scholarly journals Hypertension May Reduce the Infection Risk but Increase the Severity of COVID-19: Based on the Current Data in China

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Bo Li ◽  
Lu Zeng ◽  
Nengjun Sun ◽  
Yunhe Zhao ◽  
Faming Zhao ◽  
...  
Keyword(s):  
General Population ◽  
Clinical Outcomes ◽  
Disease Severity ◽  
Meta Analysis ◽  
Infection Risk ◽  
Current Data ◽  
Google Scholar ◽  
Icu Patients ◽  
Risk Of Death

Increasing evidence has shown an unusual relationship between hypertension and COVID-19, which may not be as simple as previously thought. The purpose of our study was to determine the association of hypertension with the onset and development of COVID-19. A meta-analysis was performed to summarize the prevalence of hypertension in COVID-19 patients, as well as the usage of ACEIs/ARBs. Metaregression analyses were used to evaluate the association of hypertension with disease severity and mortality. PubMed and Google Scholar were searched for relevant studies. A total of 42 studies including 14138 patients were enrolled in the study. The proportion of hypertension in COVID-19 patients in China was 17.7% according to the enrolled studies, while it was 6.0% in a study containing 72314 confirmed cases, which are both much lower than in the general population. All of the data from the 11 provinces in China showed the same tendency. The proportions of hypertension were higher in severe/ICU patients and nonsurvivors than in nonsevere/ICU patients and survivors. The metaregression analyses suggested that both disease severity and risk of death were associated with the incidence of hypertension. A total of 27.6% of COVID-19 patients with hypertension received ACEI/ARB therapy. The proportion of deaths in COVID-19 patients with hypertension treated with ACEIs/ARBs was significantly lower than that in nonuse patients treated with ACEIs/ARBs. In conclusion, hypertension may reduce the infection risk of COVID-19 but increase the risk of developing worse clinical outcomes. The use of ACEIs/ARBs may benefit COVID-19 patients with hypertension.

scholarly journals Meta-Analysis and Potential Role of Preexisting Heterosubtypic Cellular Immunity Based on Variations in Disease Severity Outcomes for Influenza Live Viral Challenges in Humans

2015 ◽  
Vol 22 (8) ◽  
pp. 949-956 ◽  
Author(s):  
Olga Pleguezuelos ◽  
Stuart Robinson ◽  
Ana Fernandez ◽  
Gregory A. Stoloff ◽  
Wilson Caparrós-Wanderley
Keyword(s):  
Placebo Group ◽  
Clinical Outcomes ◽  
Disease Severity ◽  
Cellular Response ◽  
Influenza Pandemic ◽  
Meta Analysis ◽  
Antiviral Agents ◽  
Test Group ◽  
Investigational Agent ◽  
Viral Shedding

ABSTRACTInfluenza live viral challenges in humans are valuable models for testing the efficacy of vaccines and antiviral agents. Volunteers are treated with an investigational agent, and their clinical outcomes postchallenge are compared to those of placebo-treated volunteers. Despite using a common protocol, similar recruitment criteria, and similar doses of the same challenge strain, we noticed differences in disease severity outcomes between the placebo groups from different studies. We investigated whether these differences were significant and, if so, whether any pattern and its possible causes could be identified. We compared the clinical outcomes postchallenge in placebo groups from five clinical studies carried out between 2008 and 2013. Correlations between the prechallenge heterosubtypic cellular response (gamma interferon [IFN-γ]) and postchallenge clinical outcomes were also investigated in one study. Placebo groups from studies carried out between 2009 and 2010 attained significantly reduced (P< 0.05) symptom scores postchallenge compared to those of placebo groups from studies carried out in either 2008 or 2013. Also, in a 2010 study, the frequency of high-influenza heterosubtypic cellular responders prevaccination was significantly lower in the test group (FLU-v) than that in the placebo group (P= 0.04). Moreover, the increased preexisting heterosubtypic cellular response of the placebo group correlated with reductions in symptom score and viral shedding postchallenge (P≤ 0.023). Only postvaccination did the test group display an equivalent correlation. The last influenza pandemic coincided with a significant reduction in disease severity outcomes. This reduction also appears to correlate with increased preexisting influenza heterosubtypic cellular responses. (This study is registered at ClinicalTrials.gov under registration number NCT01226758.)

scholarly journals Cardiovascular drugs and COVID-19 clinical outcomes: a living systematic review and meta-analysis

2021 ◽  
Author(s):  
Innocent Asiimwe ◽  
Sudeep Pushpakon ◽  
Richard Turner ◽  
Ruwanthi Kolamunnage-Dona ◽  
Andrea Jorgensen ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Disease Severity ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cardiovascular Drugs ◽  
Mean Difference ◽  
Converting Enzyme Inhibitors ◽  
All Cause Mortality

Aims: To continually evaluate the role of cardiovascular drugs in COVID-19 clinical outcomes. Methods: Eligible publications were identified from >500 databases on 1-Nov-2020. One reviewer extracted data with 20% of the records independently extracted/evaluated by a second reviewer. Results: Of 52,735 screened records, 429 and 390 studies were included in the qualitative and quantitative syntheses, respectively. The most-reported drugs were angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) with ACEI/ARB exposure having borderline association with positive COVID-19 status (OR 1.14, 95% CI 1.00–1.31). Among COVID-19 patients, unadjusted estimates showed that ACEI/ARB exposure was associated with hospitalization (OR 1.76, 1.34–2.32), disease severity (OR 1.41, 1.27–1.56) and all-cause mortality (OR 1.22, 1.12–1.33) but not hospitalization length (mean difference -0.27, -1.36; 0.82 days). After adjustment, ACEI/ARB exposure was not associated with positive COVID-19 status (OR 0.92, 0.71–1.19), hospitalization (OR 0.93, 0.70–1.24), disease severity (OR 1.05, 0.81–1.38), or all-cause mortality (OR 0.85, 0.71–1.01). Similarly, subgroup analyses involving only hypertensive patients revealed that ACEI/ARB exposure was not associated with positive COVID-19 status (OR 0.93, 0.79–1.09), hospitalization (OR 0.84, 0.58–1.22), hospitalization length (mean difference -0.14, -1.65; 1.36 days), disease severity (OR 0.92, 0.76–1.11) while it decreased the odds of dying (OR 0.76, 0.65–0.88). A similar trend was observed for other cardiovascular drugs. However, the validity of these findings is limited by a high level of heterogeneity and serious risk of bias. Conclusion: Cardiovascular drugs are not associated with poor COVID-19 outcomes in adjusted analyses. Patients should continue taking these drugs as prescribed.

scholarly journals Cardiovascular drugs and COVID-19 clinical outcomes: a living systematic review and meta-analysis

2020 ◽  
Author(s):  
Innocent G Asiimwe ◽  
Sudeep Pushpakom ◽  
Richard M Turner ◽  
Ruwanthi Kolamunnage-Dona ◽  
Andrea Jorgensen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Disease Severity ◽  
Meta Analysis ◽  
Severe Disease ◽  
Cardiovascular Drugs ◽  
Susceptibility To Infection ◽  
Drug Classes ◽  
All Cause Mortality ◽  
Length Of Hospitalization

ABSTRACTOBJECTIVETo continually evaluate the rapidly evolving evidence base on the role of cardiovascular drugs in COVID-19 clinical outcomes (susceptibility to infection, hospitalization, hospitalization length, disease severity, and all-cause mortality).DESIGNLiving systematic review and meta-analysis.DATA SOURCESEligible publications identified from >500 databases indexed through 31st July 2020 and additional studies from reference lists, with planned continual surveillance for at least two years.STUDY SELECTIONObservational and interventional studies that report on the association between cardiovascular drugs and COVID-19 clinical outcomes.DATA EXTRACTIONSingle-reviewer extraction and quality evaluation (using ROBINS-I), with half the records independently extracted and evaluated by a second reviewer.RESULTSOf 23,427 titles screened, 175 studies were included in the quantitative synthesis. The most reported drug classes were angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) with ACEI/ARB exposure being associated with higher odds of testing positive for COVID-19 (pooled unadjusted OR 1.15, 95% CI 1.02 to 1.30). Among patients with COVID-19, unadjusted estimates showed that ACEI/ARB exposure was associated with being hospitalized (OR 2.25, 1.70 to 2.98) and having severe disease (OR 1.50, 1.27 to 1.77) but not with the length of hospitalization (mean difference −0.45, −1.33 to 0.43 days) or all-cause mortality (OR 1.25, CI 0.98 to 1.58). However, after adjustment, ACEI/ARB exposure was not associated with testing positive for COVID-19 (pooled adjusted OR 1.01, 0.93 to 1.10), being hospitalized (OR 1.16, 0.80 to 1.68), having severe disease (1.04, 0.76 to 1.42), or all-cause mortality (0.86, 0.64 to 1.15). Similarly, subgroup analyses involving only hypertensive patients revealed that ACEI/ARB exposure was not associated with being hospitalized (OR 0.84, 0.58 to 1.22), disease severity (OR 0.88, 0.68 to 1.14) or all-cause mortality (OR 0.77, 0.54 to 1.12) while it decreased the length of hospitalization (mean difference −0.71, −1.11 to −0.30 days). After adjusting for relevant covariates, other cardiovascular drug classes were mostly not found to be associated with poor COVID-19 clinical outcomes. However, the validity of these findings is limited by a high level of heterogeneity in terms of effect sizes and a serious risk of bias, mainly due to confounding in the included studies.CONCLUSIONOur comprehensive review shows that ACEI/ARB exposure is associated with COVID-19 outcomes such as susceptibility to infection, severity, and hospitalization in unadjusted analyses. However, after adjusting for potential confounding factors, this association is not evident. Patients on cardiovascular drugs should continue taking their medications as currently recommended. Higher quality evidence in the form of randomized controlled trials will be needed to determine any adverse or beneficial effects of cardiovascular drugs.PRIMARY FUNDING SOURCENoneSYSTEMATIC REVIEW REGISTRATIONPROSPERO (CRD42020191283)

scholarly journals The risk of infections in adult patients with systemic lupus erythematosus: systematic review and meta-analysis

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 60-72 ◽  
Author(s):  
José María Pego-Reigosa ◽  
Lindsay Nicholson ◽  
Nick Pooley ◽  
Sue Langham ◽  
Nina Embleton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Herpes Zoster ◽  
General Population ◽  
Meta Analysis ◽  
Severe Infection ◽  
Infection Risk ◽  
Sensitivity Analyses ◽  
Healthy Controls ◽  
Increased Risk ◽  
The Impact

Abstract Objectives We conducted a systematic review and meta-analysis to determine the magnitude of infection risk in patients with SLE and evaluate the effect of general and SLE-related factors on infection risk. Methods We searched MEDLINE and Embase from inception to July 2018, screening for observational studies that evaluated infection risk in patients with SLE compared with the general population/healthy controls. Outcomes of interest included overall severe infection, herpes zoster infection/reactivation, opportunistic infections, pneumonia and tuberculosis. Random-effects models were used to calculate pooled risk ratios (RRs) for each type of infection. Sensitivity analysis assessed the impact of removing studies with high risk of bias. Results Eleven retrospective or prospective cohort studies were included in the meta-analysis: overall severe infection (n = 4), pneumonia (n = 6), tuberculosis (n = 3) and herpes zoster (n = 2). Pooled RRs for overall severe infection significantly increased for patients with SLE compared with the general population/healthy controls [RR 2.96 (95% CI 1.28, 6.83)]. Pooled RRs for pneumonia, herpes zoster and tuberculosis showed significantly increased risk compared with the general population/healthy controls [RR 2.58 (1.80, 3.70), 2.50 (2.36, 2.65) and 6.11 (3.61, 10.33), respectively]. Heterogeneity and evidence of publication bias were present for all analyses, except herpes zoster. Sensitivity analyses confirmed robustness of the results. Conclusion Patients with SLE have significantly higher risk of infection compared with the general population/healthy controls. Efforts to strengthen strategies aimed at preventing infections in SLE are needed. Protocol registration PROSPERO number: CRD42018109425.

scholarly journals Is the association between blood pressure and mortality in older adults different with frailty? A systematic review and meta-analysis

2019 ◽  
Vol 48 (5) ◽  
pp. 627-635 ◽  
Author(s):  
Oliver M Todd ◽  
Chris Wilkinson ◽  
Matthew Hale ◽  
Nee Ling Wong ◽  
Marlous Hall ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Systolic Blood Pressure ◽  
Clinical Outcomes ◽  
Observational Studies ◽  
Meta Analysis ◽  
Current Evidence ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Mortality Difference

Abstract Objective to investigate whether the association between blood pressure and clinical outcomes is different in older adults with and without frailty, using observational studies. Methods MEDLINE, EMBASE and CINAHL were searched from 1st January 2000 to 13th June 2018. PROSPERO CRD42017081635. We included all observational studies reporting clinical outcomes in older adults with an average age over 65 years living in the community with and without treatment that measured blood pressure and frailty using validated methods. Two independent reviewers evaluated study quality and risk of bias using the ROBANS tool. We used generic inverse variance modelling to pool risks of all-cause mortality adjusted for age and sex. Results nine observational studies involving 21,906 older adults were included, comparing all-cause mortality over a mean of six years. Fixed effects meta-analysis of six studies demonstrated that in people with frailty, there was no mortality difference associated with systolic blood pressure <140 mm Hg compared to systolic blood pressure >140 mm Hg (HR 1.02, 95% CI 0.90 to 1.16). In the absence of frailty, systolic blood pressure <140 mm Hg was associated with lower risk of death compared to systolic blood pressure >140 mm Hg (HR 0.86, 95% CI 0.77 to 0.96). Conclusions evidence from observational studies demonstrates no mortality difference for older people with frailty whose systolic blood pressure is <140 mm Hg, compared to those with a systolic blood pressure >140 mm Hg. Current evidence fails to capture the complexities of blood pressure measurement, and the association with non-fatal outcomes.

scholarly journals Association Between SARS-CoV-2 Cycle Threshold Values and Clinical Outcomes in Patients With COVID-19: A Systematic Review and Meta-analysis

2021 ◽  
Vol 8 (9) ◽  
Author(s):  
Vishal P Shah ◽  
Wigdan H Farah ◽  
James C Hill ◽  
Leslie C Hassett ◽  
Matthew J Binnicker ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Disease Severity ◽  
Meta Analysis ◽  
Severe Disease ◽  
Sample Type ◽  
Sample Collection ◽  
Cycle Threshold ◽  
Significant Difference ◽  
Polymerase Chain

Abstract Cycle threshold (CT) values are correlated with the amount of viral nucleic acid in a sample and may be obtained from some qualitative real-time polymerase chain reaction tests used for diagnosis of most patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, CT values cannot be directly compared across assays, and they must be interpreted with caution as they are influenced by sample type, timing of sample collection, and assay design. Presently, the correlation between CT values and clinical outcomes is not well understood. We conducted a systematic review and meta-analysis of published studies through April 19, 2021, that reported an association between CT values and hospitalization, disease severity, and mortality in patients ≥18 years old with SARS-CoV-2. A meta-analysis of 7 studies showed no significant difference in mean CT values between hospitalized and nonhospitalized patients. Among hospitalized patients, those with CT values &lt;25 had a high risk of more severe disease and mortality than patients with CT values &gt;30 (odds ratio [OR], 2.31; 95% CI, 1.70 to 3.13; and OR, 2.95; 95% CI, 2.19 to 3.96; respectively). The odds of increased disease severity and mortality were less pronounced in patients with CT values of 25–30 compared with &gt;30.

scholarly journals Demographic disparities in clinical outcomes of COVID-19: data from a statewide cohort in South Carolina

2021 ◽  
Author(s):  
Xueying Yang ◽  
Jiajia Zhang ◽  
Shujie Chen ◽  
Bankole Olatosi ◽  
Larisa Bruner ◽  
...  
Keyword(s):  
Older Adults ◽  
South Carolina ◽  
Clinical Outcomes ◽  
Disease Severity ◽  
Rural Areas ◽  
Population Based ◽  
Health Care Facilities ◽  
Case Report Form ◽  
Risk Of Death ◽  
Asian Patients

Abstract Background Current literature examining the clinical characteristics of COVID-19 patients under-represent COVID-19 cases who were either asymptomatic or had mild symtoms. Methods We analyzed statewide data from 280,177 COVID-19 cases from various health care facilities during March 04–December 31, 2020. Each COVID-19 case was reported using the standardized Case Report Form (CRF), which collected information on demographic characteristics, symptoms, hospitalization, and death. We used multivariable logistic regression to analyze the associations between socio-demographics and disease severity, hospitalization and mortality. Results Among a total of 280,177 COVID-19 cases, 5.2% (14,451) were hospitalized and 1.9% (5,308) died. Older adults, males, and Black individuals had higher odds for hospitalization and death from COVID-19 (Ps&lt;0.0001). Particularly, individuals residing in rural areas experienced a high risk of death (OR: 1.16; 95%CI: 1.08, 1.25). Regarding disease severity, older adults (OR: 1.06, 95%CI: 1.03, 1.10) and Hispanic or Latino patients (OR: 2.06; 95%CI: 1.95, 2.18), had higher odds of experiencing moderate/severe symptoms, while male and Asian patients, compared to White patients, had lower odds of experiencing moderate/severe symptoms. Conclusions As the first statewide population-based study using data from multiple healthcare systems with a long follow-up period in the US, we provide a more generalizable picture of COVID-19 symptoms and clinical outcomes. The findings from this study reinforce the fact that rural residence and racial/ethnic social determinants of health, unfortunately, remain predictors of adverse health outcomes for COVID-19 patients.

scholarly journals Immune-Related Adverse Events Associated With Outcomes in Patients With NSCLC Treated With Anti-PD-1 Inhibitors: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhe Zhao ◽  
Xinfeng Wang ◽  
Jinghan Qu ◽  
Wei Zuo ◽  
Yan Tang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Objective Response ◽  
Progression Free Survival ◽  
Predictive Biomarker ◽  
Pooled Analysis ◽  
Conclusive Evidence ◽  
Risk Of Death

Background and ObjectiveAlthough anti-programmed cell death protein 1 (PD-1) antibodies have exerted remarkable anticancer activity in non-small cell lung cancer (NSCLC), it remains a challenge to identify patients who can benefit from these treatments. Immune-related adverse events (irAEs) may be associated with improved clinical outcomes after immune checkpoint inhibition. However, no conclusive evidence of this correlation has been summarized in patients with NSCLC receiving PD-1 inhibitors. We performed a systematic review and meta-analysis to evaluate the association between irAEs induced by anti-PD-1 antibodies and clinical outcomes in patients with NSCLC.MethodsVarious databases were searched from their inception to January 9, 2021, followed by screening of eligible studies. Hazard ratios were used for the pooled analysis of overall survival (OS) and progression-free survival (PFS), while odds ratios (ORs) were utilized to pool objective response rates (ORRs) and disease control rates (DCRs). A random-effects model was applied to all analyses.ResultsA total of 26 cohorts, including 8,452 patients with NSCLC receiving anti-PD-1 antibodies, were enrolled in the study. Significantly improved OS (HR: 0.51; 95% CI: 0.44-0.60; P &lt; 0.01) and PFS (HR: 0.50; 95% CI: 0.43-0.58; P &lt; 0.01) were found to be correlated with irAEs. In addition, patients with NSCLC who developed irAEs after PD-1 inhibition demonstrated better responses to therapies, confirmed by pooled ORs of ORRs (OR: 3.41; 95% CI: 2.66-4.35; P &lt; 0.01) and DCRs (OR: 4.08; 95% CI: 2.30-7.24; P &lt; 0.01). Furthermore, subgroup analysis suggested that both skin and endocrine irAEs are closely correlated with a reduced risk of death, whereas pulmonary irAEs showed no association with longer OS.ConclusionsIn patients with NSCLC treated with anti-PD-1 therapies, the presence of irAEs was strongly correlated with better survival and response, suggesting its potential role as a predictive biomarker for outcomes after PD-1 inhibition.

scholarly journals Temporal trends of sex differences for COVID-19 infection, hospitalisation, severe disease, intensive care unit (ICU) admission and death: a meta-analysis of 229 studies covering over 10M patients

F1000Research ◽  
2022 ◽  
Vol 11 ◽  
pp. 5
Author(s):  
Bart G. Pijls ◽  
Shahab Jolani ◽  
Anique Atherley ◽  
Janna I.R. Dijkstra ◽  
Gregor H.L. Franssen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Disease Severity ◽  
Meta Analysis ◽  
Severe Disease ◽  
Temporal Trends ◽  
Icu Admission ◽  
Risk Of Death ◽  
Relative Risks ◽  
Meta Analyses

Background: This review aims to investigate the association of sex with the risk of multiple COVID-19 health outcomes, ranging from infection to death. Methods: Pubmed and Embase were searched through September 2020. We considered studies reporting sex and coronavirus disease 2019 (COVID-19) outcomes. Qualitative and quantitative data were extracted using standardised electronic data extraction forms with the assessment of Newcastle Ottawa Scale for risk of bias. Pooled trends in infection, hospitalization, severity, intensive care unit (ICU) admission and death rate were calculated separately for men and women and subsequently random-effects meta-analyses on relative risks (RR) for sex was performed. Results: Of 10,160 titles, 229 studies comprising 10,417,452 patients were included in the analyses. Methodological quality of the included studies was high (6.9 out of 9). Men had a higher risk for infection with COVID-19 than women (RR = 1.14, 95%CI: 1.07 to 1.21). When infected, they also had a higher risk for hospitalization (RR = 1.33, 95%CI: 1.27 to 1.41), higher risk for severe COVID-19 (RR = 1.22, 95%CI: 1.17 to 1.27), higher need for Intensive Care (RR = 1.41, 95%CI: 1.28 to 1.55), and higher risk of death (RR = 1.35, 95%CI: 1.28 to 1.43). Within the period studied, the RR for infection and severity increased for men compared to women, while the RR for mortality decreased for men compared to women. Conclusions: Meta-analyses on 229 studies comprising over 10 million patients showed that men have a higher risk for COVID-19 infection, hospitalization, disease severity, ICU admission and death. The relative risks of infection, disease severity and death for men versus women showed temporal trends with lower relative risks for infection and severity of disease and higher relative risk for death at the beginning of the pandemic compared to the end of our inclusion period. PROSPERO registration: CRD42020180085 (20/04/2020)

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