bims-covirf 2020-12-06 papers

Issue of 2020–12–06
five papers selected by
Catherine Rycroft, BresMed

Euro Surveill. 2020 Dec;25(48):

Clinical characteristics and risk factors associated with severe COVID-19: prospective analysis of 1,045 hospitalised cases in North-Eastern France, March 2020.

Covid Alsace Study Group

BackgroundIn March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization.AimOur objective was to identify risk factors predictive of severe disease and death in France.MethodsIn this prospective cohort study, we included patients ≥ 18 years old with confirmed COVID-19, hospitalised in Strasbourg and Mulhouse hospitals (France), in March 2020. We respectively compared patients who developed severe disease (admission to an intensive care unit (ICU) or death) and patients who died, to those who did not, by day 7 after hospitalisation.ResultsAmong 1,045 patients, 424 (41%) had severe disease, including 335 (32%) who were admitted to ICU, and 115 (11%) who died. Mean age was 66 years (range: 20-100), and 612 (59%) were men. Almost 75% of patients with body mass index (BMI) data (n = 897) had a BMI ≥ 25 kg/m2 (n = 661). Independent risk factors associated with severe disease were advanced age (odds ratio (OR): 1.1 per 10-year increase; 95% CrI (credible interval): 1.0-1.2), male sex (OR: 2.1; 95% CrI: 1.5-2.8), BMI of 25-29.9 kg/m2 (OR: 1.8; 95% CrI: 1.2-2.7) or ≥ 30 (OR: 2.2; 95% CrI: 1.5-3.3), dyspnoea (OR: 2.5; 95% CrI: 1.8-3.4) and inflammatory parameters (elevated C-reactive protein and neutrophil count, low lymphocyte count). Risk factors associated with death were advanced age (OR: 2.7 per 10-year increase; 95% CrI: 2.1-3.4), male sex (OR: 1.7; 95% CrI: 1.1-2.7), immunosuppression (OR: 3.8; 95% CrI: 1.6-7.7), diabetes (OR: 1.7; 95% CrI: 1.0-2.7), chronic kidney disease (OR: 2.3; 95% CrI: 1.3-3.9), dyspnoea (OR: 2.1; 95% CrI: 1.2-3.4) and inflammatory parameters.ConclusionsOverweightedness, obesity, advanced age, male sex, comorbidities, dyspnoea and inflammation are risk factors for severe COVID-19 or death in hospitalised patients. Identifying these features among patients in routine clinical practice might improve COVID-19 management.

Keywords: COVID-19; coronavirus; death; outcome; risk factors

DOI: https://doi.org/10.2807/1560-7917.ES.2020.25.48.2000895

Int J Environ Res Public Health. 2020 Nov 28. pii: E8847. [Epub ahead of print]17(23):

Risk Factors on the Progression to Clinical Outcomes of COVID-19 Patients in South Korea: Using National Data.

Seon-Rye Kim, Seoul-Hee Nam, Yu-Rin Kim.

10-20% of COVID (Corona Virus Disease)-19 cases proceed to a severe stage, and age and the presence of comorbidity increased the risk of death from COVID-19. The identification of risk factors on progression to the severity stages is essential in providing more efficient and suitable management to COVID-19 patients. However, there is insufficient study on risk factors for severity stages of COVID-19 patients. In this study, 2959 confirmed COVID-19 patients were analyzed while using national data, COVID-19 patients Clinical Epidemiological Information provided from the Korea Disease Control and Prevention Agency. The epidemiological variable, hospital room, periods from confirmation to release, initial symptom and vital signs, underlying comorbidities, and initial blood variables were used to verify the relation with progression to severity stages of COVID-19 and severe COVID-19. The chi-square test, welch test, multiple regression and logistic regression analysis were performed. The ICU (Intensive Care Unit) admission rate of patients having characteristics, such as older age, male, abnormal BMI (Body Mass Index), high heart rate, high body temperature, fever, cough, sputum, sore throat, rhinorrhea, fatigue, dyspnea, change of consciousness, diabetes mellitus, hypertension, chronic artery disease, chronic kidney disease, cancer, dementia, abnormal hemoglobin, abnormal hematocrit, abnormal lymphocyte, abnormal platelets, and abnormal white blood cell were high. The risk factors for severe COVID-19 were older age, shorter hospitalization, abnormal lymphocyte, abnormal platelets, dyspnea, change of consciousness, and dementia. Whereas, significant predictors for progression to severity stages of COVID-19 were older age, longer period from confirmation to release, higher BMI, higher body temperature, abnormal lymphocyte, abnormal platelets, fever, no sore throat, dyspnea, no headache, COPD (Chronic Obstructive Pulmonary Disease), and dementia. Therefore, classifying patients with a high risk of severe stage of COVID-19 and managing patients by considering the risk factors could be helpful in the efficient management of COVID-19 patients.

Keywords: COVID-19; ICU; blood variables; risk factor; severity

DOI: https://doi.org/10.3390/ijerph17238847

Eur J Med Res. 2020 Dec 02. 25(1): 64

Obesity is associated with increased severity of disease in COVID-19 pneumonia: a systematic review and meta-analysis.

Yanan Chu, Jinxiu Yang, Jiaran Shi, Pingping Zhang, Xingxiang Wang.

BACKGROUND: Obesity has been widely reported to be associated with the disease progression of coronavirus disease 2019 (COVID-19); however, some studies have reported different findings. We conducted a systematic review and meta-analysis to investigate the association between obesity and poor outcomes in patients with COVID-19 pneumonia.
METHODS: A systematic review and meta-analysis of studies from the PubMed, Embase, and Web of Science databases from 1 November 2019 to 24 May 2020 was performed. Study quality was assessed, and data extraction was conducted. The meta-analysis was carried out using fixed-effects and random-effects models to calculate odds ratios (ORs) of several poor outcomes in obese and non-obese COVID-19 patients.
RESULTS: Twenty-two studies (n = 12,591 patients) were included. Pooled analysis demonstrated that body mass index (BMI) was higher in severe/critical COVID-19 patients than in mild COVID-19 patients (MD 2.48 kg/m2, 95% CI [2.00 to 2.96 kg/m2]). Additionally, obesity in COVID-19 patients was associated with poor outcomes (OR = 1.683, 95% CI [1.408-2.011]), which comprised severe COVID-19, ICU care, invasive mechanical ventilation use, and disease progression (OR = 4.17, 95% CI [2.32-7.48]; OR = 1.57, 95% CI [1.18-2.09]; OR = 2.13, 95% CI [1.10-4.14]; OR = 1.41, 95% CI [1.26-1.58], respectively). Obesity as a risk factor was greater in younger patients (OR 3.30 vs. 1.72). However, obesity did not increase the risk of hospital mortality (OR = 0.89, 95% CI [0.32-2.51]).
CONCLUSIONS: As a result of a potentially critical role of obesity in determining the severity of COVID-19, it is important to collect anthropometric information for COVID-19 patients, especially the younger group. However, obesity may not be associated with hospital mortality, and efforts to understand the impact of obesity on the mortality of COVID-19 patients should be a research priority in the future.

Keywords: COVID-19; Meta-analysis; Obesity; Poor outcomes

DOI: https://doi.org/10.1186/s40001-020-00464-9

Med Hypotheses. 2020 Nov;pii: S0306-9877(20)31946-0. [Epub ahead of print]144 110237

Hypotheses about sub-optimal hydration in the weeks before coronavirus disease (COVID-19) as a risk factor for dying from COVID-19.

Jodi D Stookey, Prasanna K R Allu, Dorothee Chabas, David Pearce, Florian Lang.

To address urgent need for strategies to limit mortality from coronavirus disease 2019 (COVID-19), this review describes experimental, clinical and epidemiological evidence that suggests that chronic sub-optimal hydration in the weeks before infection might increase risk of COVID-19 mortality in multiple ways. Sub-optimal hydration is associated with key risk factors for COVID-19 mortality, including older age, male sex, race-ethnicity and chronic disease. Chronic hypertonicity, total body water deficit and/or hypovolemia cause multiple intracellular and/or physiologic adaptations that preferentially retain body water and favor positive total body water balance when challenged by infection. Via effects on serum/glucocorticoid-regulated kinase 1 (SGK1) signaling, aldosterone, tumor necrosis factor-alpha (TNF-alpha), vascular endothelial growth factor (VEGF), aquaporin 5 (AQP5) and/or Na+/K+-ATPase, chronic sub-optimal hydration in the weeks before exposure to COVID-19 may conceivably result in: greater abundance of angiotensin converting enzyme 2 (ACE2) receptors in the lung, which increases likelihood of COVID-19 infection, lung epithelial cells which are pre-set for exaggerated immune response, increased capacity for capillary leakage of fluid into the airway space, and/or reduced capacity for both passive and active transport of fluid out of the airways. The hypothesized hydration effects suggest hypotheses regarding strategies for COVID-19 risk reduction, such as public health recommendations to increase intake of drinking water, hydration screening alongside COVID-19 testing, and treatment tailored to the pre-infection hydration condition. Hydration may link risk factors and pathways in a unified mechanism for COVID-19 mortality. Attention to hydration holds potential to reduce COVID-19 mortality and disparities via at least 5 pathways simultaneously.

Keywords: ACE2 receptors; AQP5; COVID-19; Chronic hydration; Drinking water intervention; Hypertonicity; Mortality; SGK1; Saliva osmolality; VEGF

DOI: https://doi.org/10.1016/j.mehy.2020.110237

medRxiv. 2020 Nov 30. pii: 2020.11.25.20238915. [Epub ahead of print]

Alcohol Consumption is Associated with Poor Prognosis in Obese Patients with COVID-19: a Mendelian Randomization Study using UK Biobank.

Xiude Fan, Zhengwen Liu, Kyle L Poulsen, Xiaoqin Wu, Tatsunori Miyata, Srinivasan Dasarathy, Daniel M Rotroff, Laura E Nagy.

Background: Acute and chronic alcohol abuse have adverse impacts on both the innate and adaptive immune response, which may result in reduced resistance to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and promote the progression of coronavirus disease 2019 (COVID-19). However, there are no large population-based data evaluating potential causal associations between alcohol consumption and COVID-19.
Method: We conducted a Mendelian randomization study using data from UK Biobank to explore the association between alcohol consumption and risk of SARS-CoV-2 infection and serious clinical outcomes in patients with COVID-19. A total of 12,937 participants aged 50-83 who tested for SARS-CoV-2 between 16 March to 27 July 2020 (12.1% tested positive) were included in the analysis. The exposure factor was alcohol consumption. Main outcomes were SARS-CoV-2 positivity and death in COVID-19 patients. We generated weighted and unweighted allele scores using three genetic variants (rs1229984, rs1260326, and rs13107325) and applied the allele scores as the instrumental variables to assess the effect of alcohol consumption on outcomes. Analyses were conducted separately for white participates with and without obesity.
Results: Of the 12,937 participants, 4,496 were never or infrequent drinkers and 8,441 were frequent drinkers. (including 1,156 light drinkers, 3,795 moderate drinkers, and 3,490 heavy drinkers). Both logistic regression and Mendelian randomization analyses found no evidence that alcohol consumption was associated with risk of SARS-CoV-2 infection in participants either with (OR=0.963, 95%CI 0.800-1.159; q =1.000) or without obesity (OR=0.891, 95%CI 0.755-1.053; q =.319). However, frequent drinking (HR=1.565, 95%CI 1.012-2.419; q =.079), especially heavy drinking (HR=2.071, 95%CI 1.235-3.472; q =.054), was associated with higher risk of death in patients with obesity and COVID-19, but not in patients without obesity. Notably, the risk of death in frequent drinkers with obesity increased slightly with the average amount of alcohol consumed weekly (HR=1.480, 95%CI 1.059-2.069; q =.099).
Conclusions: Our findings suggested alcohol consumption may had adverse effects on the progression of COVID-19 in white participants with obesity, but was not associate with susceptibility to SARS-CoV-2 infection.

DOI: https://doi.org/10.1101/2020.11.25.20238915