Synergy Between Cytokines and Risk Factors in the Cytokine Storm of COVID‐19: Does Ongoing Use of Cytokine Inhibitors Have a Protective Effect?

ObjectiveA critical role in coronavirus disease 2019 (COVID-19) pathogenesis is played by immune dysregulation that leads to a generalized uncontrolled multisystem inflammatory response, caused by overproduction of proinflammatory cytokines, known as “a cytokine storm” (CS), strongly associated with a severe course of disease. The aim of this study is to identify prognostic biomarkers for CS development in COVID-19 patients and integrate them into a prognostic score for CS-associated risk applicable to routine clinical practice.Materials and MethodsThe authors performed a review of 458 medical records from COVID-19 patients (241 men and 217 women aged 60.0 ± 10.0) who received treatment in the St. Petersburg State Budgetary Institution of Healthcare City Hospital 40 (City Hospital 40, St. Petersburg), from Apr. 18, 2020 to Nov. 21, 2020. The patients were split in two groups: one group included 100 patients with moderate disease symptoms; the other group included 358 patients with progressive moderately severe, severe, and extremely severe disease. The National Early Warning Score (NEWS) score was used alongside with clinical assessment, chest computed tomographic (CT) scans, electrocardiography (ECG), and lab tests, like ferritin, C-reactive protein (CRP), interleukin (IL)-6, lactate dehydrogenase (LDH), and D-dimer.ResultsThe basic risk factors for cytokine storms in COVID-19 patients are male gender, age over 40 years, positive test result for replicative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, absolute lymphocyte count, dynamics in the NEWS score, as well as LDH, D-dimer, ferritin, and IL-6 levels. These clinical and instrumental findings can be also used as laboratory biomarkers for diagnosis and dynamic monitoring of cytokine storms. The suggested prognostic scale (including the NEWS score dynamics; serum IL-6 greater than 23 pg/ml; serum CRP 50 mg/L or greater; absolute lymphocyte count less than 0.72 × 109/L; positive test result for replicative coronavirus (SARS-CoV-2) RNA; age 40 years and over) is a useful tool to identify patients at a high risk for cytokine storm, requiring an early onset of anti-inflammatory therapy.

Download Full-text

Protective effect of leg fat against cardiovascular risk factors in obese premenopausal women

Nutrition Metabolism and Cardiovascular Diseases ◽

10.1016/j.numecd.2008.02.004 ◽

2009 ◽

Vol 19 (1) ◽

pp. 39-44 ◽

Cited By ~ 20

Author(s):

Emanuela Faloia ◽

Giacomo Tirabassi ◽

Paola Canibus ◽

Marco Boscaro

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Protective Effect ◽

Cardiovascular Risk Factors ◽

Premenopausal Women

Download Full-text

Effects of Physical Activity on Brain Energy Biomarkers in Alzheimer’s Diseases

Diseases ◽

10.3390/diseases8020018 ◽

2020 ◽

Vol 8 (2) ◽

pp. 18

Author(s):

Khadijeh Ebrahimi ◽

Morteza Jourkesh ◽

Saeed Sadigh-Eteghad ◽

Stephen R Stannard ◽

Conrad P. Earnest ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Cognitive Function ◽

Protective Effect ◽

Aerobic Exercise ◽

The Elderly ◽

Preventive Interventions ◽

Factors Associated ◽

Positive Effects ◽

Brain Energy

The prevalence of dementia has substantially increased worldwide. Currently, there is no cure for dementia or Alzheimer’s disease (AD), and care for affected patients is financially and psychologically costly. Of late, more attention has been given to preventive interventions—in particular, physical activity/exercise. In this review, examine the risk factors associated with AD and the effects physical activity may play in the prevention of the degenerative process of this disease, loss of memory and cognitive performance in the elderly. To date, research has shown that physical activity, especially aerobic exercise, has a protective effect on cognitive function and memory in the elderly and Alzheimer’s patients. In comparison with aerobic exercise, several strength training studies have also shown positive effects, and the rare studies that compare the two different modalities show no difference.

Download Full-text

Zoster after Cyclophosphamide for Systemic Lupus Erythematosus or Vasculitis: Incidence, Risk Factors, and Effect of Antiviral Prophylaxis

The Journal of Rheumatology ◽

10.3899/jrheum.180310 ◽

2018 ◽

Vol 45 (11) ◽

pp. 1541-1548 ◽

Cited By ~ 4

Author(s):

Camille Garnier ◽

David Ribes ◽

Dominique Chauveau ◽

Antoine Huart ◽

Grégory Pugnet ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Protective Effect ◽

Lupus Erythematosus ◽

Postherpetic Neuralgia ◽

Systemic Vasculitis ◽

Laboratory Data ◽

University Hospital ◽

Systemic Lupus ◽

Cox Models

Objective.To assess the incidence and the risk factors for zoster in patients exposed to intravenous cyclophosphamide (CYC) for systemic vasculitis or systemic lupus erythematosus (SLE), as well as the protective effect of prophylaxis by valacyclovir (VCV).Methods.This retrospective study included all adults treated by intravenous CYC for SLE or systemic vasculitis between 2011 and 2015 at Toulouse University Hospital, France. Zoster occurrence was recorded using medical chart review, laboratory data, and patient interviews. Univariate Cox models were computed to assess the risk factors for zoster and the protective effect of prophylaxis by VCV.Results.The cohort consisted of 110 patients (81 systemic vasculitis and 29 SLE). During a mean followup of 3.4 years after CYC initiation, 10 cases of zoster occurred, leading to an overall incidence of 27.9/1000 patient-years (95% CI 15.2–50.6); it was 59.4/1000 patients (95% CI 27.5–123.6) during the year after CYC initiation. Four patients experienced persistent postherpetic neuralgia. Probable risk factors were lymphopenia < 500/µl at CYC initiation (HR 5.11, 95% CI 0.94–27.93) and female sex (HR 4.36, 95% CI 0.51–37.31). The incidence was higher in patients with SLE (HR as compared with systemic vasculitis patients = 2.68, 95% CI 0.54–13.26). None of the 19 patients exposed to VCV during the followup developed zoster.Conclusion.The incidence of zoster is high in systemic vasculitis and in patients with SLE exposed to intravenous CYC. CYC may favor postherpetic neuralgia. Prophylaxis by VCV should be considered, particularly in cases of lymphopenia < 500/µl at CYC initiation and during the year after.

Download Full-text

Homocysteine, Folate, and Cardiovascular Disease

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.71.3.173 ◽

2001 ◽

Vol 71 (3) ◽

pp. 173-178 ◽

Cited By ~ 28

Author(s):

Mary Ward

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Protective Effect ◽

Plasma Concentrations ◽

Fruit And Vegetables ◽

European Countries ◽

Folate Intake ◽

Western World ◽

The Past ◽

Southern European Countries

Cardiovascular disease (CVD) continues to be one of the main causes of mortality in the western world, however approximately only two-thirds of all episodes can be attributed to traditional environmental and genetic risk factors. Over the past decade it has emerged that a moderate elevation in plasma concentrations of the amino acid homocysteine (tHcy) constitutes a risk factor for atherosclerotic vascular disease in the coronary, cerebral and peripheral vessels. Furthermore, this association is a graded one with no apparent threshold and is independent of, but may enhance the effect of conventional risk factors. Plasma homocysteine is determined by both genetic and nutritional factors. The B-vitamins folate, B-12 and B-6 all play a key role in homocysteine metabolism and in fact it has been proposed that about two-thirds of all cases of hyperhomocysteinemia are due to an inadequate status of one or all of these vitamins. Of the three, folate appears to be the most important determinant and has been shown to significantly lower homocysteine concentration when administered at doses ranging from 0.2 to 10 mg/d in both healthy and hyperhomocysteinemic subjects. There is considerable variation in the rate of CVD mortality between northern and southern European countries. A common dietary element in regions with lower CVD incidence i.e. southern European countries appears to be the higher consumption of fruit and vegetables. In the past this protective effect of fruit and vegetables has been primarily attributed to antioxidants. Fruit and vegetables are however also one of the main sources of folate in the diet, contributing to more than 30% of total dietary folate intake (even in countries where consumption of fruit and vegetables is low). Thus, in light of the evidence that folate may play a role in primary prevention of CVD via homocysteine-lowering the protective effect of fruit and vegetables may be partly explained by folate.

Download Full-text

Upper Extremity Venous Thrombosis in Patients With Cancer With Peripherally Inserted Central Venous Catheters: A Retrospective Analysis of Risk Factors

Journal of Oncology Practice ◽

10.1200/jop.2012.000595 ◽

2013 ◽

Vol 9 (1) ◽

pp. e8-e12 ◽

Cited By ~ 26

Author(s):

Daniel H. Ahn ◽

Henrik Bo Illum ◽

David H. Wang ◽

Anant Sharma ◽

Jonathan E. Dowell

Keyword(s):

Risk Factors ◽

Protective Effect ◽

Venous Thrombosis ◽

Retrospective Analysis ◽

Upper Extremity ◽

Central Venous Catheters ◽

Central Venous ◽

Patients With Cancer ◽

Specific Factors

Specific factors significantly increase the risk of upper extremity venous thrombosis in patients with cancer with PICCs, whereas use of anti-platelet agents seems to have a protective effect against it.

Download Full-text

Association between Statin and Fibrate Use and Venous Thromboembolism: A Case-Control Study.

Blood ◽

10.1182/blood.v104.11.2594.2594 ◽

2004 ◽

Vol 104 (11) ◽

pp. 2594-2594

Author(s):

Karine Lacut ◽

Gregoire Le Gal ◽

Emmanuel Oger ◽

Dominique Mottier

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Protective Effect ◽

Case Control Study ◽

Case Control ◽

Increased Risk ◽

Venous Thromboembolic ◽

The Difference ◽

Control Study ◽

Statin Use

Abstract Background: Previous studies of selected patients have suggested a reduction in the risk of venous thromboembolism (VTE) with the use of statins, and no effect of fibrates. Objective: To evaluate the influence of statin and fibrate use on the risk of venous thromboembolic events. Design: Case-control study (EDITH) designed to investigate genetic and environmental risk factors of VTE. Setting: Brest University Hospital. Participants: 857 patients consecutively hospitalized for a documented venous thromboembolic event were included between May 2000 and May 2004. Controls were matched on age, sex and the main risk factors of VTE (cancer, surgery, pregnancy…). Results: The mean age of patients was 67.7 year. No significant difference was found between cases and controls concerning the main characteristics, except for smocking and body mass index. Controls had more often previous vascular events (coronary heart disease, stroke or arteriopathy of the lower limbs) than cases but the difference was no significant. Statin use was associated with a significant decreased risk of VTE (odds ratio (OR) = 0.58; 95% confidence interval (CI), 0.41–0.82), whereas fibrate use was associated with a significant increased risk of VTE (OR = 1.60; 95% CI, 1.09–2.34). After adjustment on the main confounding factors including aspirin use and cardiovascular disease, these associations remained significant. Among pleiotropic effects of statins, some antithrombotic mechanisms could be proposed to explain their possible protective effect. Concerning the possible negative effect of fibrates, some authors found that the most prescribed fibrates, but not statins, caused hyperhomocysteinemia. In our study, analyses of homocysteinemia are ongoing. Conclusion: In this case-control study of hospitalized patients, statin use was associated with a significant decreased risk of VTE, whereas fibrate use was associated with a significant increased risk. Homocysteinemia may be involved in the difference between the effects of these two categories of lipid-lowering drugs on VTE. Because our study was observational, the protective effect of statins as regards the risk of VTE remains questionable and further prospective studies are needed.

Download Full-text