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11 pages, 516 KiB

Open AccessArticle

SARS-CoV-2 Infections, Re-Infections and Clinical Characteristics: A Two-Year Retrospective Study in a Large University Hospital Cohort of Vaccinated Healthcare Workers

by Luigi De Maria, Giuseppe Delvecchio, Stefania Sponselli, Francesco Cafaro, Antonio Caputi, Gianmarco Giannelli, Pasquale Stefanizzi, Francesco Paolo Bianchi, Angela Stufano, Silvio Tafuri, Piero Lovreglio, Paolo Boffetta and Luigi Vimercati

J. Clin. Med. 2023, 12(21), 6800; https://doi.org/10.3390/jcm12216800 - 27 Oct 2023

Cited by 4 | Viewed by 1818

Abstract

At the University Hospital of Bari, during the first year after the start of the mandatory vaccination campaign with BNT162b2 mRNA COVID-19 vaccine, the preliminary results of an observational study showed a significant prevalence of SARS-CoV-2 breakthrough infections (BIs) among healthcare workers (HCWs), [...] Read more.

At the University Hospital of Bari, during the first year after the start of the mandatory vaccination campaign with BNT162b2 mRNA COVID-19 vaccine, the preliminary results of an observational study showed a significant prevalence of SARS-CoV-2 breakthrough infections (BIs) among healthcare workers (HCWs), but no hospitalization or deaths. In the present study, we extended the observation period (January 2021–January 2023) with the aim of determining the incidence, characteristics and clinical course of SARS-CoV-2 BIs among 6213 HCWs. All HCWs were regularly monitored and screened. To allow return to work after BI, the protocol required one negative nasopharyngeal swab test followed by a medical examination certifying complete clinical recovery. We observed an overall incidence rate of SARS-CoV-2 BIs of 20.2%. Females were most affected, especially in the nurse group compared with doctors and other HCWs (p < 0.0001). Cardiovascular diseases were the most frequent comorbidity (n = 140; 11.4%). The source of infection was non-occupational in 52.4% of cases. Most cases (96.9%) showed minor symptoms and only two cases of hospitalization (one in intensive care unit), 13 cases of re-infection and no deaths were recorded. Our results confirm that SARS-CoV-2 infection can break vaccination protection but the clinical course is favorable. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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13 pages, 282 KiB

Open AccessArticle

Survival Impact of an On-Site Medicalization Program in the Control of COVID-19 Outbreaks in 11 Nursing Homes

by Bosco Baron-Franco, Manuel Ollero-Baturone, Jara Eloísa Ternero-Vega, Maria Dolores Nieto-Martín, Lourdes Moreno-Gaviño, Concepcion Conde-Guzmán, Sonia Gutiérrez-Rivero, Manuel Rincón-Gómez, Pablo Díaz-Jiménez, Juan José Muñoz-Lopez, Luis Giménez-Miranda, Celia Fernández-Nieto and Máximo Bernabeu-Wittel

J. Clin. Med. 2023, 12(20), 6517; https://doi.org/10.3390/jcm12206517 - 14 Oct 2023

Cited by 1 | Viewed by 1197

Abstract

Background: The elderly admitted to nursing homes have especially suffered the havoc of the COVID-19 pandemic since most of them are not prepared to face such health problems. Methods: An innovative coordinated on-site medicalization program (MP) in response to a sizeable COVID-19 outbreak [...] Read more.

Background: The elderly admitted to nursing homes have especially suffered the havoc of the COVID-19 pandemic since most of them are not prepared to face such health problems. Methods: An innovative coordinated on-site medicalization program (MP) in response to a sizeable COVID-19 outbreak in three consecutive waves was deployed, sharing coordination and resources among primary care, the referral hospital, and the eleven residences. The objectives were providing the best possible medical care to residents in their environment, avoiding dehumanization and loneliness of hospital admission, and reducing the saturation of hospitals and the risk of spreading the infection. The main outcomes were a composite endpoint of survival or optimal palliative care (SOPC), survival, and referral to the hospital. Results: 587 of 1199 (49%) residents were infected, of whom 123 (21%) died. Patients diagnosed before the start of the MP presented SOPC, survival, and referrals to the hospital of 83%, 74%, and 22.4%, opposite to 96%, 84%, and 10.6% of patients diagnosed while the MP was set up. The SOPC was independently associated with an MP (OR 3.4 [1.6–7.2]). Conclusion: During the COVID-19 outbreak, a coordinated MP successfully obtained a better rate of SOPC while simultaneously reducing the need for hospital admissions, combining optimal medical management with a more compassionate and humanistic approach in older people. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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10 pages, 1233 KiB

Open AccessArticle

A Comparative Analysis of the Incidence, Severity and Duration of Smell and Taste Loss in COVID-19 Cases Versus Non-COVID-19 Cases: A Longitudinal Cohort Study

by Emma J. A. Schepens, Digna M. A. Kamalski, Inge Stegeman and Lifelines Corona Research Initiative

J. Clin. Med. 2023, 12(19), 6267; https://doi.org/10.3390/jcm12196267 - 28 Sep 2023

Viewed by 1020

Abstract

The COVID-19 pandemic has highlighted the relevance of olfactory and gustatory disorders. However, these symptoms can also be caused by various other factors. In this study we aimed to compare the incidence, severity and duration between COVID-19 related and non-COVID-19 related smell and [...] Read more.

The COVID-19 pandemic has highlighted the relevance of olfactory and gustatory disorders. However, these symptoms can also be caused by various other factors. In this study we aimed to compare the incidence, severity and duration between COVID-19 related and non-COVID-19 related smell and taste disorders. We conducted a longitudinal cohort study using data from the Dutch biobank Lifelines, which includes over 167,000 participants. The data were collected using 27 questionnaires distributed between March 2020 and May 2022. Descriptive data and the incidence of smell and taste loss in both groups were calculated. To visualize the proportion of severity rates of symptoms, a heatmap was created. A survival analysis was conducted and presented in a reversed Kaplan–Meier curve to show the probability of having persistent smell loss in both groups. The study included 235,722 participants. The incidence of smell loss was higher in the COVID-19 positive group, when compared to the COVID-19 negative group. We found varying degrees of symptom severity in COVID-19 positive cases, ranging from mild to severe, while non-COVID-19 related cases mostly reported mild symptoms. The survival outcome for smell and taste loss was 0.12 (SE 0.03, 95% CI 0.07–0.21) in COVID-19 related cases, and was 0.17 (SE 0.03, 95% CI 0.12–0.24) in cases related to other causes. This study reveals a higher incidence and severity of smell and taste loss in individuals with COVID-19 compared to non-COVID-19 related cases. However, non-COVID-19 related smell and taste loss tend to have a longer duration. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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12 pages, 283 KiB

Open AccessFeature PaperArticle

Long-Term Prognosis among COVID-19 Patients: The Predictive Role Played by Hyperinflammation and Arrhythmic Disorders in Fatal Outcome

by Domenico Cozzolino, Ciro Romano, Celestino Sardu, Riccardo Nevola, Giuseppina Rosaria Umano, Luca Rinaldi, Luigi Elio Adinolfi, Christian Catalini, Aldo Marrone, Maurizio Municinò, Ferdinando Carlo Sasso and Raffaele Marfella

J. Clin. Med. 2023, 12(17), 5691; https://doi.org/10.3390/jcm12175691 - 31 Aug 2023

Cited by 3 | Viewed by 1683

Abstract

Limited data are available on outcomes among COVID-19 patients beyond the acute phase of the disease. All-cause mortality among our COVID-19 patients one year after hospital discharge and factors/conditions associated with death were evaluated. All patients discharged from our COVID center were periodically [...] Read more.

Limited data are available on outcomes among COVID-19 patients beyond the acute phase of the disease. All-cause mortality among our COVID-19 patients one year after hospital discharge and factors/conditions associated with death were evaluated. All patients discharged from our COVID center were periodically evaluated by clinical assessment and by digital healthcare registry consultation. All findings acquired on discharge day represented the baseline data and were utilized for statistics. Of the 208 patients admitted, 187 patients were discharged. Among these, 17 patients died within 12 months (non-survivors). Compared to survivors, non-survivor patients were significantly (p < 0.05) older, exhibited significantly greater comorbidities and prevalence of active malignancy, heart failure, and arrhythmias, and showed significantly higher circulating levels of B-type natriuretic peptide, troponin, C-reactive protein, and d-dimer, as well as a longer heart-rate-corrected QT interval and significantly lower values for the glomerular filtration rate. Following multivariate analysis, cancer, arrhythmias, and high C-reactive protein levels were found to be factors independently associated with death. At the one-year follow-up, about 9% of patients discharged from our COVID center had a fatal outcome. Ageing, myocardial injury, impaired renal function, and, in particular, cancer, hyperinflammation, and arrhythmias represented strong predictors of the worst long-term outcome among COVID-19 patients. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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13 pages, 863 KiB

Open AccessArticle

Change in the Clinical Picture of Hospitalized Patients with COVID-19 between the Early and Late Period of Dominance of the Omicron SARS-CoV-2 Variant

by Robert Flisiak, Dorota Zarębska-Michaluk, Krystyna Dobrowolska, Marta Rorat, Magdalena Rogalska, Justyna Anna Kryńska, Anna Moniuszko-Malinowska, Piotr Czupryna, Dorota Kozielewicz, Jerzy Jaroszewicz, Katarzyna Sikorska, Agnieszka Bednarska, Anna Piekarska and Piotr Rzymski

J. Clin. Med. 2023, 12(17), 5572; https://doi.org/10.3390/jcm12175572 - 26 Aug 2023

Cited by 12 | Viewed by 1790

Abstract

This study aimed to compare the clinical picture of COVID-19 in the initial and later period of Omicron dominance and to identify populations still at risk. A retrospective comparison of the clinical data of 965 patients hospitalized during the early period of Omicron’s [...] Read more.

This study aimed to compare the clinical picture of COVID-19 in the initial and later period of Omicron dominance and to identify populations still at risk. A retrospective comparison of the clinical data of 965 patients hospitalized during the early period of Omicron’s dominance (EO, January–June 2022) with 897 patients from a later period (LO, July 2022–April 2023) from the SARSTer database was performed. Patients hospitalized during LO, compared to EO, were older, had a better clinical condition on admission, had a lower need for oxygen and mechanical ventilation, had less frequent lung involvement in imaging, and showed much faster clinical improvement. Moreover, the overall mortality during EO was 14%, higher than that in LO—9%. Despite the milder course of the disease, mortality exceeding 15% was similar in both groups among patients with lung involvement. The accumulation of risk factors such as an age of 60+, comorbidities, lung involvement, and oxygen saturation <90% resulted in a constant need for oxygen in 98% of patients, an 8% risk of mechanical ventilation, and a 30% mortality rate in the LO period. Multiple logistic regression revealed lower odds of death during the LO phase. Despite the milder course of infections caused by the currently dominant subvariants, COVID-19 prophylaxis is necessary in people over 60 years of age, especially those with comorbidities, and in the case of pneumonia and respiratory failure. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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10 pages, 1045 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic in Spain in the Successive Pandemic Waves on Hemodialysis Patients and Healthcare Personnel

by Sebastian Mas-Fontao, Blanca Miranda-Serrano, David Hernán, Raúl López, Paula Manso, Fabiola Dapena, Mº Luz Sánchez-Tocino, Jose Guerrero, Mónica Pereira, Damián Carneiro, Adriana Iglesias, Lola Piña, Elena Guerrero, Marta San Juan, Cristina Ledesma, Alicia González, Araceli Rossignoli, Concepción Pereira, Marina Burgos, Ana Mª Sacristán, Emilio González-Parra and María Dolores Arenas Show full author list Hide full author list

J. Clin. Med. 2023, 12(13), 4337; https://doi.org/10.3390/jcm12134337 - 28 Jun 2023

Cited by 1 | Viewed by 1464

Abstract

(1) Background: The impact of SARS-CoV-2 has been variable over the time course of the pandemic and in different populations. The aim was to analyze the impact of COVID-19 infection in a known population of hemodialysis (HD) patients and professionals in Spain at [...] Read more.

(1) Background: The impact of SARS-CoV-2 has been variable over the time course of the pandemic and in different populations. The aim was to analyze the impact of COVID-19 infection in a known population of hemodialysis (HD) patients and professionals in Spain at different times of the pandemic. (2) Methods: We conducted an observational, descriptive study with a follow-up from 3 March 2020 to 23 April 2022 (776 days), using in average of 414 professionals and 1381 patients from 18 HD units in Spain. The data from the positive PCR or the rapid antigen detection test (RADT) subject were analyzed and segmented into six periods (waves). (3) Results: Of 703 positive COVID-19 tests, 524 were HD patients (74.5%), and 179 were HD professionals (25.5%). Overall, 38% of staff and 43% of patients were affected. Differences were observed in regard to incidence (21% vs. 13%), mortality (3.5% vs. 0%), and symptomatology between the patients and professionals and throughout the pandemic. (4) Conclusions: COVID-19 severity varied during different pandemic waves, with a greater impact seen in the first wave. HD professionals and patients had similar infection rates, but patients had higher mortality rates. Community transmission was the primary route of infection. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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9 pages, 413 KiB

Open AccessArticle

From Acute Phase to Long COVID: A Cross-Sectional Study of the Epidemiological Profile and Clinical Evaluation of SARS-CoV-2 Infection in Employees at a Pediatric Hospital

by Marielen Ribeiro Tavares da Silva, Ana Paula Costa, Amanda Almeida da Luz, Caio Henrique Pelaio, Felipe Baleche Cruz, Giovanna Fischer Steil, Heloisa Ihle Garcia Giamberardino and Carolina Prando

J. Clin. Med. 2023, 12(13), 4325; https://doi.org/10.3390/jcm12134325 - 27 Jun 2023

Cited by 2 | Viewed by 1115

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic began in Brazil on 26 February 2020. By 6 May 2023, 37.4 million cases had been confirmed, causing 701 thousand deaths in the country. We aimed to describe the epidemiological profile and clinical development of COVID-19 [...] Read more.

Background: The coronavirus disease 2019 (COVID-19) pandemic began in Brazil on 26 February 2020. By 6 May 2023, 37.4 million cases had been confirmed, causing 701 thousand deaths in the country. We aimed to describe the epidemiological profile and clinical development of COVID-19 cases among the employees of a health institution, from acute infection to long COVID. Methods: This was a longitudinal study using a retrospective and prospective approach via questionnaires referring to epidemiological investigation, which was the inclusion criteria, and about long-term symptoms. Results: A total of 809 employees were detected with SARS-CoV-2 infection via RT-PCR, 466 of them answered the epidemiological investigation, and 101 completed the Long COVID Symptom Questionnaire. The most commonly affected employees were women (88.6%) working in patient care (68.6%). Headache, myalgia, cough, odynophagia, and runny nose were the most frequent symptoms. Only three employees (0.6%) required hospitalization, while the other employees required outpatient management due to mild symptoms. We identified 19 (4.1%) cases of reinfection, and 42 (41.6%) employees reported long-term symptoms, such as myalgia, dyspnea, and headache. Conclusions: Although most cases were mild with good outcomes, long COVID cases identified are noteworthy, as these symptoms may impact quality of life even months after SARS-CoV-2 infection. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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18 pages, 1010 KiB

Open AccessArticle

Treatment of COVID-19 during the Acute Phase in Hospitalized Patients Decreases Post-Acute Sequelae of COVID-19

by Diana Badenes Bonet, Oswaldo Antonio Caguana Vélez, Xavier Duran Jordà, Merce Comas Serrano, Margarita Posso Rivera, Mireia Admetlló, Anna Herranz Blasco, Elisa Cuadrado Godia, Ester Marco Navarro, Gemma Martin Ezquerra, Zenaida Pineiro Aguin, Maria Cinta Cumpli Gargallo, Jose Gregorio Gonzalez Garcia, Eva Balcells Vilarnau, Diego Rodriguez Chiaradia, Xavier Castells, Joaquim Gea, Juan P. Horcajada and Judit Villar-García

J. Clin. Med. 2023, 12(12), 4158; https://doi.org/10.3390/jcm12124158 - 20 Jun 2023

Cited by 7 | Viewed by 2117

Abstract

Background: The post-acute sequelae of SARS-CoV-2 (PASC) infection have caused a significant impact on our health system, but there is limited evidence of approved drugs focused on its prevention. Our objective was to identify risk factors that can determine the presence of PASC, [...] Read more.

Background: The post-acute sequelae of SARS-CoV-2 (PASC) infection have caused a significant impact on our health system, but there is limited evidence of approved drugs focused on its prevention. Our objective was to identify risk factors that can determine the presence of PASC, with special attention to the treatment received in the acute phase, and to describe the profile of persistent symptoms in a multidisciplinary Post-Coronavirus Disease-19 (COVID-19) Unit. Methods: This one-year prospective observational study included patients following an acute COVID-19 infection, irrespective of whether they required hospital admission. A standardized symptom questionnaire and blood sampling were performed at the first follow-up visit, and demographic and clinical electronic data were collected. We compared subjects with PASC with those who had fully recovered. Multivariate logistic regression was performed to identify factors associated with PASC in hospitalized patients, and Kaplan–Meier curves were used to assess duration of symptoms according to disease severity and treatments received in the acute phase. Results: 1966 patients were evaluated; 1081 had mild disease, 542 moderate and 343 severe; around one third of the subjects had PASC, and were more frequently female, with obesity, asthma, and eosinophilia during acute COVID-19 disease. Patients who received treatment with dexamethasone and remdesivir during the course of the acute illness showed a lower median duration of symptoms, compared with those who received none of these treatments. Conclusion: Treatment with dexamethasone and/or remdesivir may be useful to reduce the impact of PASC secondary to SARS-CoV-2 infection. In addition, we identified female gender, obesity, asthma, and disease severity as risk factors for having PASC. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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12 pages, 1609 KiB

Open AccessArticle

Impact of COVID-19 on Sedation Requirements during Veno-Venous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome

by Maria Paparoupa, Marlene Fischer, Hans O. Pinnschmidt, Jörn Grensemann, Kevin Roedl, Stefan Kluge and Dominik Jarczak

J. Clin. Med. 2023, 12(10), 3515; https://doi.org/10.3390/jcm12103515 - 17 May 2023

Cited by 1 | Viewed by 1520

Abstract

COVID-19-associated ARDS (C-ARDS) is mentioned to express higher analgosedation needs, in comparison to ARDS of other etiologies. The objective of this monocentric retrospective cohort study was to compare the analgosedation needs between C-ARDS and non-COVID-19 ARDS (non-C-ARDS) on veno-venous extracorporeal membrane oxygenation (VV-ECMO). [...] Read more.

COVID-19-associated ARDS (C-ARDS) is mentioned to express higher analgosedation needs, in comparison to ARDS of other etiologies. The objective of this monocentric retrospective cohort study was to compare the analgosedation needs between C-ARDS and non-COVID-19 ARDS (non-C-ARDS) on veno-venous extracorporeal membrane oxygenation (VV-ECMO). Data were collected from the electronic medical records of all adult patients treated with C-ARDS in our Department of Intensive Care Medicine between March 2020 and April 2022. The control group included patients treated with non-C-ARDS between the years 2009 and 2020. A sedation sum score was created in order to describe the overall analgosedation needs. A total of 115 (31.5%) patients with C-ARDS and 250 (68.5%) with non-C-ARDS requiring VV-ECMO therapy were included in the study. The sedation sum score was significantly higher in the C-ARDS group (p < 0.001). COVID-19 was significantly associated with analgosedation in the univariable analysis. By contrast, the multivariable model did not show a significant association between COVID-19 and the sum score. The year of VV-ECMO support, BMI, SAPS II and prone positioning were significantly associated with sedation needs. The potential impact of COVID-19 remains unclear, and further studies are warranted in order to evaluate specific disease characteristics linked with analgesia and sedation. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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12 pages, 293 KiB

Open AccessArticle

Association of Pre-Pregnancy Obesity and COVID-19 with Poor Pregnancy Outcome

by Sladjana Mihajlovic, Dejan Nikolic, Biljana Milicic, Milena Santric-Milicevic, Natalya Glushkova, Zhansaya Nurgalieva and Milan Lackovic

J. Clin. Med. 2023, 12(8), 2936; https://doi.org/10.3390/jcm12082936 - 18 Apr 2023

Cited by 5 | Viewed by 1462

Abstract

Background and Objectives: During the COVID-19 pandemic, a possible overlap of obesity and COVID-19 infection has raised concerns among patients and healthcare professionals about protecting pregnant women from developing a severe infection and unwanted pregnancy outcomes. The aim of this study was to [...] Read more.

Background and Objectives: During the COVID-19 pandemic, a possible overlap of obesity and COVID-19 infection has raised concerns among patients and healthcare professionals about protecting pregnant women from developing a severe infection and unwanted pregnancy outcomes. The aim of this study was to evaluate the associations of body mass index with clinical, laboratory, and radiology diagnostic parameters as well as pregnancy complications and maternal outcomes in pregnant patients with COVID-19. Materials and Methods: Clinical status, laboratory, and radiology diagnostic parameters and pregnancy outcomes were analyzed for pregnant women hospitalized between March 2020 and November 2021 in one tertiary-level university clinic in Belgrade, Serbia, due to infection with SARS-CoV-2. Pregnant women were divided into the three sub-groups according to their pre-pregnancy body mass index. For testing the differences between groups, a two-sided p-value <0.05 (the Kruskal–Wallis and ANOVA tests) was considered statistically significant. Results: Out of 192 hospitalized pregnant women, obese pregnant women had extended hospitalizations, including ICU duration, and they were more likely to develop multi-organ failure, pulmonary embolism, and drug-resistant nosocomial infection. Higher maternal mortality rates, as well as poor pregnancy outcomes, were also more likely to occur in the obese group of pregnant women. Overweight and obese pregnant women were more likely to develop gestational hypertension, and they had a higher grade of placental maturity. Conclusions: Obese pregnant women hospitalized due to COVID-19 infection were more likely to develop severe complications. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

10 pages, 652 KiB

Open AccessArticle

Sex, Age, and Comorbidities Are Associated with SARS-CoV-2 Infection, COVID-19 Severity, and Fatal Outcome in a Mexican Population: A Retrospective Multi-Hospital Study

by Maria Elena Camacho Moll, Viviana Leticia Mata Tijerina, Beatriz Silva Ramírez, Katia Peñuelas Urquides, Laura Adiene González Escalante, Brenda Leticia Escobedo Guajardo, Jorge Eleazar Cruz Luna, Roberto Corrales Pérez, Salvador Gómez García and Mario Bermúdez de León

J. Clin. Med. 2023, 12(7), 2676; https://doi.org/10.3390/jcm12072676 - 3 Apr 2023

Cited by 11 | Viewed by 2111

Abstract

People with comorbidities and the male sex are at a higher risk of developing severe COVID-19. In the present study, we aim to investigate the associated factors for infection, severity, and death due to COVID-19 in a population from Nuevo León, México. Epidemiological [...] Read more.

People with comorbidities and the male sex are at a higher risk of developing severe COVID-19. In the present study, we aim to investigate the associated factors for infection, severity, and death due to COVID-19 in a population from Nuevo León, México. Epidemiological COVID-19 data were collected from 65 hospitals from December 2020 to May 2022. A total of 75,232 cases were compiled from which 25,722 cases were positive for SARS-CoV-2. Male sex, older age, diabetes, obesity, and hypertension were associated with infection. In addition to the above-mentioned factors, renal disease, cardiovascular disease, and immunosuppression were found to be associated with increased COVID-19 severity. These factors, as well as neurological diseases, are also associated with death due to COVID-19. When comparing the different variants of SARs-CoV-2, the variant B1.1.519 increased the probability of death by 2.23 times compared to the AY.20 variant. Male sex, older age, diabetes, obesity, and hypertension are associated with SARS-CoV-2 infection, severity, and death. Along with the aforementioned comorbidities, renal disease, cardiovascular disease, and immunosuppression are also associated with severity and death. Another factor associated with death is the presence of neurological disease. The SARS-CoV-2 B1.1.519 variant increases the odds of death compared to the SARS-CoV-2 AY.20 variant. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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13 pages, 1289 KiB

Open AccessArticle

The Relative Contributions of Occupational and Community Risk Factors for COVID-19 among Hospital Workers: The HOP-COVID Cohort Study

by Sylvie Bastuji-Garin, Ludivine Brouard, Irma Bourgeon-Ghittori, Sonia Zebachi, Emmanuelle Boutin, Francois Hemery, Frédéric Fourreau, Nadia Oubaya, Quentin De Roux, Nicolas Mongardon, Slim Fourati and Jean-Winoc Decousser

J. Clin. Med. 2023, 12(3), 1208; https://doi.org/10.3390/jcm12031208 - 2 Feb 2023

Viewed by 1336

Abstract

The relative contributions of occupational and community sources of COVID-19 among health-care workers (HCWs) are still subject to debate. In a cohort study at a 2814-bed tertiary medical center (five hospitals) in the Paris area of France, we assessed the proportion of hospital-acquired [...] Read more.

The relative contributions of occupational and community sources of COVID-19 among health-care workers (HCWs) are still subject to debate. In a cohort study at a 2814-bed tertiary medical center (five hospitals) in the Paris area of France, we assessed the proportion of hospital-acquired cases among staff and identified risk factors. Between May 2020 and June 2021, HCWs were invited to complete a questionnaire on their COVID-19 risk factors. RT-PCR and serology test results were retrieved from the virology department. Mixed-effects logistic regression was used to account for clustering by hospital. The prevalence of COVID-19 was 15.6% (n = 213/1369 respondents) overall, 29.7% in the geriatric hospitals, and 56.8% of the infections were hospital-acquired. On multivariable analyses adjusted for COVID-19 incidence and contact in the community, a significantly higher risk was identified for staff providing patient care (especially nursing assistants), staff from radiology/functional assessment units and stretcher services, and staff working on wards with COVID-19 clusters among patients or HCWs. The likelihood of infection was greater in geriatric wards than in intensive care units. The presence of significant occupational risk factors after adjustment for community exposure is suggestive of a high in-hospital risk and emphasizes the need for stronger preventive measures—especially in geriatric settings. Clinicaltrials.gov NCT04386759. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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10 pages, 399 KiB

Open AccessArticle

The Influence of Sex on Characteristics and Outcomes of Coronavirus-19 Patients: A Retrospective Cohort Study

by Song-I Lee, Chaeuk Chung, Dongil Park, Da Hyun Kang, Ye-Rin Ju and Jeong Eun Lee

J. Clin. Med. 2023, 12(3), 1118; https://doi.org/10.3390/jcm12031118 - 31 Jan 2023

Cited by 1 | Viewed by 1877

Abstract

Background: The influence of sex on the clinical characteristics and prognosis of coronavirus disease (COVID-19) patients is variable. This study aimed to evaluate COVID-19 management based on sex differences. Methods: We retrospectively reviewed COVID-19 patients who were admitted to the tertiary hospital between [...] Read more.

Background: The influence of sex on the clinical characteristics and prognosis of coronavirus disease (COVID-19) patients is variable. This study aimed to evaluate COVID-19 management based on sex differences. Methods: We retrospectively reviewed COVID-19 patients who were admitted to the tertiary hospital between January 2020 and March 2021. Logistic regression analysis was used to evaluate the factors associated with in-hospital mortality. Results: During the study period, 584 patients were admitted to our hospital. Among them, 305 patients (52.2%) were female, and 279 patients (47.8%) were male. Males were younger than females, and frailty scale was lower in males than in females. Fever was more common in males, and there was no difference in other initial symptoms. Among the underlying comorbidities, chronic obstructive disease was more common in males, and there were no significant differences in other comorbidities. Moreover, treatment, severity, and outcome did not significantly differ between the groups. The risk factors for in-hospital mortality were age, high white blood cell count, and c-reactive protein level. Conclusions: We found no definite sex differences in the clinical characteristics and outcomes of COVID-19 patients. However, a better understanding of sex-dependent differences in COVID-19 patients could help in understanding and treating patients. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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13 pages, 635 KiB

Open AccessArticle

by Lidia Stopyra, Aleksandra Kowalik, Justyna Stala, Ida Majchrzak, Justyna Szebla, Mateusz Jakosz and Przemko Kwinta

J. Clin. Med. 2022, 11(24), 7347; https://doi.org/10.3390/jcm11247347 - 10 Dec 2022

Cited by 3 | Viewed by 1666

Abstract

Since the beginning of the pandemic, many reports have pointed to age as the most important risk factor for severe COVID-19 in adults, but this relationship is less clear in children. Between March 2020 and April 2022, 1405 pediatric COVID-19 patients were included [...] Read more.

Since the beginning of the pandemic, many reports have pointed to age as the most important risk factor for severe COVID-19 in adults, but this relationship is less clear in children. Between March 2020 and April 2022, 1405 pediatric COVID-19 patients were included in our prospective study, which aimed to analyze the disease’s characteristics in three age groups: infants, toddlers (1–5 years), and children (5–18 years). We observed male prevalence of the disease in infants and toddlers compared to female prevalence in children. Comorbidities appeared most often in children. In the first pandemic wave, the vast majority of pediatric patients were children, but later, the percentage of infant and toddler patients increased significantly. A total of 74% of hospitalized children were younger than five years. Upper respiratory tract symptoms were most common in infants and toddlers, and lower respiratory tract symptoms and gastroenterocolitis were more common in children. Neurological symptoms appeared similarly in all age groups. The activities of ALT, CK, and LDH were the most elevated in infants, along with D-dimers. The median length of hospitalization fluctuated between three and four days and was highest in infants. Severe courses were more common in adolescents. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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13 pages, 785 KiB

Open AccessArticle

Admission Predictors of Mortality in Hospitalized COVID-19 Patients—A Serbian Cohort Study

by Mina Poskurica, Đorđe Stevanović, Vladimir Zdravković, Ivan Čekerevac, Vojislav Ćupurdija, Nebojša Zdravković, Tomislav Nikolić, Marina Marković, Marina Jovanović, Marija Popović, Katarina Vesić, Ana Azanjac Arsić, Snežana Lazarević, Andra Jevtović, Aleksandar Patrnogić, Marija Anđelković and Marina Petrović

J. Clin. Med. 2022, 11(20), 6109; https://doi.org/10.3390/jcm11206109 - 17 Oct 2022

Cited by 4 | Viewed by 2127

Abstract

Background: Early prediction of COVID-19 patients’ mortality risk may be beneficial in adequate triage and risk assessment. Therefore, we aimed to single out the independent morality predictors of hospitalized COVID-19 patients among parameters available on hospital admission. Methods: An observational, retrospective–prospective cohort study [...] Read more.

Background: Early prediction of COVID-19 patients’ mortality risk may be beneficial in adequate triage and risk assessment. Therefore, we aimed to single out the independent morality predictors of hospitalized COVID-19 patients among parameters available on hospital admission. Methods: An observational, retrospective–prospective cohort study was conducted on 703 consecutive COVID-19 patients hospitalized in the University Clinical Center Kragujevac between September and December 2021. Patients were followed during the hospitalization, and in-hospital mortality was observed as a primary end-point. Within 24 h of admission, patients were sampled for blood gas and laboratory analysis, including complete blood cell count, inflammation biomarkers and other biochemistry, coagulation parameters, and cardiac biomarkers. Socio-demographic and medical history data were obtained using patients’ medical records. Results: The overall prevalence of mortality was 28.4% (n = 199). After performing multiple regression analysis on 20 parameters, according to the initial univariate analysis, only four independent variables gave statistically significant contributions to the model: SaO2 < 88.5 % (aOR 3.075), IL-6 > 74.6 pg/mL (aOR 2.389), LDH > 804.5 U/L (aOR 2.069) and age > 69.5 years (aOR 1.786). The C-index of the predicted probability calculated using this multivariate logistic model was 0.740 (p < 0.001). Conclusions: Parameters available on hospital admission can be beneficial in predicting COVID-19 mortality. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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12 pages, 1159 KiB

Open AccessArticle

External Validation of Mortality Scores among High-Risk COVID-19 Patients: A Romanian Retrospective Study in the First Pandemic Year

by Amanda Rădulescu, Mihaela Lupse, Alexandru Istrate, Mihai Calin, Adriana Topan, Nicholas Florin Kormos, Raul Vlad Macicasan and Violeta Briciu

J. Clin. Med. 2022, 11(19), 5630; https://doi.org/10.3390/jcm11195630 - 24 Sep 2022

Cited by 2 | Viewed by 1461

Abstract

Background: We aimed to externally validate three prognostic scores for COVID-19: the 4C Mortality Score (4CM Score), the COVID-GRAM Critical Illness Risk Score (COVID-GRAM), and COVIDAnalytics. Methods: We evaluated the scores in a retrospective study on adult patients hospitalized with severe/critical COVID-19 (1 [...] Read more.

Background: We aimed to externally validate three prognostic scores for COVID-19: the 4C Mortality Score (4CM Score), the COVID-GRAM Critical Illness Risk Score (COVID-GRAM), and COVIDAnalytics. Methods: We evaluated the scores in a retrospective study on adult patients hospitalized with severe/critical COVID-19 (1 March 2020–1 March 2021), in the Teaching Hospital of Infectious Diseases, Cluj-Napoca, Romania. We assessed all the deceased patients matched with two survivors by age, gender, and at least two comorbidities. The areas under the receiver-operating characteristic curves (AUROCs) were computed for in-hospital mortality. Results: Among 780 severe/critical COVID-19 patients, 178 (22.8%) died. We included 474 patients according to the case definition (158 deceased/316 survivors). The median age was 75 years; diabetes mellitus, malignancies, chronic pulmonary diseases, and chronic kidney and moderate/severe liver diseases were associated with higher risks of death. According to the predefined 4CM Score, the mortality rates were 0% (low), 13% (intermediate), 27% (high), and 61% (very high). The AUROC for the 4CM Score was 0.72 (95% CI: 0.67–0.77) for in-hospital mortality, close to COVID-GRAM, with slightly greater discriminatory ability for COVIDAnalytics: 0.76 (95% CI: 0.71–0.80). Conclusion: All the prognostic scores showed close values compared to their validation cohorts, were fairly accurate in predicting mortality, and can be used to prioritize care and resources. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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11 pages, 2417 KiB

Open AccessArticle

Evaluation of a Triage Checklist for Mild COVID-19 Outpatients in Predicting Subsequent Emergency Department Visits and Hospitalization during the Isolation Period: A Single-Center Retrospective Study

by Yasuhiro Tanaka, Kazuko Yamamoto, Shimpei Morimoto, Takeshi Nabeshima, Kayoko Matsushima, Hiroshi Ishimoto, Nobuyuki Ashizawa, Tatsuro Hirayama, Kazuaki Takeda, Hiroshi Gyotoku, Naoki Iwanaga, Shinnosuke Takemoto, Susumu Fukahori, Takahiro Takazono, Hiroyuki Yamaguchi, Takashi Kido, Noriho Sakamoto, Naoki Hosogaya, Shogo Akabame, Takashi Sugimoto, Hirotomo Yamanashi, Kosuke Matsui, Mai Izumida, Ayumi Fujita, Masato Tashiro, Takeshi Tanaka, Koya Ariyoshi, Akitsugu Furumoto, Kouichi Morita, Koichi Izumikawa, Katsunori Yanagihara and Hiroshi Mukae Show full author list Hide full author list

J. Clin. Med. 2022, 11(18), 5444; https://doi.org/10.3390/jcm11185444 - 16 Sep 2022

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Abstract

Managing mild illness in COVID-19 and predicting progression to severe disease are concerning issues. Here, we investigated the outcomes of Japanese patients with mild COVID-19, and identified triage risk factors for further hospitalization and emergency department (ED) visits at a single tertiary hospital. [...] Read more.

Managing mild illness in COVID-19 and predicting progression to severe disease are concerning issues. Here, we investigated the outcomes of Japanese patients with mild COVID-19, and identified triage risk factors for further hospitalization and emergency department (ED) visits at a single tertiary hospital. A triage checklist with 30 factors was used. Patients recommended for isolation were followed up for 10 days for subsequent ED visits or hospital admission. Overall, 338 patients (median age, 44.0; 45% women) visited the clinic 5.0 days (median) after symptom onset. Thirty-six patients were immediately hospitalized following triage; others were isolated. In total, 72 non-hospitalized patients visited the ED during their isolation, and 30 were hospitalized after evaluation for oxygen desaturation. The median ED visit and hospitalization durations after symptom onset were 5.0 and 8.0 days, respectively. The checklist factors associated with hospitalization during isolation were age > 50 years, body mass index > 25 kg/m², hypertension, tachycardia with pulse rate > 100/min or blood pressure > 135 mmHg at triage, and >3-day delay in hospital visit after symptom onset. No patients died. Altogether, 80% of patients with mild COVID-19 could be safely isolated at home. Age, BMI, underlying hypertension, date after symptom onset, tachycardia, and systolic blood pressure at triage might be related to later hospitalization. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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13 pages, 3308 KiB

Open AccessArticle

Plasma Endothelial and Oxidative Stress Biomarkers Associated with Late Mortality in Hospitalized COVID-19 Patients

by Arturo Orea-Tejada, Carlos Sánchez-Moreno, Octavio Gamaliel Aztatzi-Aguilar, Martha Patricia Sierra-Vargas, Dulce González-Islas, Yazmín Debray-García, Manolo Sibael Ortega-Romero, Candace Keirns-Davis, Laura Cornejo-Cornejo and Jorge Aguilar-Meza

J. Clin. Med. 2022, 11(14), 3950; https://doi.org/10.3390/jcm11143950 - 7 Jul 2022

Cited by 9 | Viewed by 1908

Abstract

Background: Coronavirus infectious disease 2019 (COVID-19) is a significant public health problem worldwide. COVID-19 increases the risk of non-pulmonary complications such as acute myocardial injury, renal failure, thromboembolic events, and multi-organic damage. Several studies have documented increased inflammation molecules, endothelial dysfunction biomarkers, and [...] Read more.

Background: Coronavirus infectious disease 2019 (COVID-19) is a significant public health problem worldwide. COVID-19 increases the risk of non-pulmonary complications such as acute myocardial injury, renal failure, thromboembolic events, and multi-organic damage. Several studies have documented increased inflammation molecules, endothelial dysfunction biomarkers, and dysregulation of coagulation factors in COVID-19 patients. In addition, endothelium dysfunction is exacerbated by the oxidative stress (OxS) promoted by endocrine and cardiovascular molecules. Our objective was to evaluate whether endothelial and OxS biomarkers were associated with mortality in hospitalized COVID-19 patients. Methods: A prospective cohort study was performed. Patients ≥18 years old with confirmed COVID-19 that required hospitalization were included in a prospective cohort study. Endothelium and oxidative stress biomarkers were collected between 3 and 5 days after admission. Results: A total of 165 patients were evaluated; 56 patients succumbed. The median follow-up was 71 days [23–129]. Regarding endothelial dysfunction and OxS biomarkers, patients who did not survive had higher levels of nitrates (0.4564 [0.1817–0.6761] vs. 0.2817 [0.0517–0.5], p = 0.014), total nitrates (0.0507 [−0.0342–0.1809] vs. −0.0041 [−0.0887–0.0909], p = 0.016), sE-Selectin (1.095 [0.86–1.495] vs. 0.94 [0.71–1.19], p = 0.004), and malondialdehyde (MDA) (0.50 [0.26–0.72] vs. 0.36 [0.23–0.52], p = 0.010) compared to patients who survived. Endothelial and OxS biomarkers independently associated with mortality were sE-selectin (HR:2.54, CI95%; from 1.11 to 5.81, p = 0.027), nitrates (HR:4.92, CI95%; from 1.23 to 19.63, p = 0.024), and MDA (HR: 3.05, CI95%; from 1.14 to 8.15, p = 0.025). Conclusions: Endothelial dysfunction (sE-selectin and nitrates) and OxS (MDA) are independent indicators of a worse prognosis in COVID-19 patients requiring hospitalization. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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9 pages, 482 KiB

Open AccessBrief Report

Importance of Demographic and Clinical Features in Evaluating the Severity of COVID-19 in Hospitalized Patients: A Serbian Retrospective Study in the First Pandemic Year

by Jelena Aritonovic Pribakovic, Milica Peric, Aleksandra Milenkovic, Aleksandra Janicevic, Snezana Hadzistevic, Aleksandra Ilic, Mirjana Stojanovic-Tasic, Kristina Bulatovic, Dragisa Rasic and Jadranka Mitic

J. Clin. Med. 2023, 12(14), 4638; https://doi.org/10.3390/jcm12144638 - 12 Jul 2023

Cited by 1 | Viewed by 1185

Abstract

The aim of this study is to determine the demographic and initial clinical characteristics of patients with COVID-19 and their importance in evaluating the severity of the disease. A retrospective study included patients suffering from COVID-19 who were hospitalized at The Department of [...] Read more.

The aim of this study is to determine the demographic and initial clinical characteristics of patients with COVID-19 and their importance in evaluating the severity of the disease. A retrospective study included patients suffering from COVID-19 who were hospitalized at The Department of Infectious Disease of the Clinical Hospital Center Pristina—Gracanica from the beginning of the pandemic until the end of 2020. We compared the symptoms of the disease, radiographic findings of pneumonia, laboratory parameters, duration of symptoms before admission, the difference in the need for certain therapies, and the presence of comorbidities between non-severe and severe groups of patients. Patients with a severe disease were statistically significantly older. Hypertension was significantly associated with severe clinical conditions. Radiographic findings of bilateral pneumonia on admission were much more frequent among the severe group, and these patients’ need for oxygen support was significantly higher. Lower neutrophil and higher lymphocyte counts were statistically significant in the non-severe group. Biochemical parameters at admission also showed statistical significance between the examined groups. Based on our research, we can conclude that a complete overview of the patient, including demographic and laboratory parameters as perhaps the most significant attributes, can help doctors in the timely clinical assessment of patients and, thus, in the timely application of adequate therapeutic protocols in the treatment of COVID-19. Full article

(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)

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