Purpose
To assess the association between acute disease severity and 1-year quality of life in patients discharged after hospitalisation due to coronavirus disease 2019 (COVID-19).
Methods
We conducted a prospective cohort study nested in 5 randomised clinical trials between March 2020 and March 2022 at 84 sites in Brazil. Adult post-hospitalisation COVID-19 patients were followed for 1 year. The primary outcome was the utility score of EuroQol five-dimension three-level (EQ-5D-3L). Secondary outcomes included all-cause mortality, major cardiovascular events, and new disabilities in instrumental activities of daily living. Adjusted generalised estimating equations were used to assess the association between outcomes and acute disease severity according to the highest level on a modified ordinal scale during hospital stay (2: no oxygen therapy; 3: oxygen by mask or nasal prongs; 4: high-flow nasal cannula oxygen therapy or non-invasive ventilation; 5: mechanical ventilation).
Results
1508 COVID-19 survivors were enrolled. Primary outcome data were available for 1156 participants. At 1 year, compared with severity score 2, severity score 5 was associated with lower EQ-5D-3L utility scores (0.7 vs 0.84; adjusted difference, − 0.1 [95% CI − 0.15 to − 0.06]); and worse results for all-cause mortality (7.9% vs 1.2%; adjusted difference, 7.1% [95% CI 2.5%–11.8%]), major cardiovascular events (5.6% vs 2.3%; adjusted difference, 2.6% [95% CI 0.6%–4.6%]), and new disabilities (40.4% vs 23.5%; adjusted difference, 15.5% [95% CI 8.5%–22.5]). Severity scores 3 and 4 did not differ consistently from score 2.
Conclusions
COVID-19 patients who needed mechanical ventilation during hospitalisation have lower 1-year quality of life than COVID-19 patients who did not need mechanical ventilation during hospitalisation.
Supplementary Information
The online version contains supplementary material available at 10.1007/s00134-022-06953-1.
Meningiomas are common, usually benign tumors, with a high postoperative recurrence
rate. However, the genesis and development of these tumors remain controversial. We
aimed to investigate the presence and implications of a mutated p53 protein and
dopamine D2 receptor in a representative series of meningiomas and to
correlate these findings with age, gender, tumor grade, and recurrence. Tumor tissue
samples of 157 patients diagnosed with meningioma (37 males and 120 females, mean age
53.6±14.3 years) who underwent surgical resection between 2003 and 2012 at our
institution were immunohistochemically evaluated for the presence of p53 protein and
dopamine D2 receptor and were followed-up to analyze tumor recurrence or
regrowth. Tumors were classified as grades I (n=141, 89.8%), II (n=13, 8.3%), or
grade III (n=3, 1.9%). Dopamine D2 receptor and p53 protein expression
were positive in 93.6% and 49.7% of the cases, respectively. Neither of the markers
showed significant expression differences among different tumor grades or recurrence
or regrowth statuses. Our findings highlight the potential role of p53 protein in
meningioma development and/or progression. The high positivity of dopamine
D2 receptor observed in this study warrants further investigation of
the therapeutic potential of dopamine agonists in the evolution of meningiomas.
Meningiomas are common, usually benign tumors of the central nervous system that have a high rate of post-surgical recurrence or regrowth. We determined expression of the proteins merlin, NDRG2, ERBB2, and c-MYC in meningiomas using immunohistochemistry and assessed relationships between protein expression and gender, age, tumor grade, and recurrence or regrowth. The study sample comprised 60 patients, (44 women and 16 men) with a mean age of 53.2±12.7 years. Tumors were classified as grade I (n=48) or grades II and III (n=12). Expression of merlin, NDRG2, ERBB2, and c-MYC was not significantly different statistically with relation to gender, age, or meningioma recurrence or regrowth. Merlin was expressed in 100% of the cases. No statistically significant difference between tumor grade and recurrence or regrowth was identified. Statistically significant differences were identified between the mean age of patients with grade I (54.83±11.60) and grades II and III (46.58±15.08) meningiomas (P=0.043), between strong c-MYC expression and grades II and III (P<0.001), and between partial surgical resection and tumor recurrence or regrowth (P<0.001). These findings reveal the lower mean age among grades II and III meningioma patients than grade I patients, the influence of the protein merlin on tumorigenesis, the association of c-MYC with aggressive meningiomas, and that partial surgical resection is associated with tumor recurrence or regrowth.
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