A one-year hospital-based prospective COVID-19 open-cohort in the Eastern Mediterranean region: The Khorshid COVID Cohort (KCC) study

Sami, Ramin; Soltaninejad, Forogh; Amra, Babak; Naderi, Zahra; Javanmard, Shaghayegh Haghjooy; Iraj, Bijan; Hajiahmadi, Somayeh; Shayganfar, Azin; Dehghan, Mehrnegar; Khademi, Nilufar; Hosseini, Nastaran Sadat; Mortazavi, Mojgan; Mansourian, Marjan; Mañanas, Miguel Ángel; Marateb, Hamid Reza; Adibi, Peyman

doi:10.1101/2020.05.11.20096727

Cited by 17 publications

(9 citation statements)

References 45 publications

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“…In another study, residual signs suggesting pulmonary fibrosis were found most frequently in a subgroup of critical COVID-19 patients [ 5 ]. Comparisons between ward and ICU patients did not reveal statistically significant differences regarding symptoms at three months of follow-up [ 20 ] or between severe or non-severe patients at one month of follow-up [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of patients following hospitalization for coronavirus disease 2019: a prospective observational study

Meije

Sanz

et al. 2021

Clinical Microbiology and Infection

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Objectives: Few data are available regarding follow up of patients with coronavirus disease 2019 (COVID-19) after their discharge. We aim to describe the long-term outcomes of survivors of hospitalization for COVID-19 followed up first at an outpatient facility and subsequently by telephone. Methods: Observational prospective study conducted at a tertiary general hospital. Clinical and radiological progression was assessed and data were recorded on a standardized reporting form. Patients were divided into three groups according to PaO 2 /FiO 2 at hospitalization: PaO 2 /FiO 2 >300, PaO 2 /FiO 2 300e200 and PaO 2 /FiO 2 <200. A logistic multivariate regression model was performed to identify factors associated with persistence of symptoms. Results: For facility follow up, 302 individuals were enrolled. Median follow up was 45 days after discharge; 78% (228/294) of patients had COVID-19-related symptoms (53% asthenia, 56% respiratory symptoms) and 40% (122/302) had residual pulmonary radiographic lesions. PaO 2 /FiO 2 <200 was an independent predictor of persistent dyspnoea (OR 1.87, 95% CI 1.38e2.52, p < 0.0001). PaO 2 /FiO 2 >300 was associated with resolution of chest radiographic lesions (OR 0.56, 95% CI 0.42e0.74, p < 0.0001). Fifty per cent of patients required specific medical follow up after the first consultation and were transferred to another physician. A total of 294 patients were contacted for telephone follow up after a median followup time of 7 months. Fifty per cent of patients (147/294) still presented symptoms and 49% (145/294) had psychological disorders. Asthenia was identified in 27% (78/294) and dyspnoea in 10% (28/294) of patients independently of PaO 2 /FiO 2 . Conclusions: Patients with COVID-19 require long-term follow up because of the persistence of symptoms; patients with low PaO 2 /FiO 2 during the acute illness require special attention.

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Section: Discussionmentioning

confidence: 99%

Long-term outcomes of patients following hospitalization for coronavirus disease 2019: a prospective observational study

Meije

Sanz

et al. 2021

Clinical Microbiology and Infection

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“…A recent review of smoking and COVID-19 by Simons, et al found that a similar underrepresentation was apparent in seven other countries: Italy, Israel, Kuwait, Mexico, Spain, Switzerland, and the U.K. 4 They found only marginal under-representation in South Korea and a reversed pattern in Iran. Using sex-adjusted rates of smoking prevalence there was moderate under-representation of smokers in South Korea --18.5% of 28 hospitalized patients 5 vs a sexadjusted national rate of 28.6%, 6 and in Iran --14% of 490 hospitalized COVID-19 patients 7 vs. a sex-adjusted national rate of 24.6%. 8 Additionally, a small study from Germany found a smoking rate of 6% of 50 hospitalized patients 9 vs. a sex adjusted national rate of 24.9%.…”

Section: Introductionmentioning

confidence: 94%

National Smoking Rates Correlate Inversely with COVID-19 Mortality

Norden¹,

Avery

Norden

et al. 2020

Preprint

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IntroductionRecent studies show cigarette smokers are markedly under-represented among patients hospitalized for COVID-19 in over a dozen countries. It is unclear if this may be related to confounding factors such as age distribution, access to care, and inaccurate records. We hypothesized that these concerns could be avoided by studying smoking prevalence in relation to COVID-19 mortality. Since climate has been identified as a factor in COVID-19, we studied groups of countries with relatively comparable temperatures.MethodsThe 20 hottest and 20 coldest countries in the Johns Hopkins Mortality Analysis database with a minimum mortality rate of .3 deaths/100,000 were selected on the basis of the average temperatures of their largest city. Mortality rates were determined as of May 1, 2020 and correlated with national smoking rate adjusting for sex ratio, obesity, temperature, and elderly population.ResultsA highly significant inverse correlation between current daily smoking prevalence and COVID-19 mortality rate was noted for the group of hot countries (R=-.718, p = .0002), cold countries (R=-.567, p=.0046), and the combined group (R=-.324, p=.0207). However, after adjustments only the regression for hot countries and the combined group remained significant. In hot countries, for each percentage point increase in smoking rate mortality decreased by .147 per 100,000 population (95% CI .102-192, p=.0066). This resulted in mortality rates several-fold elevated in the countries with the lowest smoking rates relative to the highest smoking rates. In the combined group, mortality decreased by .257 per 100,000 population (95% CI .175-.339, p=.0034).DiscussionThese findings add support to the finding of an inverse relationship between current smoking and seriously symptomatic COVID-19. However, we conclude that the difference in mortality between the highest and lowest smoking countries appears too large to be due primarily to the effects of smoking per se. A potentially beneficial effect of smoking is surprising, but compatible with a number of hypothetical mechanisms which deserve exploration: 1) Studies show smoking alters ACE2 expression which may affect COVID-19 infection or its progression to serious lung pathology. 2) Nicotine has anti-inflammatory activity and also appears to alter ACE2 expression. 3) Nitric oxide in cigarette smoke is known to be effective in treating pulmonary hypertension and has shown in vitro antiviral effects including against SARS-CoV-2. 4) Smoking has complicated effects on the immune system involving both up and down regulation, any of which might alone or in concert antagonize progression of COVID-19. 5) Smokers are exposed to hot vapors which may stimulate immunity in the respiratory tract by various heat-related mechanisms (e.g. heat shock proteins). Studies of steam and sauna treatments have shown efficacy in other viral respiratory conditions. At this time there is no clear evidence that smoking is protective against COVID-19, so the established recommendations to avoid smoking should be emphasized. The interaction of smoking and COVID-19 will only be reliably determined by carefully designed prospective study, and there is reason to believe that there are unknown confounds that may be spuriously suggesting a protective effect of smoking. However, the magnitude of the apparent inverse association of COVID-19 and smoking and its myriad clinical implications suggest the importance of further investigation.

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“…Considering more comprehensive variables such as IL-6 levels, D-Dimer, and radiographic diagnosis, may yield more accurate results in the laboratory-based risk charts. Furthermore, the variability in treatment protocols across countries and individual organizations might lead to different results [22,52]. External validation of the proposed risk assessment method is the focus of our future work.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, the Khorshid COVID-19 Cohort (KCC) dataset [22,34] weeks, and the first year after discharge. In total, 630 COVID-19 patients were enrolled in our study.…”

Section: Dataset and Variable Selectionmentioning

confidence: 99%

“…The event-of-interest is death in the hospital, and discharge alive is considered as the competing event. To demonstrate the methodology, the Khorshid COVID-19 Cohort (KCC) dataset [22] with 630 patients is used. To the best of our knowledge, this is the first study in which absolute risk assessment is performed on in-hospital COVID-19 patients considering the competing events.…”

Section: Introductionmentioning

confidence: 99%

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Absolute Mortality Risk Assessment of COVID-19 Patients: The Khorshid COVID Cohort (KCC) Study

Marateb

Cube

Sami

et al. 2021

Preprint

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Background: Already at the time of hospital admission, clinicians require simple tools to identify hospitalized COVID-19 patients at high risk of mortality. Such tools can significantly improve resource allocation and patient management within hospitals. From the statistical point of view, extended time-to-event models are required to account for competing risks (discharge from hospital) and censoring so that active cases can also contribute to the analysis.Methods: We used the hospital-based open Khorshid COVID Cohort (KCC) study with 630 COVID-19 patients from Isfahan, Iran. Competing risk methods are used to develop a death risk chart based on following variables which can simply be measured at hospital admission: gender, age, hypertension, oxygen saturation, and Charlson Comorbidity Index. The area under the receiver operator curve was used to assess accuracy concerning discrimination between patients discharged alive and dead.Results: Cause-specific hazard regression models show that these baseline variables are associated with both hazards, the death as well as the discharge hazard. The risk chart reflects the combined results of the two cause-specific hazard regression models. The proposed risk assessment method had a very good accuracy (AUC=0.872 [CI 95%: 0.835-0.910]).Conclusions: This study aims to improve and validate a personalized mortality risk calculator based on hospitalized COVID-19 patients. The risk assessment of patient mortality provides physicians with additional guidance for making tough decisions.

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A one-year hospital-based prospective COVID-19 open-cohort in the Eastern Mediterranean region: The Khorshid COVID Cohort (KCC) study

Abstract: 47

Cited by 17 publications

References 45 publications

Long-term outcomes of patients following hospitalization for coronavirus disease 2019: a prospective observational study

Long-term outcomes of patients following hospitalization for coronavirus disease 2019: a prospective observational study

National Smoking Rates Correlate Inversely with COVID-19 Mortality

Absolute Mortality Risk Assessment of COVID-19 Patients: The Khorshid COVID Cohort (KCC) Study

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