scholarly journals Age-adjusted associations between comorbidity and outcomes of COVID-19: a review of the evidence

2020 ◽  
Author(s):  
Kate E. Mason ◽  
Philip McHale ◽  
Andy Pennington ◽  
Gillian Maudsley ◽  
Jennifer Day ◽  
...  
Keyword(s):  
Severe Disease ◽  
Evidence Base ◽  
Control Measures ◽  
Current Evidence ◽  
Chronic Obstructive ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Increase Risk ◽  
Care Outcomes ◽  
Obesity Hypertension

ABSTRACTBackgroundCurrent evidence suggests that older people and people with underlying comorbidities are at increased risk of severe disease and death following hospitalisation with COVID-19. As comorbidity increases with age, it is necessary to understand the age-adjusted relationship between comorbidity and COVID-19 outcomes, in order to enhance planning capabilities and our understanding of COVID-19.MethodsWe conducted a rapid, comprehensive review of the literature up to 10 April 2020, to assess the international empirical evidence on the association between comorbidities and severe or critical care outcomes of COVID-19, after accounting for age, among hospitalised patients with COVID-19.ResultsAfter screening 579 studies, we identified seven studies eligible for inclusion and these were synthesised narratively. All were from China. The emerging evidence base mostly indicates that after adjustment for age (and in some cases other potential confounders), obesity, hypertension, diabetes mellitus, chronic obstructive airways disease (COPD), and cancer are all associated with worse outcomes. The largest study, using a large nationwide sample of COVID-19 patients in China, found that those with multiple comorbidities had more than twice the risk of a severe outcome or death compared with patients with no comorbidities, after adjusting for age and smoking (HR=2.59, 95% CI 1.61, 4.17).ConclusionsThis review summarises for clinicians, policymakers, and academics the most robust evidence to date on this topic, to inform the management of patients and control measures for tackling the pandemic. Given the intersection of comorbidity with ethnicity and social disadvantage, these findings also have important implications for health inequalities. As the pandemic develops, further research should confirm these trends in other settings outside China and explore mechanisms by which various underlying health conditions increase risk of severe COVID-19.

scholarly journals Age-Adjusted Associations Between Comorbidity and Outcomes of COVID-19: A Review of the Evidence From the Early Stages of the Pandemic

2021 ◽  
Vol 9 ◽  
Author(s):  
Kate E. Mason ◽  
Gillian Maudsley ◽  
Philip McHale ◽  
Andy Pennington ◽  
Jennifer Day ◽  
...  
Keyword(s):  
Early Stage ◽  
Severe Disease ◽  
Evidence Base ◽  
Population Based ◽  
Control Measures ◽  
International Evidence ◽  
Early Stages ◽  
Hospitalised Patients ◽  
Adjusted Association ◽  
Obesity And Cancer

Objectives: Early in the COVID-19 pandemic, people with underlying comorbidities were overrepresented in hospitalised cases of COVID-19, but the relationship between comorbidity and COVID-19 outcomes was complicated by potential confounding by age. This review therefore sought to characterise the international evidence base available in the early stages of the pandemic on the association between comorbidities and progression to severe disease, critical care, or death, after accounting for age, among hospitalised patients with COVID-19.Methods: We conducted a rapid, comprehensive review of the literature (to 14 May 2020), to assess the international evidence on the age-adjusted association between comorbidities and severe COVID-19 progression or death, among hospitalised COVID-19 patients – the only population for whom studies were available at that time.Results: After screening 1,100 studies, we identified 14 eligible for inclusion. Overall, evidence for obesity and cancer increasing risk of severe disease or death was most consistent. Most studies found that having at least one of obesity, diabetes mellitus, hypertension, heart disease, cancer, or chronic lung disease was significantly associated with worse outcomes following hospitalisation. Associations were more consistent for mortality than other outcomes. Increasing numbers of comorbidities and obesity both showed a dose-response relationship. Quality and reporting were suboptimal in these rapidly conducted studies, and there was a clear need for additional studies using population-based samples.Conclusions: This review summarises the most robust evidence on this topic that was available in the first few months of the pandemic. It was clear at this early stage that COVID-19 would go on to exacerbate existing health inequalities unless actions were taken to reduce pre-existing vulnerabilities and target control measures to protect groups with chronic health conditions.

Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment

2020 ◽  
Vol 18 (5) ◽  
pp. 431-446 ◽  
Author(s):  
George E. Fragoulis ◽  
Ismini Panayotidis ◽  
Elena Nikiphorou
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Current Evidence ◽  
Pharmacological Intervention ◽  
Cvd Risk ◽  
The Past ◽  
Increased Risk ◽  
Cv Disease ◽  
Obesity Hypertension ◽  
Inflammatory Burden

Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. Inflammation, however, can spread beyond the joints to involve other organs. During the past few years, it has been well recognized that RA associates with increased risk for cardiovascular (CV) disease (CVD) compared with the general population. This seems to be due not only to the increased occurrence in RA of classical CVD risk factors and comorbidities like smoking, obesity, hypertension, diabetes, metabolic syndrome, and others but also to the inflammatory burden that RA itself carries. This is not unexpected given the strong links between inflammation and atherosclerosis and CVD. It has been shown that inflammatory cytokines which are present in abundance in RA play a significant role in every step of plaque formation and rupture. Most of the therapeutic regimes used in RA treatment seem to offer significant benefits to that end. However, more studies are needed to clarify the effect of these drugs on various parameters, including the lipid profile. Of note, although pharmacological intervention significantly helps reduce the inflammatory burden and therefore the CVD risk, control of the so-called classical risk factors is equally important. Herein, we review the current evidence for the underlying pathogenic mechanisms linking inflammation with CVD in the context of RA and reflect on the possible impact of treatments used in RA.

scholarly journals Mortality and high risk of major adverse events in patients with COVID-19 and history of cardiovascular disease

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001526
Author(s):  
Elena Tessitore ◽  
David Carballo ◽  
Antoine Poncet ◽  
Nils Perrin ◽  
Cedric Follonier ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Male Gender ◽  
Hospital Death ◽  
Chronic Obstructive ◽  
University Hospitals ◽  
Adverse Cardiovascular Event ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
History Of

ObjectiveHistory of cardiovascular diseases (CVDs) may influence the prognosis of patients hospitalised for COVID-19. We investigated whether patients with previous CVD have increased risk of death and major adverse cardiovascular event (MACE) when hospitalised for COVID-19.MethodsWe included 839 patients with COVID-19 hospitalised at the University Hospitals of Geneva. Demographic characteristics, medical history, laboratory values, ECG at admission and medications at admission were collected based on electronic medical records. The primary outcome was a composite of in-hospital mortality or MACE.ResultsMedian age was 67 years, 453 (54%) were males and 277 (33%) had history of CVD. In total, 152 (18%) died and 687 (82%) were discharged, including 72 (9%) who survived a MACE. Patients with previous CVD were more at risk of composite outcomes 141/277 (51%) compared with those without CVD 83/562 (15%) (OR=6.0 (95% CI 4.3 to 8.4), p<0.001). Multivariate analyses showed that history of CVD remained an independent risk factor of in-hospital death or MACE (OR=2.4; (95% CI 1.6 to 3.5)), as did age (OR for a 10-year increase=2.2 (95% CI 1.9 to 2.6)), male gender (OR=1.6 (95% CI 1.1 to 2.3)), chronic obstructive pulmonary disease (OR=2.1 (95% CI 1.0 to 4.2)) and lung infiltration associated with COVID-19 at CT scan (OR=1.9 (95% CI 1.2 to 3.0)). History of CVD (OR=2.9 (95% CI 1.7 to 5)), age (OR=2.5 (95% CI 2.0 to 3.2)), male gender (OR=1.6 (95% CI 0.98 to 2.6)) and elevated C reactive protein (CRP) levels on admission (OR for a 10 mg/L increase=1.1 (95% CI 1.1 to 1.2)) were independent risk factors for mortality.ConclusionHistory of CVD is associated with higher in-hospital mortality and MACE in hospitalised patients with COVID-19. Other factors associated with higher in-hospital mortality are older age, male sex and elevated CRP on admission.

scholarly journals P525 Patients’ Perception of Risks of biologic therapy During Covid-19 Pandemic in Israel Orly Lior, Ilia Sergeev, Nahum Ruhimovich, Michal Openheim, Fabiana Benjaminov, Dan Feldman, Yehuda Ringel, Timna Naftali Division of Gastroenterology and Liver Diseases, Meir Medical Center, Kfar Saba, Israel

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S501-S501
Author(s):  
O Lior ◽  
I Sergeev ◽  
N Ruhimovich ◽  
M Openheim ◽  
F Benjaminov ◽  
...  
Keyword(s):  
Medical Center ◽  
Severe Disease ◽  
Treatment Decision ◽  
Mild Disease ◽  
Treatment Decision Making ◽  
Increased Risk ◽  
Increase Risk ◽  
History Of ◽  
Stopping Treatment ◽  
Theoretical Question

Abstract Background Current inflammatory bowel disease (IBD) therapies are highly effective. However, compliance with treatment is influenced by patients’ perception of benefits versus risks. Understanding these perceptions and their influence on patients’ treatment decision-making is crucial for achieving compliance, especially during Covid-19 pandemic. Aim: to assess patients’ perception of risks of IBD exacerbation and SARS-CoV-2 infection, and their influence on patients’ decisions regarding biologic and immunosuppressive treatments during Covid-19 pandemic in Israel. Methods A prospective internet-based survey among Meir Medical Center, IBD clinic patients. Results 116 patients have responded. Mean age 42 (18–84), 44 (38%) males, 75 (64%) Crohn’s disease, 38 (32%) ulcerative colitis, 34 (29%) with history of abdominal surgery, 47 (40%) were in remission and 9(7.5%) with severe disease. 18 (15%) patients were on Immunosuppressive and 76 (66%) on biologic treatments. Concerns of contracting SARS-CoV-2 infection: 56 (48%) patients considered their risk as equal to that of the general population whereas 53 (46%) considered it to be increased. 55% of the patients related the increase risk of COVID-19 infection to their IBD treatment, whereas 47% related it to having IBD. Patients treated with biologics were more concerned of becoming infected with SARS-CoV-2 then those who were not. There was also a significant association between depression and anxiety levels and the fear of becoming infected (r= 0.3 for depression and 0.4 for anxiety). Adherence to IBD treatment: Only 8 (7.5%) patients considered stopping their IBD treatment, and only 4 (3.7%) patients actually stopped their treatment. Patients with more severe disease were more inclined to stop their treatment compared to those with mild disease. Reasons for not stopping treatment were fear of disease exacerbation in 37 (32%) patients, and reassuring information received from medical providers, in 25 (21.5%) patients. When faced with a theoretical question of trading long-term remission versus risk of SARS-CoV-2infection, 34 (29%) patients were willing to accept a 10% infection risk for a 10-year remission Conclusion Significant portion of the patients with IBD believe that they are at increased risk of contracting SARS-CoV-2 infection, and more than half of them related the increase risk to their IBD treatment. However, despite their fear most patients felt safe enough to continue their treatment. Patients with more severe disease and treated with biologics experienced higher levels of anxiety, depression and fear of COVID-19 infection. Identifying and addressing these fears early might increase patient’s adherence to treatment and prevent the hazardous effects of discontinuation of treatment.

scholarly journals Airway inflammation in COPD: progress to precision medicine

2019 ◽  
Vol 54 (2) ◽  
pp. 1900651 ◽  
Author(s):  
Christopher Brightling ◽  
Neil Greening
Keyword(s):  
Precision Medicine ◽  
Airway Inflammation ◽  
Severe Disease ◽  
Chronic Obstructive ◽  
Inflammasome Activation ◽  
Eosinophilic Inflammation ◽  
Obstructive Pulmonary Disease ◽  
Interleukin 5 ◽  
Increased Risk ◽  
Anti Inflammatory

Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality worldwide, and its prevalence is increasing. Airway inflammation is a consistent feature of COPD and is implicated in the pathogenesis and progression of COPD, but anti-inflammatory therapy is not first-line treatment. The inflammation has many guises and phenotyping this heterogeneity has revealed different patterns. Neutrophil-associated COPD with activation of the inflammasome, T1 and T17 immunity is the most common phenotype with eosinophil-associated T2-mediated immunity in a minority and autoimmunity observed in more severe disease. Biomarkers have enabled targeted anti-inflammatory strategies and revealed that corticosteroids are most effective in those with evidence of eosinophilic inflammation, whereas, in contrast to severe asthma, response to anti-interleukin-5 biologicals in COPD has been disappointing, with smaller benefits for the same intensity of eosinophilic inflammation questioning its role in COPD. Biological therapies beyond T2-mediated inflammation have not demonstrated benefit and in some cases increased risk of infection, suggesting that neutrophilic inflammation and inflammasome activation might be largely driven by bacterial colonisation and dysbiosis. Herein we describe current and future biomarker approaches to assess inflammation in COPD and how this might reveal tractable approaches to precision medicine and unmask important host–environment interactions leading to airway inflammation.

Beta-blocker use and acute exacerbations of COPD following myocardial infarction: a Danish nationwide cohort study

Thorax ◽  
2020 ◽  
Vol 75 (11) ◽  
pp. 928-933
Author(s):  
Daniel B Rasmussen ◽  
Uffe Bodtger ◽  
Morten Lamberts ◽  
Christian Torp-Pedersen ◽  
Gunnar Gislason ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Beta Blocker ◽  
Cox Regression ◽  
Beta Blockers ◽  
Severe Disease ◽  
Symptom Burden ◽  
Chronic Obstructive ◽  
Increased Risk ◽  
Acute Exacerbations ◽  
First Time

IntroductionPatients with chronic obstructive pulmonary disease (COPD) are undertreated with beta-blockers following myocardial infarction (MI), possibly due to fear for acute exacerbations of COPD (AECOPD). Is beta-blocker use associated with increased risk of AECOPD in patients following first-time MI?MethodsDanish nationwide study of patients with COPD following hospitalisation for MI from 2003 to 2015. Multivariable, time-dependent Cox regression accounting for varying beta-blocker use based on claimed prescriptions during up to 13 years of follow-up.ResultsA total of 10 884 patients with COPD were discharged after first-time MI. The 1-year rate of AECOPD was 35%, and 65% used beta-blockers at 1 year. Beta-blocker use was associated with a lower risk of AECOPD (multivariable-adjusted HR 0.78, 95% CI 0.74–0.83). This association was independent of the type of MI (HR 0.70, 95% CI 0.59–0.83 in ST-elevation MI (STEMI) and HR 0.80, 95% CI 0.75–0.84 in non-STEMI), presence or absence of heart failure (HR 0.82, 95% CI 0.74–0.90 and HR 0.77, 95% CI 0.72–0.82, respectively), beta-blocker dosage and type, as well as exacerbation severity. Results were similar in 1118 patients with full data on COPD severity and symptom burden (median forced expiratory volume in 1 s as percentage of predicted was 46 and majority had moderate dyspnoea), and in 1358 patients with severe COPD and frequent AECOPD with a high 1-year rate of AECOPD of 70%.DiscussionBeta-blocker use was not associated with increased risk of AECOPD following MI. This finding was independent of COPD severity, symptom burden and exacerbation history, and supports the safety of beta-blockers in patients with COPD, including high-risk patients with severe disease.

scholarly journals Associations with covid-19 hospitalisation amongst 406,793 adults: the UK Biobank prospective cohort study

2020 ◽  
Author(s):  
Anthony P Khawaja ◽  
Alasdair N Warwick ◽  
Pirro G Hysi ◽  
Alan Kastner ◽  
Andrew Dick ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Antihypertensive Medication ◽  
Severe Disease ◽  
Chronic Obstructive ◽  
Uk Biobank ◽  
Antihypertensive Medications ◽  
Asian Ethnicity ◽  
Increased Risk

ABSTRACTOBJECTIVESTo identify the sociodemographic, lifestyle, comorbidity and antihypertensive medication associations with the development of hospitalisation with covid-19 in an English population.DESIGNProspective cohort studySETTINGThe population-based UK Biobank study was linked to English covid-19 test results.PARTICIPANTSIndividuals resident in England and alive in 2020.MAIN OUTCOME MEASURESCases (n=605) were defined by a positive covid-19 test result conducted between 16th March and 16th April 2020, during a restricted testing policy for hospitalised individuals with severe disease.RESULTSA total of 406,793 participants were included. Mean age on 1st January 2020 was 68 years (range 48 to 85 years). 55% were women. In multivariable models, major independent risk factors for hospitalisation with covid-19 were male sex (odds ratio 1.52; 95% confidence interval 1.28 to 1.81; P<0.001), South Asian ethnicity (2.02; 1.28 to 3.17; P=0.002) or black ethnicity (3.09; 2.18 to 4.38; P<0.001) compared to white ethnicity, greater residential deprivation (1.92 for most deprived quartile compared to least deprived quartile; 1.50 to 2.47; P<0.001), higher BMI (2.04 for BMI >35 compared to <25 Kg/m2; 1.50 to 2.77; P<0.001), former smoking (1.39 compared to never smoked; 1.16 to 1.66; P<0.001), and comorbidities hypertension (1.28; 1.06 to 1.53; P=0.009) and chronic obstructive pulmonary disease (1.81; 1.34 to 2.44; P<0.001). Increased risk was observed with increasing number of antihypertensive medications used rather than any individual class.CONCLUSIONUnderstanding why these factors confer increased risk of severe covid-19 in the population may help elucidate the underlying mechanisms as well as inform strategy and policy to prevent this disease and its consequences. We found no evidence of increased risk with specific classes of antihypertensive medication.

scholarly journals Association of energy and protein intakes with length of stay, readmission and mortality in hospitalised patients with chronic obstructive pulmonary disease

2018 ◽  
Vol 119 (5) ◽  
pp. 543-551 ◽  
Author(s):  
Arora R. Ingadottir ◽  
Anne M. Beck ◽  
Christine Baldwin ◽  
C. Elizabeth Weekes ◽  
Olof G. Geirsdottir ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Protein Intake ◽  
Nutritional Risk ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Oral Nutritional Supplements

AbstractLow energy and protein intakes have been associated with an increased risk of malnutrition in outpatients with chronic obstructive pulmonary disease (COPD). We aimed to assess the energy and protein intakes of hospitalised COPD patients according to nutritional risk status and requirements, and the relative contribution from meals, snacks, drinks and oral nutritional supplements (ONS), and to examine whether either energy or protein intake predicts outcomes. Subjects were COPD patients (n 99) admitted to Landspitali University Hospital in 1 year (March 2015–March 2016). Patients were screened for nutritional risk using a validated screening tool, and energy and protein intake for 3 d, 1–5 d after admission to the hospital, was estimated using a validated plate diagram sheet. The percentage of patients reaching energy and protein intake ≥75 % of requirements was on average 59 and 37 %, respectively. Malnourished patients consumed less at mealtimes and more from ONS than lower-risk patients, resulting in no difference in total energy and protein intakes between groups. No clear associations between energy or protein intake and outcomes were found, although the association between energy intake, as percentage of requirement, and mortality at 12 months of follow-up was of borderline significance (OR 0·12; 95 % CI 0·01, 1·15; P=0·066). Energy and protein intakes during hospitalisation in the study population failed to meet requirements. Further studies are needed on how to increase energy and protein intakes during hospitalisation and after discharge and to assess whether higher intake in relation to requirement of hospitalised COPD patients results in better outcomes.

scholarly journals Ward-Based Non-Invasive Ventilation in Acute Exacerbations of COPD: A Narrative Review of Current Practice and Outcomes in the UK

Healthcare ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. 145 ◽  
Author(s):  
Samuel Trethewey ◽  
Ross Edgar ◽  
Alice Turner ◽  
Rahul Mukherjee
Keyword(s):  
Current Practice ◽  
Evidence Base ◽  
Narrative Review ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Hospitalised Patients ◽  
The Uk

Non-invasive ventilation (NIV) is frequently used as a treatment for acute hypercapnic respiratory failure (AHRF) in hospitalised patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In the UK, many patients with AHRF secondary to AECOPD are treated with ward-based NIV, rather than being treated in critical care. NIV has been increasingly used as an alternative to invasive ventilation and as a ceiling of treatment in patients with a ‘do not intubate’ order. This narrative review describes the evidence base for ward-based NIV in the context of AECOPD and summarises current practice and clinical outcomes in the UK.

The impact of comorbidities on COVID -19 severity and mortality in Egypt (Preprint)

2021 ◽  
Author(s):  
Shereen Elghazaly ◽  
Hanaa Abu El Sood ◽  
Sahar Samy ◽  
Mohamad AbdelFatah ◽  
Mohamed Hassany ◽  
...  
Keyword(s):  
Disease Surveillance ◽  
Severe Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Disease Surveillance System ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Risk Of Disease ◽  
The Impact ◽  
Epidemiologic Characteristics

BACKGROUND Older population and people of any age with underlying certain comorbidities such as diabetes mellitus, cardiovascular, lung disease, kidney disease, liver disease and cancer are at higher risk of severe disease course and death if they become infected with COVID-19. Identifying risky group and risk factors for COVID-19 severity and mortality is important for guiding efficient and appropriate prevention and management of patients with COVID-19. OBJECTIVE This study aims at describing demographics and epidemiologic characteristics of confirmed COVID-19 cases in Egypt and determine the impact of different comorbidities on patients’ outcomes. METHODS Data of all confirmed COVID-19 patients admitted to 408 governmental hospitals allover Egypt February-May 2020 were collected retrospectively from the National Egyptian Disease Surveillance System. Cases were confirmed using RT-PCR. RESULTS Overall, 28,415 patients (55.0% males, 45.0% females) were identified. Their median age was 44 years. Of those, 743(2.6%) were admitted to ICU, 408(1.4%) required ventilator and 1,045(3.7%) died. Of 21,617(76.1%) patients with completed data, 4,687(21.7%) had comorbidities. Overall, 11.8% had diabetes, 5.3% cardiovascular disease and 4.3% chronic obstructive pulmonary disease. Those with one comorbidity were more likely to die (OR = 2.83), admitted to ICU (OR = 6.36) and need ventilator (OR = 5.95) compared to patients with no comorbidities. Having multiple comorbidities increased risk of mortality (OR = 3.53), ICU admission (OR = 8.62), and requiring ventilator (OR = 9.06). CONCLUSIONS COVID-19 Patients with comorbidities had higher risk of disease severity and mortality. Multiple comorbidities further increase the risk to higher extent. All necessary precautions should be taken for patients with comorbidities to avoid COVID-19 infection to prevent the worst prognosis.

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