nationwide, retrospective, multicenter, observational study analyzed hospitalized patients with confirmed COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry) from 1 March 2020 to 31 December 2021. Clinical outcomes were assessed according to ethnicity (Latin Americans, Sub-Saharan Africans, Asians, North Africans, Europeans). The outcomes were in-hospital mortality (IHM), intensive care unit (ICU) admission, and the use of invasive mechanical ventilation (IMV). Associations between ethnic groups and clinical outcomes adjusted for patient characteristics and baseline Charlson Comorbidity Index values and wave were evaluated using logistic regression. (3) Results: Of 23,953 patients (median age 69.5 years, 42.9% women), 7.0% were Latin American, 1.2% were North African, 0.5% were Asian, 0.5% were Sub-Saharan African, and 89.7% were European. Ethnic minority patients were significantly younger than European patients (median (IQR) age 49.1 (40.5–58.9) to 57.1 (44.1–67.1) vs. 71.5 (59.5–81.4) years, p < 0.001). The unadjusted IHM was higher in European (21.6%) versus North African (11.4%), Asian (10.9%), Latin American (7.1%), and Sub-Saharan African (3.2%) patients. After further adjustment, the IHM was lower in Sub-Saharan African (OR 0.28 (0.10–0.79), p = 0.017) versus European patients, while ICU admission rates were higher in Latin American and North African versus European patients (OR (95%CI) 1.37 (1.17–1.60), p < 0.001) and (OR (95%CI) 1.74 (1.26–2.41), p < 0.001). Moreover, Latin American patients were 39% more likely than European patients to use IMV (OR (95%CI) 1.43 (1.21–1.71), p < 0.001). (4) Conclusion: The adjusted IHM was similar in all groups except for Sub-Saharan Africans, who had lower IHM. Latin American patients were admitted to the ICU and required IMV more often. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
10 pages, 620 KiB  
Article
Clinical Outcomes in Patients Aged 80 Years or Older Receiving Non-Invasive Respiratory Support for Hypoxemic Acute Respiratory Failure Consequent to COVID-19
by Andrea Vianello, Nello De Vita, Lorenza Scotti, Gabriella Guarnieri, Marco Confalonieri, Valeria Bonato, Beatrice Molena, Carlo Maestrone, Gianluca Airoldi, Carlo Olivieri, Pier Paolo Sainaghi, Federico Lionello, Giovanna Arcaro, Francesco Della Corte, Paolo Navalesi and Rosanna Vaschetto
J. Clin. Med. 2022, 11(5), 1372; https://doi.org/10.3390/jcm11051372 - 2 Mar 2022
Cited by 1 | Viewed by 1728
Abstract
As the clinical outcome of octogenarian patients hospitalised for COVID-19 is very poor, here we assessed the clinical characteristics and outcomes of patients aged 80 year or older hospitalised for COVID-19 receiving non-invasive respiratory support (NIRS). A multicentre, retrospective, observational study was conducted [...] Read more.
As the clinical outcome of octogenarian patients hospitalised for COVID-19 is very poor, here we assessed the clinical characteristics and outcomes of patients aged 80 year or older hospitalised for COVID-19 receiving non-invasive respiratory support (NIRS). A multicentre, retrospective, observational study was conducted in seven hospitals in Northern Italy. All patients aged ≥80 years with COVID-19 associated hypoxemic acute respiratory failure (hARF) undergoing NIRS between 24 February 2020, and 31 March 2021, were included. Out of 252 study participants, 156 (61.9%) and 163 (64.6%) died during hospital stay and within 90 days from hospital admission, respectively. In this case, 228 (90.5%) patients only received NIRS (NIRS group), while 24 (9.5%) were treated with invasive mechanical ventilation (IMV) after NIRS failure (NIRS+IMV group). In-hospital mortality did not significantly differ between NIRS and NIRS+IMV group (61.0% vs. 70.8%, respectively; p = 0.507), while survival probability at 90 days was significantly higher for NIRS compared to NIRS+IMV patients (0.379 vs. 0.147; p = 0.0025). The outcome of octogenarian patients with COVID-19 receiving NIRS is quite poor. Caution should be used when considering transition from NIRS to IMV after NIRS failure. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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11 pages, 1143 KiB  
Article
Incidence of SARS-CoV-2 Infection and Related Mortality by Education Level during Three Phases of the 2020 Pandemic: A Population-Based Cohort Study in Rome
by Laura Angelici, Chiara Sorge, Mirko Di Martino, Giovanna Cappai, Massimo Stafoggia, Nera Agabiti, Enrico Girardi, Simone Lanini, Emanuele Nicastri, Marina Davoli and Giulia Cesaroni
J. Clin. Med. 2022, 11(3), 877; https://doi.org/10.3390/jcm11030877 - 7 Feb 2022
Cited by 6 | Viewed by 1870
Abstract
Evidence on social determinants of health on the risk of SARS-CoV-2 infection and adverse outcomes is still limited. Therefore, this work investigates educational disparities in the incidence of infection and mortality within 30 days of the onset of infection during 2020 in Rome, [...] Read more.
Evidence on social determinants of health on the risk of SARS-CoV-2 infection and adverse outcomes is still limited. Therefore, this work investigates educational disparities in the incidence of infection and mortality within 30 days of the onset of infection during 2020 in Rome, with particular attention to changes in socioeconomic inequalities over time. A cohort of 1,538,231 residents in Rome on 1 January 2020, aged 35+, followed from 1 March to 31 December 2020, were considered. Cumulative incidence and mortality rates by education were estimated. Multivariable log-binomial and Cox regression models were used to investigate educational disparities in the incidence of SARS-CoV-2 infection and mortality during the entire study period and in three phases of the pandemic. During 2020, there were 47,736 incident cases and 2281 deaths. The association between education and the incidence of infection changed over time. Till May 2020, low- and medium-educated individuals had a lower risk of infection than that of the highly educated. However, there was no evidence of an association between education and the incidence of SARS-CoV-2 infection during the summer. Lastly, low-educated adults had a 25% higher risk of infection from September to December than that of the highly educated. Similarly, there was substantial evidence of educational inequalities in mortality within 30 days of the onset of infection in the last term of 2020. In Rome, social inequalities in COVID-19 appeared in the last term of 2020, and they strengthen the need for monitoring inequalities emerging from this pandemic. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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29 pages, 1875 KiB  
Article
Usefulness of the C2HEST Score in Predicting the Clinical Outcomes of COVID-19 in Diabetic and Non-Diabetic Cohorts
by Damian Gajecki, Adrian Doroszko, Małgorzata Trocha, Katarzyna Giniewicz, Krzysztof Kujawa, Marek Skarupski, Jakub Gawryś, Tomasz Matys, Ewa Szahidewicz-Krupska, Piotr Rola, Barbara Stachowska, Jowita Halupczok-Żyła, Barbara Adamik, Krzysztof Kaliszewski, Katarzyna Kilis-Pstrusinska, Krzysztof Letachowicz, Agnieszka Matera-Witkiewicz, Michał Pomorski, Marcin Protasiewicz, Marcin Madziarski, Klaudia Konikowska, Agata Remiorz, Maja Orłowska, Krzysztof Proc, Małgorzata Szymala-Pedzik, Joanna Zorawska, Karolina Lindner, Janusz Sokołowski, Ewa A. Jankowska and Katarzyna Madziarskaadd Show full author list remove Hide full author list
J. Clin. Med. 2022, 11(3), 873; https://doi.org/10.3390/jcm11030873 - 7 Feb 2022
Cited by 4 | Viewed by 2726
Abstract
Background: Diabetes mellitus is among the most frequent comorbidities worsening COVID-19 outcome. Nevertheless, there are no data regarding the optimal risk stratification of patients with diabetes and COVID-19. Since individual C2HEST components reflect the comorbidities, we assumed that the score could [...] Read more.
Background: Diabetes mellitus is among the most frequent comorbidities worsening COVID-19 outcome. Nevertheless, there are no data regarding the optimal risk stratification of patients with diabetes and COVID-19. Since individual C2HEST components reflect the comorbidities, we assumed that the score could predict COVID-19 outcomes. Material and Methods: A total of 2184 medical records of patients hospitalized for COVID-19 at the medical university center were analyzed, including 473 diabetic patients and 1666 patients without any glucose or metabolic abnormalities. The variables of patients’ baseline characteristics were retrieved to calculate the C2HEST score and subsequently the diabetic and non-diabetic subjects were assigned to the following categories: low-, medium- or high-risk. The measured outcomes included: in-hospital mortality; 3-month and 6-month all-cause mortality; non-fatal end of hospitalization (discharged home/sudden-deterioration/rehabilitation) and adverse in-hospital clinical events. Results: A total of 194 deaths (41%) were reported in the diabetic cohort, including 115 in-hospital deaths (24.3%). The 3-month and 6-month in-hospital mortality was highest in the high-risk C2HEST stratum. The C2HEST score revealed to be more sensitive in non-diabetic-group. The estimated six-month survival probability for high-risk subjects reached 0.4 in both cohorts whereas for the low-risk group, the six-month survival probability was 0.7 in the diabetic vs. 0.85 in the non-diabetic group—levels which were maintained during whole observation period. In both cohorts, receiver operating characteristics revealed that C2HEST predicts the following: cardiogenic shock; acute heart failure; myocardial injury; and in-hospital acute kidney injury. Conclusions: We demonstrated the usefulness and performance of the C2HEST score in predicting the adverse COVID-19 outcomes in hospitalized diabetic subjects. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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11 pages, 670 KiB  
Article
Predictors of Mortality in Hemodialyzed Patients after SARS-CoV-2 Infection
by Leszek Tylicki, Ewelina Puchalska-Reglińska, Piotr Tylicki, Aleksander Och, Karolina Polewska, Bogdan Biedunkiewicz, Aleksandra Parczewska, Krzysztof Szabat, Jacek Wolf and Alicja Dębska-Ślizień
J. Clin. Med. 2022, 11(2), 285; https://doi.org/10.3390/jcm11020285 - 6 Jan 2022
Cited by 11 | Viewed by 2332
Abstract
Introduction: The determinants of COVID-19 mortality are well-characterized in the general population. Less numerous and inconsistent data are among the maintenance hemodialysis (HD) patients, who are the population most at risk of an unfavorable prognosis. Methods: In this retrospective cohort study we included [...] Read more.
Introduction: The determinants of COVID-19 mortality are well-characterized in the general population. Less numerous and inconsistent data are among the maintenance hemodialysis (HD) patients, who are the population most at risk of an unfavorable prognosis. Methods: In this retrospective cohort study we included all adult HD patients from the Pomeranian Voivodeship, Poland, with laboratory-confirmed SARS-CoV-2 infection hospitalized between 6 October 2020 and 28 February 2021, both those who survived, and also those who died. Demographic, clinical, treatment, and laboratory data on admission, were extracted from the electronic medical records of the dedicated hospital and patients’ dialysis unit, and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with 3-month all-cause mortality. Results: The 133 patients (53.38% males) aged 73.0 (67–79) years, with a median duration of hemodialysis of 42.0 (17–86) months, were included in this study. At diagnosis, the majority were considered to have a mild course (34 of 133 patients were asymptomatic, another 63 subjects presented mild symptoms), while 36 (27.07%) patients had low blood oxygen saturation and required oxygen supplementation. Three-month mortality was 39.08% including an in-hospital case fatality rate of 33.08%. Multivariable logistic regression showed that the frailty clinical index of 4 or greater (OR 8.36, 95%CI 1.81–38.6; p < 0.01), D-Dimer of 1500 ng/mL or greater (6.00, 1.94–18.53; p < 0.01), and CRP of >118 mg/L at admission (3.77 1.09–13.01; p = 0.04) were found to be predictive of mortality. Conclusion: Very high 3-month all-cause mortality in hospitalized HD patients was determined mainly by frailty. High CRP and D-dimer levels upon admission further confer mortality risk. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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11 pages, 636 KiB  
Article
HDL in COVID-19 Patients: Evidence from an Italian Cross-Sectional Study
by Bianca Papotti, Chiara Macchi, Chiara Favero, Simona Iodice, Maria Pia Adorni, Francesca Zimetti, Alberto Corsini, Stefano Aliberti, Francesco Blasi, Stefano Carugo, Valentina Bollati, Marco Vicenzi and Massimiliano Ruscica
J. Clin. Med. 2021, 10(24), 5955; https://doi.org/10.3390/jcm10245955 - 18 Dec 2021
Cited by 10 | Viewed by 2607
Abstract
A number of studies have highlighted important alterations of the lipid profile in COVID-19 patients. Besides the well-known atheroprotective function, HDL displays anti-inflammatory, anti-oxidative, and anti-infectious properties. The aim of this retrospective study was to assess the HDL anti-inflammatory and antioxidant features, by [...] Read more.
A number of studies have highlighted important alterations of the lipid profile in COVID-19 patients. Besides the well-known atheroprotective function, HDL displays anti-inflammatory, anti-oxidative, and anti-infectious properties. The aim of this retrospective study was to assess the HDL anti-inflammatory and antioxidant features, by evaluation of HDL-associated Serum amyloid A (SAA) enrichment and HDL-paraoxonase 1 (PON-1) activity, in a cohort of COVID-19 patients hospitalized at the Cardiorespiratory COVID-19 Unit of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan. COVID-19 patients reached very low levels of HDL-c (mean ± SD: 27.1 ± 9.7 mg/dL) with a marked rise in TG (mean ± SD: 165.9 ± 62.5 mg/dL). Compared to matched-controls, SAA levels were significantly raised in COVID-19 patients at admission. There were no significant differences in the SAA amount between 83 alive and 22 dead patients for all-cause in-hospital mortality. Similar findings were reached in the case of PON-1 activity, with no differences between alive and dead patients for all-cause in-hospital mortality. In conclusion, although not related to the prediction of in-hospital mortality, reduction in HDL-c and the enrichment of SAA in HDL are a mirror of SARS-CoV-2 positivity even at the very early stages of the infection. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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10 pages, 1039 KiB  
Article
Anti-SARS-CoV-2 S-RBD IgG Antibody Responses after COVID-19 mRNA Vaccine in the Chronic Disorder of Consciousness: A Pilot Study
by Maria Elena Pugliese, Riccardo Battaglia, Antonio Cerasa, Maria Girolama Raso, Francesco Coschignano, Angela Pagliuso, Roberta Bruschetta, Giovanni Pugliese, Paolo Scola and Paolo Tonin
J. Clin. Med. 2021, 10(24), 5830; https://doi.org/10.3390/jcm10245830 - 13 Dec 2021
Cited by 1 | Viewed by 2159
Abstract
Objective: In the last year, a large amount of research has investigated the anti-spike protein receptor-binding domain (S-RBD) antibody responses in patients at high risk of developing severe acute respiratory syndrome because of COVID-19 infection. However, no data are available on the chronic [...] Read more.
Objective: In the last year, a large amount of research has investigated the anti-spike protein receptor-binding domain (S-RBD) antibody responses in patients at high risk of developing severe acute respiratory syndrome because of COVID-19 infection. However, no data are available on the chronic disorder of consciousness (DOC). Methods: Here, we evaluated anti-S-RBD IgG levels after vaccination in chronic DOC patients compared with demographically matched healthy controls (HC) by indirect chemiluminescence immunoassay. All individuals completed a two-dose-cycle vaccination with Pfizer mRNA vaccine (BNT162b2), and antibody responses were evaluated at 30 and 180 days after the administration of the second dose of vaccination. Results: We compared 32 DOC patients with 34 demographically matched healthy controls. Both DOC and HC groups showed a similar antibody response at 30 days, whereas at follow-up (180 days) DOC patients were characterized by lower S-RBD IgG levels with respect to controls. Additional multiple regression analyses including demographical and clinical comorbidities as predictors revealed that age was the only factor associated with the decrease in S-RBD IgG levels at follow-up (180 days). Elderly individuals of both groups were characterized by a reduction in the antibody responses with respect to younger individuals. Conclusions: Our results show an efficacy seroconversion in DOC patients in the first period after vaccination, which significantly declines over time with respect to healthy controls. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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14 pages, 1393 KiB  
Article
SARS-CoV-2 Infection in Patients on Dialysis: Incidence and Outcomes in the Lazio Region, Italy
by Claudia Marino, Laura Angelici, Valentina Pistolesi, Santo Morabito, Anteo Di Napoli, Enrico Calandrini, Silvia Cascini, Anna Maria Bargagli, Nicola Petrosillo, Nera Agabiti, Marina Davoli and on behalf of the Regional Registry Dialysis and Transplant Lazio Region
J. Clin. Med. 2021, 10(24), 5818; https://doi.org/10.3390/jcm10245818 - 13 Dec 2021
Cited by 4 | Viewed by 2197
Abstract
Patients with end-stage kidney disease represent a frail population and might be at higher risk of SARS-CoV-2 infection. The Lazio Regional Dialysis and Transplant Registry collected information on dialysis patients with a positive swab. The study investigated incidence of SARS-CoV-2 infection, mortality and [...] Read more.
Patients with end-stage kidney disease represent a frail population and might be at higher risk of SARS-CoV-2 infection. The Lazio Regional Dialysis and Transplant Registry collected information on dialysis patients with a positive swab. The study investigated incidence of SARS-CoV-2 infection, mortality and their potential associated factors in patients undergoing maintenance hemodialysis (MHD) in the Lazio region. Method: The occurrence of infection was assessed among MHD patients included in the RRDTL from 1 March to 30 November 2020. The adjusted cumulative incidence of infection and mortality risk within 30 days of infection onset were estimated. Logistic and Cox regression models were applied to identify factors associated with infection and mortality, respectively. Results: The MHD cohort counted 4942 patients; 256 (5.2%) had COVID-19. The adjusted cumulative incidence was 5.1%. Factors associated with infection included: being born abroad, educational level, cystic renal disease/familial nephropathy, vascular disease and being treated in a dialysis center located in Local Health Authority (LHA) Rome 2. Among infected patients, 59 (23.0%) died within 30 days; the adjusted mortality risk was 21.0%. Factors associated with 30-day mortality included: age, malnutrition and fever at the time of swab. Conclusions: Factors associated with infection seem to reflect socioeconomic conditions. Factors associated with mortality, in addition to age, are related to clinical characteristics and symptoms at the time of swab. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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10 pages, 2939 KiB  
Article
Predictive Modeling of Poor Outcome in Severe COVID-19: A Single-Center Observational Study Based on Clinical, Cytokine and Laboratory Profiles
by Óscar Gorgojo-Galindo, Marta Martín-Fernández, María Jesús Peñarrubia-Ponce, Francisco Javier Álvarez, Christian Ortega-Loubon, Hugo Gonzalo-Benito, Pedro Martínez-Paz, José Pablo Miramontes-González, Esther Gómez-Sánchez, Rodrigo Poves-Álvarez, Pablo Jorge-Monjas, Eduardo Tamayo, María Heredia-Rodríguez and Álvaro Tamayo-Velasco
J. Clin. Med. 2021, 10(22), 5431; https://doi.org/10.3390/jcm10225431 - 20 Nov 2021
Cited by 7 | Viewed by 2135
Abstract
Pneumonia is the main cause of hospital admission in COVID-19 patients. We aimed to perform an extensive characterization of clinical, laboratory, and cytokine profiles in order to identify poor outcomes in COVID-19 patients. Methods: A prospective and consecutive study involving 108 COVID-19 patients [...] Read more.
Pneumonia is the main cause of hospital admission in COVID-19 patients. We aimed to perform an extensive characterization of clinical, laboratory, and cytokine profiles in order to identify poor outcomes in COVID-19 patients. Methods: A prospective and consecutive study involving 108 COVID-19 patients was conducted between March and April 2020 at Hospital Clínico Universitario de Valladolid (Spain). Plasma samples from each patient were collected after emergency room admission. Forty-five serum cytokines were measured in duplicate, and clinical data were analyzed using SPPS version 25.0. Results: A multivariate predictive model showed high hepatocyte growth factor (HGF) plasma levels as the only cytokine related to intubation or death risk at hospital admission (OR = 7.38, 95%CI—(1.28–42.4), p = 0.025). There were no comorbidities included in the model except for the ABO blood group, in which the O blood group was associated with a 14-fold lower risk of a poor outcome. Other clinical variables were also included in the predictive model. The predictive model was internally validated by the receiver operating characteristic (ROC) curve with an area under the curve (AUC) of 0.94, a sensitivity of 91.7% and a specificity of 95%. The use of a bootstrapping method confirmed these results. Conclusions: A simple, robust, and quick predictive model, based on the ABO blood group, four common laboratory values, and one specific cytokine (HGF), could be used in order to predict poor outcomes in COVID-19 patients. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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17 pages, 2119 KiB  
Article
Education Attainment, Intelligence and COVID-19: A Mendelian Randomization Study
by Gloria Hoi-Yee Li, Stanley Kam-Ki Lam, Ian Chi-Kei Wong, Jody Kwok-Pui Chu and Ching-Lung Cheung
J. Clin. Med. 2021, 10(21), 4870; https://doi.org/10.3390/jcm10214870 - 22 Oct 2021
Cited by 13 | Viewed by 3178
Abstract
Background: Evidence of socioeconomic inequality in COVID-19-related outcomes is emerging, with a higher risk of infection and mortality observed among individuals with lower education attainment. We aimed to evaluate the potential interventions against COVID-19 from the socioeconomic perspective, including improvement in education and [...] Read more.
Background: Evidence of socioeconomic inequality in COVID-19-related outcomes is emerging, with a higher risk of infection and mortality observed among individuals with lower education attainment. We aimed to evaluate the potential interventions against COVID-19 from the socioeconomic perspective, including improvement in education and intelligence. Methods: With a two-sample Mendelian randomization approach using summary statistics from the largest genome-wide association meta-analysis, univariable analysis was adopted to evaluate the total causal effects of genetically determined education attainment and intelligence on COVID-19 outcomes. Multivariable analysis was performed to dissect the potential mechanisms. Results: Genetic predisposition to higher education attainment by 1 SD (4.2 years) was independently associated with reduced risk of COVID-19 severity (OR = 0.508 [95% CI: 0.417–0.617]; p < 0.001). Genetically higher education attainment also lowered the risk of COVID-19 hospitalization (0.685 [0.593–0.791]; p < 0.001), but the association was attenuated after adjustment for beta estimates of intelligence in multivariable analysis. Genetically higher intelligence was associated with reduced risk of COVID-19 hospitalization (0.780 [0.655–0.930]; p = 0.006), with attenuation of association after adjustment for education attainment. Null association was observed for genetically determined education attainment and intelligence with SARS-CoV-2 infection. Conclusion: Education may act independently and jointly with intelligence in improving the COVID-19 outcomes. Improving education may potentially alleviate the COVID-19-related health inequality. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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11 pages, 918 KiB  
Article
Outbreaks of COVID-19 in Nursing Homes: A Cross-Sectional Survey of 74 Nursing Homes in a French Area
by Emilie Piet, Alexis Maillard, Franck Olivier Mallaval, Jean Yves Dusseau, Murielle Galas-Haddad, Sébastien Ducki, Hélène Creton, Marc Lallemant, Emmanuel Forestier, Gaëtan Gavazzi and Tristan Delory
J. Clin. Med. 2021, 10(18), 4280; https://doi.org/10.3390/jcm10184280 - 21 Sep 2021
Cited by 10 | Viewed by 1976
Abstract
In this multi-centric cross-sectional survey conducted in nursing homes of the French Alps, from 1 March to 31 May 2020, we analyze the relationship between the occurrence of an outbreak of COVID 19 among residents and staff members. Out of 225 eligible nursing [...] Read more.
In this multi-centric cross-sectional survey conducted in nursing homes of the French Alps, from 1 March to 31 May 2020, we analyze the relationship between the occurrence of an outbreak of COVID 19 among residents and staff members. Out of 225 eligible nursing homes, 74 (32.8%) completed the survey. Among 5891 residents, the incidence of confirmed or probable COVID-19 was 8.2% (95CI, 7.5% to 8.9%), and 22 (29.7%) facilities had an outbreak with at least 3 cases. Among the 4652 staff members, the incidence of confirmed or probable COVID-19 was 6.3% (95CI, 5.6% to 7.1%). A strong positive correlation existed between residents and staff members for both numbers of cases (r2 = 0.77, p < 0.001) and the incidence (r2 = 0.76, p < 0.001). In univariate analyses, cases among the staff were the only factor associated with the occurrence of an outbreak among residents (OR = 11.2 (95CI, 2.25 to 53.6)). In bivariate analysis, this relationship was not influenced by any nursing home characteristics, nor the action they implemented to mitigate the COVID-19 crisis. Staff members were, therefore, likely to be a source of contamination and spread of COVID-19 among nursing home residents during the first wave of the pandemic. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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13 pages, 788 KiB  
Article
Circulating Osteopontin Levels and Outcomes in Patients Hospitalized for COVID-19
by Salim S. Hayek, Christoph Roderburg, Pennelope Blakely, Christopher Launius, Jesper Eugen-Olsen, Frank Tacke, Sofia Ktena, Verena Keitel, Mark Luedde, Evangelos J. Giamarellos-Bourboulis, Tom Luedde and Sven H. Loosen
J. Clin. Med. 2021, 10(17), 3907; https://doi.org/10.3390/jcm10173907 - 30 Aug 2021
Cited by 17 | Viewed by 2296
Abstract
Background: Severe coronavirus disease 2019 (COVID-19) is the result of a hyper-inflammatory reaction to the severe acute respiratory syndrome coronavirus 2. The biomarkers of inflammation have been used to risk-stratify patients with COVID-19. Osteopontin (OPN) is an integrin-binding glyco-phosphoprotein involved in the modulation [...] Read more.
Background: Severe coronavirus disease 2019 (COVID-19) is the result of a hyper-inflammatory reaction to the severe acute respiratory syndrome coronavirus 2. The biomarkers of inflammation have been used to risk-stratify patients with COVID-19. Osteopontin (OPN) is an integrin-binding glyco-phosphoprotein involved in the modulation of leukocyte activation; its levels are associated with worse outcomes in patients with sepsis. Whether OPN levels predict outcomes in COVID-19 is unknown. Methods: We measured OPN levels in serum of 341 hospitalized COVID-19 patients collected within 48 h from admission. We characterized the determinants of OPN levels and examined their association with in-hospital outcomes; notably death, need for mechanical ventilation, and need for renal replacement therapy (RRT) and as a composite outcome. The risk discrimination ability of OPN was compared with other inflammatory biomarkers. Results: Patients with COVID-19 (mean age 60, 61.9% male, 27.0% blacks) had significantly higher levels of serum OPN compared to healthy volunteers (96.63 vs. 16.56 ng/mL, p < 0.001). Overall, 104 patients required mechanical ventilation, 35 needed dialysis, and 53 died during their hospitalization. In multivariable analyses, OPN levels ≥140.66 ng/mL (third tertile) were associated with a 3.5 × (95%CI 1.44–8.27) increase in the odds of death, and 4.9 × (95%CI 2.48–9.80) increase in the odds of requiring mechanical ventilation. There was no association between OPN and need for RRT. Finally, OPN levels in the upper tertile turned out as an independent prognostic factor of event-free survival with respect to the composite endpoint. Conclusion: Higher OPN levels are associated with increased odds of death and mechanical ventilation in patients with COVID-19, however, their utility in triage is questionable. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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11 pages, 712 KiB  
Article
Comparison of COVID-19 and Non-COVID-19 Pneumonia in Down Syndrome
by Diego Real de Asua, Miguel A. Mayer, María del Carmen Ortega, Jose M. Borrel, Teresa de Jesús Bermejo, Domingo González-Lamuño, Coral Manso, Fernando Moldenhauer, María Carmona-Iragui, Anke Hüls, Stephanie L. Sherman, Andre Strydom, Rafael de la Torre and Mara Dierssen
J. Clin. Med. 2021, 10(16), 3748; https://doi.org/10.3390/jcm10163748 - 23 Aug 2021
Cited by 7 | Viewed by 4428
Abstract
Whether the increased risk for coronavirus disease 2019 (COVID-19) hospitalization and death observed in Down syndrome (DS) are disease specific or also occur in individuals with DS and non-COVID-19 pneumonias is unknown. This retrospective cohort study compared COVID-19 cases in persons with DS [...] Read more.
Whether the increased risk for coronavirus disease 2019 (COVID-19) hospitalization and death observed in Down syndrome (DS) are disease specific or also occur in individuals with DS and non-COVID-19 pneumonias is unknown. This retrospective cohort study compared COVID-19 cases in persons with DS hospitalized in Spain reported to the Trisomy 21 Research Society COVID-19 survey (n = 86) with admissions for non-COVID-19 pneumonias from a retrospective clinical database of the Spanish Ministry of Health (n = 2832 patients). In-hospital mortality rates were significantly higher for COVID-19 patients (26.7% vs. 9.4%), especially among individuals over 40 and patients with obesity, dementia, and/or epilepsy. The mean length of stay of deceased patients with COVID-19 was significantly shorter than in those with non-COVID-19 pneumonias. The rate of admission to an ICU in patients with DS and COVID-19 (4.3%) was significantly lower than that reported for the general population with COVID-19. Our findings confirm that acute SARS-CoV-2 infection leads to higher mortality than non-COVID-19 pneumonias in individuals with DS, especially among adults over 40 and those with specific comorbidities. However, differences in access to respiratory support might also account for some of the heightened mortality of individuals with DS with COVID-19. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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19 pages, 341 KiB  
Article
Autoimmune Diseases and COVID-19 as Risk Factors for Poor Outcomes: Data on 13,940 Hospitalized Patients from the Spanish Nationwide SEMI-COVID-19 Registry
by María del Mar Ayala Gutiérrez, Manuel Rubio-Rivas, Carlos Romero Gómez, Abelardo Montero Sáez, Iván Pérez de Pedro, Narcís Homs, Blanca Ayuso García, Carmen Cuenca Carvajal, Francisco Arnalich Fernández, José Luis Beato Pérez, Juan Antonio Vargas Núñez, Laura Letona Giménez, Carmen Suárez Fernández, Manuel Méndez Bailón, Carlota Tuñón de Almeida, Julio González Moraleja, Mayte de Guzmán García-Monge, Cristina Helguera Amezua, María del Pilar Fidalgo Montero, Vicente Giner Galvañ, Ricardo Gil Sánchez, Jorge Collado Sáenz, Ramon Boixeda, José Manuel Ramos Rincón, Ricardo Gómez Huelgas and on behalf of the SEMI-COVID-19 Networkadd Show full author list remove Hide full author list
J. Clin. Med. 2021, 10(9), 1844; https://doi.org/10.3390/jcm10091844 - 23 Apr 2021
Cited by 12 | Viewed by 4660
Abstract
(1) Objectives: To describe the clinical characteristics and clinical course of hospitalized patients with COVID-19 and autoimmune diseases (ADs) compared to the general population. (2) Methods: We used information available in the nationwide Spanish SEMI-COVID-19 Registry, which retrospectively compiles data from the first [...] Read more.
(1) Objectives: To describe the clinical characteristics and clinical course of hospitalized patients with COVID-19 and autoimmune diseases (ADs) compared to the general population. (2) Methods: We used information available in the nationwide Spanish SEMI-COVID-19 Registry, which retrospectively compiles data from the first admission of adult patients with COVID-19. We selected all patients with ADs included in the registry and compared them to the remaining patients. The primary outcome was all-cause mortality during admission, readmission, and subsequent admissions, and secondary outcomes were a composite outcome including the need for intensive care unit (ICU) admission, invasive and non-invasive mechanical ventilation (MV), or death, as well as in-hospital complications. (3) Results: A total of 13,940 patients diagnosed with COVID-19 were included, of which 362 (2.6%) had an AD. Patients with ADs were older, more likely to be female, and had greater comorbidity. On the multivariate logistic regression analysis, which involved the inverse propensity score weighting method, AD as a whole was not associated with an increased risk of any of the outcome variables. Habitual treatment with corticosteroids (CSs), age, Barthel Index score, and comorbidity were associated with poor outcomes. Biological disease-modifying anti-rheumatic drugs (bDMARDs) were associated with a decrease in mortality in patients with AD. (4) Conclusions: The analysis of the SEMI-COVID-19 Registry shows that ADs do not lead to a different prognosis, measured by mortality, complications, or the composite outcome. Considered individually, it seems that some diseases entail a different prognosis than that of the general population. Immunosuppressive/immunoregulatory treatments (IST) prior to admission had variable effects. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
11 pages, 986 KiB  
Article
Physical Activity and the Risk of COVID-19 Infection and Mortality: A Nationwide Population-Based Case-Control Study
by Dong-Hyuk Cho, Sun Ju Lee, Sae Young Jae, Woo Joo Kim, Seong Jun Ha, Jun Gyo Gwon, Jimi Choi, Dong Wook Kim and Jang Young Kim
J. Clin. Med. 2021, 10(7), 1539; https://doi.org/10.3390/jcm10071539 - 6 Apr 2021
Cited by 36 | Viewed by 6160
Abstract
Regular physical activity (PA) is known to reduce the risk of serious community-acquired infections. We examined the association of PA with the morbidity and mortality resulting from coronavirus disease (COVID-19) infection in the South Korean population. Patients who tested positive for severe acute [...] Read more.
Regular physical activity (PA) is known to reduce the risk of serious community-acquired infections. We examined the association of PA with the morbidity and mortality resulting from coronavirus disease (COVID-19) infection in the South Korean population. Patients who tested positive for severe acute respiratory coronavirus 2 and who underwent public health screening between 2014 and 2017 (n = 6288) were included. Age- and sex-matched controls (n = 125,772) were randomly selected from the Korean National Health Insurance Service database. Leisure-time PA was assessed using a self-reported questionnaire. The mean PA levels were lower in the patient than in the control group (558.2 ± 516.3 vs. 580.2 ± 525.7 metabolic equivalent of task (MET)-min/week, p = 0.001). Patients with moderate to vigorous PA (MVPA) were associated with a lower risk of COVID-19 morbidity (odds ratio (OR), 0.90; 95% confidence interval (CI), 0.86–0.95). In addition, a standard deviation (SD) increment in MET/week (525.3 MET-min/week) was associated with a 4% decrease in the risk of COVID-19 morbidity (OR, 0.96; 95% CI, 0.93–0.99). MVPA and an SD increment in MET/week were associated with lower mortality (MVPA: OR, 0.47; 95% CI, 0.26–0.87; per SD increment: OR, 0.65; 95% CI, 0.48–0.88). Higher levels of regular PA were associated with a lower risk of COVID-19 infection and mortality, highlighting the importance of maintaining appropriate levels of PA along with social distancing amid the COVID-19 pandemic. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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21 pages, 1820 KiB  
Article
Gender-Based Differences by Age Range in Patients Hospitalized with COVID-19: A Spanish Observational Cohort Study
by Claudia Josa-Laorden, Anxela Crestelo-Vieitez, María del Mar García Andreu, Manuel Rubio-Rivas, Marcos Sánchez, Neera Toledo Samaniego, Francisco Arnalich Fernández, Rosario Iguaran Bermudez, Eva Ma Fonseca Aizpuru, Juan Antonio Vargas Núñez, Paula Maria Pesqueira Fontan, Jorge Serrano Ballesteros, Santiago Jesús Freire Castro, Melani Pestaña Fernández, Alba Viana García, Victoria Nuñez Rodriguez, Vicente Giner-Galvañ, Francisco Javier Carrasco Sánchez, Almudena Hernández Milián, Marta Cobos-Siles, Jose Javier Napal Lecumberri, Virginia Herrero García, Maria de los Reyes Pascual Pérez, Jesús Millán Núñez-Cortés, José Manuel Casas Rojo and on behalf of the SEMI-COVID-19 Networkadd Show full author list remove Hide full author list
J. Clin. Med. 2021, 10(5), 899; https://doi.org/10.3390/jcm10050899 - 25 Feb 2021
Cited by 11 | Viewed by 6495
Abstract
There is some evidence that male gender could have a negative impact on the prognosis and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of the present study was to compare the characteristics of coronavirus disease 2019 (COVID-19) between [...] Read more.
There is some evidence that male gender could have a negative impact on the prognosis and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of the present study was to compare the characteristics of coronavirus disease 2019 (COVID-19) between hospitalized men and women with confirmed SARS-CoV-2 infection. This multicenter, retrospective, observational study is based on the SEMI-COVID-19 Registry. We analyzed the differences between men and women for a wide variety of demographic, clinical, and treatment variables, and the sex distribution of the reported COVID-19 deaths, as well as intensive care unit (ICU) admission by age subgroups. This work analyzed 12,063 patients (56.8% men). The women in our study were older than the men, on average (67.9 vs. 65.7 years; p < 001). Bilateral condensation was more frequent among men than women (31.8% vs. 29.9%; p = 0.007). The men needed non-invasive and invasive mechanical ventilation more frequently (5.6% vs. 3.6%, p < 0.001, and 7.9% vs. 4.8%, p < 0.001, respectively). The most prevalent complication was acute respiratory distress syndrome, with severe cases in 19.9% of men (p < 0.001). In men, intensive care unit admission was more frequent (10% vs. 6.1%; p < 0.001) and the mortality rate was higher (23.1% vs. 18.9%; p < 0.001). Regarding mortality, the differences by gender were statistically significant in the age groups from 55 years to 89 years of age. A multivariate analysis showed that female sex was significantly and independently associated with a lower risk of mortality in our study. Male sex appears to be related to worse progress in COVID-19 patients and is an independent prognostic factor for mortality. In order to fully understand its prognostic impact, other factors associated with sex must be considered. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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Review

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55 pages, 2549 KiB  
Review
Factors Modulating COVID-19: A Mechanistic Understanding Based on the Adverse Outcome Pathway Framework
by Laure-Alix Clerbaux, Maria Cristina Albertini, Núria Amigó, Anna Beronius, Gillina F. G. Bezemer, Sandra Coecke, Evangelos P. Daskalopoulos, Giusy del Giudice, Dario Greco, Lucia Grenga, Alberto Mantovani, Amalia Muñoz, Elma Omeragic, Nikolaos Parissis, Mauro Petrillo, Laura A. Saarimäki, Helena Soares, Kristie Sullivan and Brigitte Landesmann
J. Clin. Med. 2022, 11(15), 4464; https://doi.org/10.3390/jcm11154464 - 31 Jul 2022
Cited by 19 | Viewed by 5214
Abstract
Addressing factors modulating COVID-19 is crucial since abundant clinical evidence shows that outcomes are markedly heterogeneous between patients. This requires identifying the factors and understanding how they mechanistically influence COVID-19. Here, we describe how eleven selected factors (age, sex, genetic factors, lipid disorders, [...] Read more.
Addressing factors modulating COVID-19 is crucial since abundant clinical evidence shows that outcomes are markedly heterogeneous between patients. This requires identifying the factors and understanding how they mechanistically influence COVID-19. Here, we describe how eleven selected factors (age, sex, genetic factors, lipid disorders, heart failure, gut dysbiosis, diet, vitamin D deficiency, air pollution and exposure to chemicals) influence COVID-19 by applying the Adverse Outcome Pathway (AOP), which is well-established in regulatory toxicology. This framework aims to model the sequence of events leading to an adverse health outcome. Several linear AOPs depicting pathways from the binding of the virus to ACE2 up to clinical outcomes observed in COVID-19 have been developed and integrated into a network offering a unique overview of the mechanisms underlying the disease. As SARS-CoV-2 infectibility and ACE2 activity are the major starting points and inflammatory response is central in the development of COVID-19, we evaluated how those eleven intrinsic and extrinsic factors modulate those processes impacting clinical outcomes. Applying this AOP-aligned approach enables the identification of current knowledge gaps orientating for further research and allows to propose biomarkers to identify of high-risk patients. This approach also facilitates expertise synergy from different disciplines to address public health issues. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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16 pages, 2021 KiB  
Review
Obesity Impact on SARS-CoV-2 Infection: Pros and Cons “Obesity Paradox”—A Systematic Review
by Damiana-Maria Vulturar, Carmen-Bianca Crivii, Olga Hilda Orăsan, Emanuel Palade, Anca-Dana Buzoianu, Iulia Georgiana Zehan and Doina Adina Todea
J. Clin. Med. 2022, 11(13), 3844; https://doi.org/10.3390/jcm11133844 - 2 Jul 2022
Cited by 17 | Viewed by 2593
Abstract
Background: During the last years, the COVID-19 pandemic meets the pandemic generated by obesity, raising many questions regarding the outcomes of those with severe forms of infection. Methods: The present systematic review summarises and analyses the data providing evidence for or against the [...] Read more.
Background: During the last years, the COVID-19 pandemic meets the pandemic generated by obesity, raising many questions regarding the outcomes of those with severe forms of infection. Methods: The present systematic review summarises and analyses the data providing evidence for or against the “obesity-paradox” in COVID-19 patients. After applying the inclusion and exclusion criteria, 23 studies were included. We also analysed the presumably underlying basic mechanisms. Results: The patients with a body mass index (BMI) of 30–40 kg/m2 presented severe symptoms that led to intensive care unit (ICU) admission but not increased death rate. Those with a higher degree of obesity, with a BMI higher than 40 kg/m2, led to a rise in the death rate, particularly in young patients. Obesity was associated with a higher rate of ICU admission but was not determined as an independent predictor of increased mortality. In contrast, some studies suggest a strong association between obesity or morbid obesity and the risk of death. Conclusions: The existence of “obesity-paradox” cannot be stated; our study presents obesity as a critical risk factor in the evolution of COVID-19. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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Other

Jump to: Research, Review

10 pages, 944 KiB  
Brief Report
SARS-CoV-2 Specific Antibody Response and T Cell-Immunity in Immunocompromised Patients up to Six Months Post COVID: A Pilot Study
by Johanna Sjöwall, Maria Hjorth, Annette Gustafsson, Robin Göransson, Marie Larsson, Hjalmar Waller, Johan Nordgren, Åsa Nilsdotter-Augustinsson and Sofia Nyström
J. Clin. Med. 2022, 11(12), 3535; https://doi.org/10.3390/jcm11123535 - 20 Jun 2022
Cited by 4 | Viewed by 2172
Abstract
COVID-19 generates SARS-CoV-2-specific antibodies in immunocompetent individuals. However, in immunocompromised patients, the humoral immunity following infection may be impaired or absent. Recently, the assessment of cellular immunity to SARS-CoV-2, both following natural infection and vaccination, has contributed new knowledge regarding patients with low [...] Read more.
COVID-19 generates SARS-CoV-2-specific antibodies in immunocompetent individuals. However, in immunocompromised patients, the humoral immunity following infection may be impaired or absent. Recently, the assessment of cellular immunity to SARS-CoV-2, both following natural infection and vaccination, has contributed new knowledge regarding patients with low or no antibody responses. As part of a prospective cohort study which included hospitalized patients with COVID-19, we identified immunocompromised patients and compared them with age- and sex-matched immunocompetent patients regarding co-morbidities, biomarkers of COVID-19 and baseline viral load by real-time PCR in nasopharyngeal swabs. Spike and nucleocapsid antibody responses were analyzed at inclusion and after two weeks, six weeks and six months. Plasma immunoglobulin G (IgG) levels were quantified, lymphocyte phenotyping was performed, and SARS-CoV-2 specific CD4 and CD8 T cell responses after in vitro antigen stimulation were assessed at six months post infection. All patients showed IgG levels above or within reference limits. At six months, all patients had detectable SARS-CoV-2 anti-spike antibody levels. SARS-CoV-2 specific T cell responses were detected in 12 of 12 immunocompetent patients and in four of six immunocompromised patients. The magnitude of long-lived SARS-CoV-2 specific T cell responses were significantly correlated with the number of CD4 T cells and NK cells. Determining the durability of the humoral and cellular immune response against SARS-CoV-2 in immunocompromised individuals could be of importance by providing insights into the risk of re-infection and the need for vaccine boosters. Full article
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
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