Identification of Endotypes of Hospitalized COVID-19 Patients

Ranard, Benjamin L.; Megjhani, Murad; Terilli, Kalijah; Doyle, Kevin; Claassen, Jan; Pinsky, Michael R.; Clermont, Gilles; Vodovotz, Yoram; Asgari, Shadnaz; Park, Soo‐Jin

doi:10.3389/fmed.2021.770343

Cited by 18 publications

(21 citation statements)

References 39 publications

(46 reference statements)

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“…Coronavirus disease 2019 (COVID- 19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has infected more than 130 million people worldwide. COVID-19 leads to respiratory manifestations that can range from mild flu-like symptoms such as fever, cough, and fatigue to severe respiratory failure requiring intensive care (1,2).…”

Section: Introductionmentioning

confidence: 99%

Characteristics and Prognostic Factors of Pulmonary Fibrosis After COVID-19 Pneumonia

et al. 2022

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BackgroundFew is known about the long-term pulmonary sequelae after COVID-19 infection. Hence, the aim of this study is to characterize patients with persisting pulmonary sequelae at follow-up after hospitalization. We also aimed to explore clinical and radiological predictors of pulmonary fibrosis following COVID-19.MethodsTwo hundred and 20 consecutive patients were evaluated at 3–6 months after discharge with high-resolution computed tomography (HRCT) and categorized as recovered (REC) or not recovered (NOT-REC). Both HRCTs at hospitalization (HRCT0), when available, and HRCT1 during follow-up were analyzed semiquantitatively as follows: ground-glass opacities (alveolar score, AS), consolidations (CONS), and reticulations (interstitial score, IS).ResultsA total of 175/220 (80%) patients showed disease resolution at their initial radiological evaluation following discharge. NOT-REC patients (45/220; 20%) were mostly older men [66 (35–85) years vs. 56 (19–87); p = 0.03] with a longer in-hospital stay [16 (0–75) vs. 8 (1–52) days; p < 0.0001], and lower P/F at admission [233 (40–424) vs. 318 (33–543); p = 0.04]. Moreover, NOT-REC patients presented, at hospital admission, higher ALV [14 (0.0–62.0) vs. 4.4 (0.0–44.0); p = 0.0005], CONS [1.9 (0.0–26.0) vs. 0.4 (0.0–18.0); p = 0.0064], and IS [11.5 (0.0– 29.0) vs. 0.0 (0.0–22.0); p < 0.0001] compared to REC patients. On multivariate analysis, the presence of CONS and IS at HRCT0 was independent predictors of radiological sequelae at follow-up [OR 14.87 (95% CI: 1.25–175.8; p = 0.03) and 28.9 (95% CI: 2.17–386.6; p = 0.01, respectively)].ConclusionsIn our population, only twenty percent of patients showed persistent lung abnormalities at 6 months after hospitalization for COVID-19 pneumonia. These patients are predominantly older men with longer hospital stay. The presence of reticulations and consolidation on HRCT at hospital admission predicts the persistence of radiological abnormalities during follow-up.

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Section: Introductionmentioning

confidence: 99%

Characteristics and Prognostic Factors of Pulmonary Fibrosis After COVID-19 Pneumonia

et al. 2022

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“…Following the method of Ranard et al [ 11 ] for a data set limited to November 2020 through November 2021, this study finds minimal quantitative differences with the conclusion of Ranard et al [ 11 ] that the most commonly cited comorbidities do not per se substantially increase the risk of serious consequences of SARS-CoV-2 infections. However, one cannot ignore that many persons with such conditions frequently have multiple cofactors and have either an inherent or medication-depressed level [ 37 ] of immune function that can worsen the effects of a COVID-19 infection.…”

Section: Discussionmentioning

confidence: 50%

“…A recent study of four unique endotypes of patients hospitalized with COVID-19 infections found that high-level comorbidities did not associate with poor outcome endotypes [ 10 , 11 ]. Previously, a study on the proximate and underlying causes of death as determined by the autopsy of 26 hospitalized patients found that death was “directly related to COVID-19 in the majority of patients.” Pre-existing health conditions had only contributory implications, and death was not an immediate result of those comorbidities [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

The Influence of SARS-CoV-2 Variants on National Case-Fatality Rates: Correlation and Validation Study

Barletta¹

2022

JMIRx Med

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Background In 2021, new variants of the SARS-CoV-2 virus appeared with increased transmissibility and virulence as compared with the original wild variant. The first variants of concern (VoCs), Alpha (B1.1.7) and Gamma (P.1), first appeared in the United Kingdom and Brazil, respectively. The Delta (B.1.617.2) variant, seen in India in October 2020, dominated COVID-19 infections across all regions through the second half of 2021. Objective This research explores the degree to which SARS-CoV-2 VoCs generate waves of fluctuations in case-fatality rates (CFRs) across countries in several regions, increase the risk of mortality to persons with certain comorbidities, and decrease the risk of mortality as the percentage of fully vaccinated populations increases. Methods This analysis introduces a measure of the temporal dynamics of COVID-19 infections in the form of a proxy CFR (pCFR), which can be compared among countries. It uses economic and demographic data reported by the World Bank and International Monetary Fund, plus publicly available epidemiological and medical statistics reported to the relevant national and international public health authorities. From these ecological data, pandemic average and daily COVID-19 CFRs and their correlations with potential cofactors were computed for 2021, a year dominated by the spread of World Health Organization–designated VoCs. The study does not investigate disease pathology; rather, it compares the daily case rates and pCFRs to reveal underlying contributing factors that vary from country to country and region to region. Results The in-depth global regression analysis of cofactors found that the strongest single correlation with COVID-19 fatality was 0.36 (SD 0.02) with P<.001 for chronic kidney disease. No other single physiological cofactors display positive correlations exceeding 0.26 (SD 0.26), with P=.008 (asthma) and P=.01 (coronary disease). The study confirms that the pCFR is a valuable metric for tracking waves of infection due to different VoCs within countries. Conclusions The influence of social, economic, and medical cofactors on the CFR due to VoCs remains qualitatively similar, albeit strengthened, to the levels found for the wild strain. The strong regional variations of the influence of all cofactors observed for the wild strain persists in infections for all VoCs with very strong correlation coefficients seen in the Middle East for asthma (0.76), coronary heart disease (0.60), lung disease (0.70), and chronic kidney disease (0.52). Strong regional variations emphasize the influence on COVID-19 mortality due to regional differences in national economics, patterns of health care policies, and variations in cultural practices and environment. The pCFR-based analysis reveals clear patterns of the spread of VoCs across regions, but there is little evidence for the spread of the Lambda and Mu (B.1.621) variants of interest outside of South America.

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“…Skin manifestations of COVID-19 include vesicular, urticarial, and maculopapular eruptions and livedo, necrosis, and other vasculitis forms 15 and are more common among European and North Americans than among Asians 16 . The heterogeneity of COVID-19 warrants the elucidation of the phenotypes and endotypes of COVID-19 that will benefit from precision medicine 17,18 . In addition, persistent symptoms such as fatigue, brain fog, body aches, and loss of smell may persist for months following acute infection and are referred as post-acute COVID-19 syndrome or long-COVID 19,20 .…”

Section: Clinical Characteristics Of Covid-19mentioning

confidence: 99%

Recent developments in the immunopathology of COVID-19

Gao

Zhang

Sun

et al. 2022

Preprint

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There has been an important change in the clinical characteristics and immune profile of COVID-19 patients during the pandemic thanks to the extensive vaccination programs. Here, we highlight recent studies on COVID-19, from the clinical and immunological characteristics to the protective and risk factors for severity and mortality of COVID-19. The efficacy COVID-19 vaccines and potential allergic reactions after administration are also discussed. The occurrence of new variants of concerns such as Omicron BA.2, BA.4 and BA.5 and the global administration of COVID-19 vaccines have changed the clinical scenario of COVID-19. Multisystem inflammatory syndrome in children (MIS-C) has been identified as an important cause of death of children with COVID-19. Perturbations in immunity of T cells, B cells, and mast cells, as well as autoantibodies and metabolic reprogramming may contribute to the long-term symptoms of COVID-19. Atopic diseases, such as allergic asthma and rhinitis, have been shown to be associated with a lower susceptibility and better outcomes of COVID-19. At the beginning of pandemic, EAACI developed guidelines that provided timely information for the management of allergic diseases and preventive measures to reduce transmission in the allergic clinics. The global distribution of COVID-19 vaccines and emerging SARS-CoV-2 variants with reduced pathogenic potential dramatically decreased the morbidity, severity, and mortality of COVID-19. Nevertheless, breakthrough infection remains a challenge for disease control. Hypersensitivity reactions (HSR) to COVID-19 vaccines are low compared to other vaccines, and these were addressed in EAACI statements that provided indications for the management of allergic reactions, including anaphylaxis to COVID-19 vaccines. We have gained a depth knowledge and experience in the over 2 years since the start of the pandemic, and yet a full eradication of SARS-CoV-2 is not on the horizon. Novel strategies are warranted to prevent severe disease in high-risk groups, the development of MIS-C and long COVID.

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Identification of Endotypes of Hospitalized COVID-19 Patients

Cited by 18 publications

References 39 publications

Characteristics and Prognostic Factors of Pulmonary Fibrosis After COVID-19 Pneumonia

Characteristics and Prognostic Factors of Pulmonary Fibrosis After COVID-19 Pneumonia

The Influence of SARS-CoV-2 Variants on National Case-Fatality Rates: Correlation and Validation Study

Recent developments in the immunopathology of COVID-19

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