Risk factors for infection, predictors of severe disease and antibody response to COVID-19 in patients with rheumatic diseases in Portugal - a multicentre, nationwide study

In order to identify risk factors for SARS-CoV-2 infection as well as for severe/critical COVID-19 in rheumatic and musculoskeletal diseases (RMDs) patients, we conducted a multicentre observational nationwide study of adult patients prospectively-followed in the Rheumatic Diseases Portuguese Register - Reuma.pt - during the first 6 months of the pandemic. We further evaluated the development of IgG antibodies against the receptor-binding domain (RBD) of SARS-CoV-2 in patients with RMDs. We used multivariate logistic regression to compare patients with COVID-19 (COVID-19+) with those who did not develop the disease (COVID-19-) and patients with mild/moderate disease with those exhibiting severe/critical COVID-19. COVID-19+ patients were asked to collect a blood sample for IgG testing >= 3 months after infection and results were compared with age-, sex- and sampling date-matched controls. Overall, 179 cases of COVID-19 were registered in Reuma.pt in the period of interest (median age 55 (IQR 20); 76.5% females) in a total of 6404 registered appointments. We found that patients treated with TNF inhibitors had reduced odds of infection (OR=0.16, 95%CI 0.10-0.26, p<0.001), severe disease (OR 0.11, 95%CI 0.01-0.84, p=0.010) and seroconversion rates (OR 0.13, 95%CI 0.02-0.91, p=0.040). Tocilizumab was also associated with a reduced risk of COVID-19 (OR 0.15, 95%CI 0.05-0.41, p<0.001). Older age, major comorbidities (diabetes, hypertension, obesity, cardiovascular disease, chronic pulmonary and kidney disease) and rituximab were associated with an increased risk of infection and worse prognosis, in line with previous reports. Importantly, most patients with inflammatory RMDs (86.2%) were able to develop a robust antibody response after SARS-CoV-2 infection, which was linked with disease severity.

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Clinical characteristics and COVID-19 outcomes in a regional cohort of pediatric patients with rheumatic diseases

10.1101/2021.05.19.21257450 ◽

2021 ◽

Author(s):

Daniel Clemente ◽

Clara Udaondo ◽

Jaime de Inocencio ◽

Juan Carlos Nieto ◽

Pilar Galan del Rio ◽

...

Keyword(s):

Risk Factors ◽

Hospital Admission ◽

Rheumatic Diseases ◽

Pediatric Patients ◽

Musculoskeletal Diseases ◽

Severe Disease ◽

Tertiary Hospital ◽

Multivariable Logistic Regression Model ◽

Symptomatic Disease ◽

Moderate Disease

Background: This study aimed to assess the baseline characteristics and clinical outcomes of coronavirus disease 2019 (COVID-19) in pediatric patients with rheumatic and musculoskeletal diseases (RMD) and identify the risk factors associated with symptomatic or severe disease defined as hospital admission, intensive care admission or death. Methods: An observational longitudinal study was conducted during the first year of pandemic SARS-CoV-2 (1st March 2020 to 1st March 2021). All pediatric patients attended at the rheumatology outpatient clinic of six tertiary hospital in Madrid, Spain, with a medical diagnosis of RMD and COVID-19 were included. Main outcomes were symptomatic disease and hospital admission. The covariates were sociodemographic, clinical, and treatments. We ran a multivariable logistic regression model to assess risk factors for outcomes. Results: The study population included 77 pediatric patients. Mean age was 11.88 (4.04) years Of these, 30 patients were asymptomatic, 41 had a mild or moderate disease and other 6 patients (7.79%) required hospital admission related to COVID-19. The median length of stay was 5 (2-20) days and there was no death. Previous comorbidities increased the risk for symptomatic disease and hospital admission. Compared with outpatients, the factor independently associated with hospital admission was the use of glucocorticoids (OR 1.08; p=0.00). No statistically significant findings for symptomatic COVID-19 were found in the final model. Conclusion: Our data found no differences in COVID-19 outcomes between children-onset rheumatic diseases. Our results suggest that associated comorbidities and being in treatment with glucocorticoids increase the risk of hospital admission.

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Frequency and Determinant Factors for Calcification in Neurocysticercosis

Clinical Infectious Diseases ◽

10.1093/cid/ciaa784 ◽

2020 ◽

Cited By ~ 4

Author(s):

Javier A Bustos ◽

Gianfranco Arroyo ◽

Robert H Gilman ◽

Percy Soto-Becerra ◽

Isidro Gonzales ◽

...

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Antibody Response ◽

Human Brain ◽

Risk Ratio ◽

Factors Associated ◽

Patient Level ◽

Increased Risk ◽

Acquired Epilepsy ◽

Antiparasitic Treatment

Abstract Background Neurocysticercosis is a major cause of acquired epilepsy. Larval cysts in the human brain eventually resolve and either disappear or leave a calcification that is associated with seizures. In this study, we assessed the proportion of calcification in parenchymal neurocysticercosis and risk factors associated with calcification. Methods Data for 220 patients with parenchymal NCC from 3 trials of antiparasitic treatment were assessed to determine what proportion of the cysts that resolved 6 months after treatment ended up in a residual calcification at 1 year. Also, we evaluated the risk factors associated with calcification. Results The overall proportion of calcification was 38% (188/497 cysts, from 147 patients). Predictors for calcification at the cyst level were cysts larger than 14 mm (risk ratio [RR], 1.34; 95% confidence interval [CI], 1.02–1.75) and cysts with edema at baseline (RR, 1.39; 95% CI, 1.05–1.85). At the patient level, having had more than 24 months with seizures (RR, 1.25; 95% CI, 1.08–1.46), mild antibody response (RR, 1.14; 95% CI, 1.002–1.27), increased dose albendazole regime (RR, 1.26; 95% CI, 1.14–1.39), lower doses of dexamethasone (RR, 1.36; 95% CI, 1.02–1.81), not receiving early antiparasitic retreatment (RR, 1.45; 95% CI, 1.08–1.93), or complete cure (RR, 1.48; 95% CI, 1.29–1.71) were associated with a increased risk of calcification. Conclusions Approximately 38% of parenchymal cysts calcify after antiparasitic treatment. Some factors associated with calcification are modifiable and may be considered to decrease or avoid calcification, potentially decreasing the risk for seizure relapses.

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Dynamics in Anemia Development and Dysregulation of Iron Homeostasis in Hospitalized Patients with COVID-19

Metabolites ◽

10.3390/metabo11100653 ◽

2021 ◽

Vol 11 (10) ◽

pp. 653

Author(s):

Lukas Lanser ◽

Francesco Robert Burkert ◽

Rosa Bellmann-Weiler ◽

Andrea Schroll ◽

Sophie Wildner ◽

...

Keyword(s):

Risk Factors ◽

Iron Homeostasis ◽

Clinical Course ◽

Severe Disease ◽

University Hospital ◽

Hospital Death ◽

Icu Admission ◽

Increased Risk ◽

Discharge From Hospital ◽

New Onset

Anemia and disturbances of iron metabolism are frequently encountered in patients with COVID-19 and associated with an adverse clinical course. We retrospectively analyzed 645 consecutive COVID-19 patients hospitalized at the Innsbruck University Hospital. Pre-existing anemia was associated with increased risk for in-hospital death. We further found that the decline in hemoglobin levels during hospital stay is more pronounced in patients with signs of hyperinflammation upon admission, the latter being associated with a nearly two-fold higher risk for new onset anemia within one week. Anemia prevalence increased from 44.3% upon admission to 87.8% in patients who were still hospitalized after two weeks. A more distinct decrease in hemoglobin levels was observed in subjects with severe disease, and new-onset anemia was associated with a higher risk for ICU admission. Transferrin levels decreased within the first week of hospitalization in all patients, however, a continuous decline was observed in subjects who died. Hemoglobin, ferritin, and transferrin levels normalized in a median of 122 days after discharge from hospital. This study uncovers pre-existing anemia as well as low transferrin concentrations as risk factors for mortality in hospitalized COVID-19 patients, whereas new-onset anemia during hospitalization is a risk factor for ICU admission. Anemia and iron disturbances are mainly driven by COVID-19 associated inflammation, and cure from infection results in resolution of anemia and normalization of dysregulated iron homeostasis.

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Risk Factors for Psychosis in Parkinson’s Disease

US Endocrinology ◽

10.17925/use.2017.13.02.78 ◽

2017 ◽

Vol 13 (02) ◽

pp. 78

Author(s):

Matthew J Barrett ◽

Keyword(s):

Risk Factors ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Visual Processing ◽

Severe Disease ◽

Executive Dysfunction ◽

Neuropsychiatric Symptom ◽

Increased Risk ◽

Common Manifestation ◽

Gba Mutations

Psychosis is a characteristic neuropsychiatric symptom of Parkinson’s disease (PD) that is common and associated with worse outcomes. The purpose of this article is to review identified risk factors for visual hallucinations in PD, the most common manifestation of psychosis. With the possible exception of dopamine agonists, antiparkinsonian medications are only considered modifiers of psychosis in PD. Dementia in PD has consistently been shown to be associated with psychosis, and executive dysfunction and impairment in visual processing appear to play a role in its pathogenesis. The association of psychosis with disorders of sleep–wake dysregulation and autonomic dysfunction supports the involvement of brainstem dysfunction in PD psychosis. Despite many studies evaluating genetic risk factors for hallucinations, GBA mutations are the only variants consistently reported to be associated with an increased risk of hallucinations in PD. Lastly, psychosis in PD is associated with a more severe disease burden, both related and unrelated to PD pathology. Any explanatory model of psychosis in PD must incorporate pharmacological, neuroanatomic, pathological, and genetic factors before there can be a complete understanding of this common and disabling neuropsychiatric symptom.

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Risk Factors for In-Hospital Mortality among a Cohort of Children with Clostridium difficile Infection

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.152 ◽

2015 ◽

Vol 36 (10) ◽

pp. 1183-1189 ◽

Cited By ~ 8

Author(s):

Neika Vendetti ◽

Theoklis Zaoutis ◽

Susan E. Coffin ◽

Julia Shaklee Sammons

Keyword(s):

Risk Factors ◽

Clostridium Difficile ◽

Hospital Mortality ◽

Severe Disease ◽

Treatment Strategies ◽

Severity Of Illness ◽

Median Number ◽

Multivariable Logistic Regression Model ◽

Risk Of Death ◽

Increased Risk

OBJECTIVEThe incidence of Clostridium difficile infection (CDI) has increased and has been associated with poor outcomes among hospitalized children, including increased risk of death. The purpose of this study was to identify risk factors for all-cause in-hospital mortality among children with CDI.METHODSA multicenter cohort of children with CDI, aged 1–18 years, was established among children hospitalized at 41 freestanding children’s hospitals between January 1, 2006 and August 31, 2011. Children with CDI were identified using a validated case-finding tool (ICD-9-CM code for CDI plus C. difficile test charge). Only the first CDI-related hospitalization during the study period was used. Risk factors for all-cause in-hospital mortality within 30 days of C. difficile test were evaluated using a multivariable logistic regression model.RESULTSWe identified 7,318 children with CDI during the study period. The median age of this cohort was 6 years [interquartile range (IQR): 2–13]; the mortality rate was 1.5% (n=109); and the median number of days between C. difficile testing and death was 12 (IQR, 7–20). Independent risk factors for death included older age [adjusted odds ratio (OR, 95% confidence interval), 2.29 (1.40–3.77)], underlying malignancy [3.57 (2.36–5.40)], cardiovascular disease [2.06 (1.28–3.30)], hematologic/immunologic condition [1.89 (1.05–3.39)], gastric acid suppression [2.70 (1.43–5.08)], and presence of >1 severity of illness marker [3.88 (2.44–6.19)].CONCLUSIONPatients with select chronic conditions and more severe disease are at increased risk of death. Identifying risk factors for in-hospital mortality can help detect subpopulations of children that may benefit from targeted CDI prevention and treatment strategies.Infect Control Hosp Epidemiol 2015;36(10):1183–1189

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Risk factors for mortality in hospitalized patients with COVID-19 at the start of the pandemic in Belgium: a retrospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-020-05605-3 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Karlijn van Halem ◽

Robin Bruyndonckx ◽

Jeroen van der Hilst ◽

Janneke Cox ◽

Paulien Driesen ◽

...

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Case Fatality Rate ◽

Clinical Characteristics ◽

Severe Disease ◽

Univariate Analysis ◽

Case Fatality ◽

Fatality Rate ◽

Risk Of Death ◽

Increased Risk

Abstract Background Belgium was among the first countries in Europe with confirmed coronavirus disease 2019 (COVID-19) cases. Since the first diagnosis on February 3rd, the epidemic has quickly evolved, with Belgium at the crossroads of Europe, being one of the hardest hit countries. Although risk factors for severe disease in COVID-19 patients have been described in Chinese and United States (US) cohorts, good quality studies reporting on clinical characteristics, risk factors and outcome of European COVID-19 patients are still scarce. Methods This study describes the clinical characteristics, complications and outcomes of 319 hospitalized COVID-19 patients, admitted to a tertiary care center at the start of the pandemic in Belgium, and aims to identify the main risk factors for in-hospital mortality in a European context using univariate and multivariate logistic regression analysis. Results Most patients were male (60%), the median age was 74 (IQR 61–83) and 20% of patients were admitted to the intensive care unit, of whom 63% needed invasive mechanical ventilation. The overall case fatality rate was 25%. The best predictors of in-hospital mortality in multivariate analysis were older age, and renal insufficiency, higher lactate dehydrogenase and thrombocytopenia. Patients admitted early in the epidemic had a higher mortality compared to patients admitted later in the epidemic. In univariate analysis, patients with obesity did have an overall increased risk of death, while overweight on the other hand showed a trend towards lower mortality. Conclusions Most patients hospitalized with COVID-19 during the first weeks of the epidemic in Belgium were admitted with severe disease and the overall case fatality rate was high. The identified risk factors for mortality are not easily amenable at short term, underscoring the lasting need of effective therapeutic and preventative measures.

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Risk factors for recurrent wheezing after bronchiolitis in infants: 2-year follow up in China

BMC Infectious Diseases ◽

10.1186/s12879-021-05937-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sainan Chen ◽

Wenjing Gu ◽

Min Wu ◽

Chuangli Hao ◽

Canhong Zhu ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Independent Risk Factor ◽

Severe Disease ◽

Recurrent Wheezing ◽

Increased Risk ◽

Tnf Α ◽

History Of ◽

Outpatient Appointments

Abstract Background Infants with bronchiolitis have an increased risk of developing recurrent wheezing and asthma. However, the risk factors for the development of recurrent wheezing after bronchiolitis remains controversial. Our study was to investigate risk factors of post-bronchiolitis recurrent wheezing. Methods Infants with bronchiolitis were enrolled from November 2016 through March 2017. Nasopharyngeal aspirates were obtained for detection of respiratory viruses which were analyzed by reverse transcriptase polymerase chain reaction (RT-PCR) and direct immunofluorescent assay. Serum cytokines including TSLP, IL2, IL13, TIMP-1, MMP-9, IL33, IL5, IL4, IL25, TNF- α and MIP-1α were measured by flow cytometry. Patients were followed up every 3 months for a duration of 2 years by telephone or at outpatient appointments. Results We enrolled 89 infants, of which 81 patients were successfully followed up. In total, 22.2% of patients experienced recurrent wheezing episodes. The proportion of patients with history of eczema, systemic glucocorticoid use and patients with moderate-to-severe disease were significantly higher in the recurrent wheezing group than the non-recurrent wheezing group (83.3% vs 52.4%; 66.7% vs 36.5%; 61.1% vs 33.3%, respectively, all P < 0.05); There were no significant differences between patients with and without recurrent wheezing episodes in the levels of TSLP, IL2, IL13, TIMP-1, MMP-9, IL33, IL5, IL4, IL25, TNF- α and MIP-1α (P > 0.05). Logistic regression analysis showed that history of eczema was an independent risk factor for post-bronchiolitis recurrent wheezing (odds ratio [OR] = 5.622; 95% confidence interval [CI], 1.3–24.9; P = 0.023). Conclusion The incidence of recurrent wheezing among infants after contracting bronchiolitis was 22.2% during a 2-year follow-up. History of eczema was the only independent risk factor identified and no correlation was found between the specific virus and disease severity in children with post-bronchiolitis recurrent wheezing.

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Should COVID-19 Patients > 75 Years be Ventilated? An Outcome Study

QJM ◽

10.1093/qjmed/hcab029 ◽

2021 ◽

Author(s):

Hitesh Raheja ◽

Nnamdi Chukwuka ◽

Chirag Agarwal ◽

Dikshya Sharma ◽

Alejandro Munoz-Martinez ◽

...

Keyword(s):

Severe Disease ◽

Current Data ◽

Adverse Outcomes ◽

Cardiovascular Comorbidities ◽

Disease Characteristics ◽

Moderate Disease ◽

Increased Risk ◽

Significant Difference ◽

Oxygen Requirements ◽

Overall Mortality

Abstract Background Elderly patients with COVID-19 disease are at increased risk for adverse outcomes. Current data regarding disease characteristics and outcomes in this population is limited. Aim To delineate the adverse factors associated with outcomes of COVID- 19 patients ≥75 years of age. Design Retrospective cohort study. Methods Patients were classified into mild/moderate, severe/very severe, and critical disease (intubated) based on oxygen requirements. The primary outcome was in-hospital mortality. Results 355 patients aged ≥75 years hospitalized with COVID-19 between March 19th and April 25th, 2020 were included. Mean age was 84.3 years. One-third of the patients developed critical disease. Mean length of stay was 7.10 days. Vasopressors were required in 27%, with the highest frequency in the critical disease group (74.1%). Overall mortality was 57.2%, with a significant difference between severity groups (mild/moderate disease : 17.4%, severe/very severe disease : 71.3%, critical disease: 94.9%, p < 0.001). Increased age, dementia, and severe/very severe and critical disease groups were each significantly associated with increased odds for mortality while diarrhea was associated with decreased odds for mortality (OR : 0.12, 95% CI : 0.02-0.60, p < 0.05)]. None of the cardiovascular comorbidities were significantly associated with mortality. Conclusion Age and dementia are associated with increased odds for mortality in patients ≥75 years of age hospitalized with COVID-19. Those who require intubation have the greatest odds for mortality. Diarrhea as a presenting symptom was associated with lower odds for mortality.

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A retrospective cohort investigation of seroprevalence of Marburg virus and ebolaviruses in two different ecological zones in Uganda

10.21203/rs.2.20899/v1 ◽

2020 ◽

Author(s):

Luke Nyakarahuka ◽

Ilana J. Schafer ◽

Stephen Balinandi ◽

Sophia Mulei ◽

Alex Tumusiime ◽

...

Keyword(s):

Risk Factors ◽

Gold Mining ◽

Ebola Virus ◽

Virus Disease ◽

Marburg Virus ◽

Igg Antibodies ◽

Mining Communities ◽

Ecological Zones ◽

Increased Risk ◽

Western Uganda

Abstract Background Uganda has experienced seven Ebola Virus Disease (EVD) outbreaks and four Marburg Virus disease (MVD) outbreaks between 2000 and 2019. We investigated the seroprevalence and risk factors for Marburg virus and ebolaviruses infections in gold mining communities around Kitaka gold mine in Western Uganda, and compared them to non-mining communities in Central UgandaMethods A questionnaire was administered and human blood samples were collected from three exposed groups in Western Uganda (gold miners, and household members of miners, non-miners living within 50 km of Kitaka mine). Controls were community members in Central Uganda far away from any gold mining activity which we considered as low-risk groups or ‘unexposed’ to filovirus infection. ELISA technique was used to analyse samples, detecting IgG antibodies against Marburg virus and ebolaviruses (filovirus).Results Miners in western Uganda were 4.8 times more likely to be seropositive compared to the non-exposed group in central Uganda (RR=4.8, 95%CI 1.3-17.9). Overall, filovirus seropositivity was 2.6% (19/724) of which 2.5% (18/724) was to Sudan virus, 0.1% (1/724) was to Bundibugyo virus, and 0.1% (1/724) to Marburg virus. One individual had IgG antibodies reactive to both Sudan virus and Bundibugyo virus. The risk factors for seropositivity to Sudan virus identified included mining (aOR=3.4, 1.3-8.5), male sex (3.1, 1.01 - 9.5), going inside mines (3.1, 1.2 - 8.2), cleaning corpses (3.1, 1.04 - 9.1) and contact with suspect filovirus cases (3.9, 1.04 -14.5).Conclusions These findings indicate that filovirus outbreaks may go undetected in Uganda and people involved in artisan gold mining or living close to mines and/or caves are more likely to be exposed to infection with either Marburg virus or ebolaviruses, likely due to increased risk of exposure to bats. This calls for active surveillance in known high-risk areas for early detection and response to prevent filovirus epidemics.

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Combinatorial Analysis of Phenotypic and Clinical Risk Factors Associated With Hospitalized COVID-19 Patients

Frontiers in Digital Health ◽

10.3389/fdgth.2021.660809 ◽

2021 ◽

Vol 3 ◽

Author(s):

Sayoni Das ◽

Matthew Pearson ◽

Krystyna Taylor ◽

Veronique Bouchet ◽

Gert Lykke Møller ◽

...

Keyword(s):

Risk Factors ◽

Severe Disease ◽

Host Cells ◽

Combinatorial Analysis ◽

Lipid Signaling ◽

Phenotypic Data ◽

Factors Associated ◽

Increased Risk ◽

Different Populations ◽

Disease Signatures

Characterization of the risk factors associated with variability in the clinical outcomes of COVID-19 is important. Our previous study using genomic data identified a potential role of calcium and lipid homeostasis in severe COVID-19. This study aimed to identify similar combinations of features (disease signatures) associated with severe disease in a separate patient population with purely clinical and phenotypic data. The PrecisionLife combinatorial analytics platform was used to analyze features derived from de-identified health records in the UnitedHealth Group COVID-19 Data Suite. The platform identified and analyzed 836 disease signatures in two cohorts associated with an increased risk of COVID-19 hospitalization. Cohort 1 was formed of cases hospitalized with COVID-19 and a set of controls who developed mild symptoms. Cohort 2 included Cohort 1 individuals for whom additional laboratory test data was available. We found several disease signatures where lower levels of lipids were found co-occurring with lower levels of serum calcium and leukocytes. Many of the low lipid signatures were independent of statin use and 50% of cases with hypocalcemia signatures were reported with vitamin D deficiency. These signatures may be attributed to similar mechanisms linking calcium and lipid signaling where changes in cellular lipid levels during inflammation and infection affect calcium signaling in host cells. This study and our previous genomics analysis demonstrate that combinatorial analysis can identify disease signatures associated with the risk of developing severe COVID-19 separately from genomic or clinical data in different populations. Both studies suggest associations between calcium and lipid signaling in severe COVID-19.

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