ObjectiveTo report clinical and laboratory characteristics, as well as treatment and clinical outcomes of patients admitted for neurologic diseases with and without COVID-19.MethodsIn this retrospective, single center cohort study, we included all adult inpatients with confirmed COVID-19, admitted to a Neuro-COVID Unit from February 21, 2020, who had been discharged or died by April 5, 2020. Demographic, clinical, treatment, and laboratory data were extracted from medical records and compared (FDR-corrected) to those of neurologic patients without COVID-19 admitted in the same period.ResultsOne hundred seventy-three patients were included in this study, of whom 56 were positive for COVID-19 while 117 were negative for COVID-19. Patients with COVID-19 were older (77.0, IQR 67.0–83.8 vs 70.1, IQR 52.9–78.6, p = 0.006), had a different distribution regarding admission diagnoses, including cerebrovascular disorders (n = 43, 76.8% vs n = 68, 58.1%), and had a higher quick Sequential Organ Failure Assessment (qSOFA) score on admission (0.5, IQR 0.4–0.6 vs 0.9, IQR 0.7–1.1, p = 0.006). In-hospital mortality rates (n = 21, 37.5% vs n = 5, 4.3%, p < 0.001) and incident delirium (n = 15, 26.8% vs n = 9, 7.7%, p = 0.003) were significantly higher in the COVID-19 group. COVID-19 and non-COVID patients with stroke had similar baseline characteristics but patients with COVID-19 had higher modified Rankin scale scores at discharge (5.0, IQR 2.0–6.0 vs 2.0, IQR 1.0–3.0, p < 0.001), with a significantly lower number of patients with a good outcome (n = 11, 25.6% vs n = 48, 70.6%, p < 0.001). In patients with COVID-19, multivariable regressions showed increasing odds of in-hospital death associated with higher qSOFA scores (OR 4.47, 95% CI 1.21–16.5; p = 0.025), lower platelet count (0.98, 0.97–0.99; p = 0.005) and higher lactate dehydrogenase (1.01, 1.00–1.03; p = 0.009) on admission.ConclusionsCOVID-19 patients admitted with neurologic disease, including stroke, have a significantly higher in-hospital mortality, incident delirium and higher disability than patients without COVID-19.
The antiangiogenic factor thrombospondin 1 (TSP-1) binds with high affinity to several heparin-binding angiogenic factors, including fibroblast growth factor 2 (FGF-2), vascular endothelial growth factor (VEGF), and hepatocyte growth factor/ scatter factor (HGF/SF). The aim of this study was to investigate whether TSP-1 affects FGF-2 association with the extracellular matrix (ECM) and its bioavailability. TSP-1 prevented the binding of free FGF-2 to endothelial cell ECM. It also IntroductionAngiogenesis, sprouting of new blood vessels from pre-existing ones, is a crucial event in physiologic and pathologic processes, including tumor growth and metastasis. 1 Angiogenesis is a complex process, regulated by pro-and antiangiogenic factors, that involves dynamic interaction between a variety of cells, growth factors, and the extracellular matrix (ECM). 2 As in other morphogenic processes, the ECM acts not just as a structural support, but also as a direct modulator of cellular functions. Matrix components and bioactive fragments released by limited proteolysis can directly regulate endothelial cell functions. 3 In addition, the matrix contributes to angiogenesis by acting as a reservoir for angiogenic factors. Growth factors are stored in the matrix through binding to heparansulfate proteoglycans (HSPGs). Binding to HSPGs is reversible, 4 and biologically active factors can be released from the matrix by different agents. 5,6 Fibroblast growth factor 2 (FGF-2, basic FGF) is the most extensively studied example of matrix-stored angiogenic factor. 5,7 As do other members of the FGF family, FGF-2 has a high affinity for the glycosaminoglycan heparin and for HSPGs. Cell-surface HSPGs are required for the formation of an active FGF/FGF receptor signaling complex, 8 for internalization, and hence for internalization-dependent activities such as endothelial cell proliferation. 7,9 Conversely, matrix-associated HSPGs allow the storage of FGF-2 within the ECM. 10 Matrix-associated FGF-2 can then act locally, or be released as a soluble, biologically active factor. 6 Mobilization of active FGF-2 from the matrix is an important mechanism of induction of angiogenesis. Biologically active FGF-2 is released by heparin, 11 matrix-degrading proteases, 12 heparanase, 13 and the FGF-binding protein (FGF-BP). 14 Conversely, other endogenous or pharmacologic agents that prevent FGF-2 interaction with HSPGs exert an antiangiogenic activity, as in the case of platelet factor 4 (PF-4), 15 a soluble syndecan ectodomain, 16 suramin, 17 chemically modified heparins, and heparin-mimicking polyanionic compounds. [18][19][20] Other important angiogenic factors, including vascular endothelial growth factor (VEGF) and hepatocyte growth factor/scatter factor (HGF/SF), bind to HSPGs that again contribute to growth factor binding to cell receptors and to the ECM. [21][22][23] Thrombospondin 1 (TSP-1) is the most studied member of a family of at least 5 related proteins. 24,25 TSP-1 is a matricellular molecule, a modular glycoprotein composed of mult...
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