Clinical presentation and initial management critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Brescia, Italy

Piva, Simone; Filippini, Matteo; Turla, Fabio; Cattaneo, Sergio; Margola, Alessio; Fulviis, Silvia De; Nardiello, Ida; Beretta, Alessandra; Ferrari, Laura; Trotta, Raffaella; Erbici, Gloria; Focà, Emanuele; Castelli, Francesco; Rasulo, Frank; Lanspa, Michael J.; Latronico, Nicola

doi:10.1016/j.jcrc.2020.04.004

Cited by 149 publications

(142 citation statements)

References 7 publications

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“…Meta-regression scatter plot representing the correlation between BMI and IMV is shown in Figure S2. 15,[28][29][30][31][32][33][34] No correlation was found F I G U R E 2 Odds ratios for intensive care unit admission in patients with obesity versus patients without obesity. BMI, body mass index; CI, confidence interval; ICU, intensive care unit F I G U R E 3 Odds ratios for invasive mechanical ventilation (IMV) in patients with obesity versus patients without obesity.…”

Section: Meta-regressionmentioning

confidence: 98%

Obesity is a risk factor for developing critical condition in COVID‐19 patients: A systematic review and meta‐analysis

et al. 2020

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Summary The disease course of COVID‐19 varies from asymptomatic infection to critical condition leading to mortality. Identification of prognostic factors is important for prevention and early treatment. We aimed to examine whether obesity is a risk factor for the critical condition in COVID‐19 patients by performing a meta‐analysis. The review protocol was registered onto PROSPERO (CRD42020185980). A systematic search was performed in five scientific databases between 1 January and 11 May 2020. After selection, 24 retrospective cohort studies were included in the qualitative and quantitative analyses. We calculated pooled odds ratios (OR) with 95% confidence intervals (CIs) in meta‐analysis. Obesity was a significant risk factor for intensive care unit (ICU) admission in a homogenous dataset (OR = 1.21, CI: 1.002‐1.46; I2 = 0.0%) as well as for invasive mechanical ventilation (IMV) (OR = 2.05, CI: 1.16‐3.64; I2 = 34.86%) in COVID‐19. Comparing body mass index (BMI) classes with each other, we found that a higher BMI always carries a higher risk. Obesity may serve as a clinical predictor for adverse outcomes; therefore, the inclusion of BMI in prognostic scores and improvement of guidelines for the intensive care of patients with elevated BMI are highly recommended.

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Section: Meta-regressionmentioning

confidence: 98%

Obesity is a risk factor for developing critical condition in COVID‐19 patients: A systematic review and meta‐analysis

et al. 2020

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“…Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: cohort study including 8. 3…”

Section: Original Researchmentioning

confidence: 99%

Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: cohort study including 8.3 million people

Hippisley‐Cox

Young

Coupland

et al. 2020

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BackgroundThere is uncertainty about the associations of angiotensive enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) drugs with COVID-19 disease. We studied whether patients prescribed these drugs had altered risks of contracting severe COVID-19 disease and receiving associated intensive care unit (ICU) admission.MethodsThis was a prospective cohort study using routinely collected data from 1205 general practices in England with 8.28 million participants aged 20–99 years. We used Cox proportional hazards models to derive adjusted HRs for exposure to ACE inhibitor and ARB drugs adjusted for sociodemographic factors, concurrent medications and geographical region. The primary outcomes were: (a) COVID-19 RT-PCR diagnosed disease and (b) COVID-19 disease resulting in ICU care.FindingsOf 19 486 patients who had COVID-19 disease, 1286 received ICU care. ACE inhibitors were associated with a significantly reduced risk of COVID-19 disease (adjusted HR 0.71, 95% CI 0.67 to 0.74) but no increased risk of ICU care (adjusted HR 0.89, 95% CI 0.75 to 1.06) after adjusting for a wide range of confounders. Adjusted HRs for ARBs were 0.63 (95% CI 0.59 to 0.67) for COVID-19 disease and 1.02 (95% CI 0.83 to 1.25) for ICU care.There were significant interactions between ethnicity and ACE inhibitors and ARBs for COVID-19 disease. The risk of COVID-19 disease associated with ACE inhibitors was higher in Caribbean (adjusted HR 1.05, 95% CI 0.87 to 1.28) and Black African (adjusted HR 1.31, 95% CI 1.08 to 1.59) groups than the white group (adjusted HR 0.66, 95% CI 0.63 to 0.70). A higher risk of COVID-19 with ARBs was seen for Black African (adjusted HR 1.24, 95% CI 0.99 to 1.58) than the white (adjusted HR 0.56, 95% CI 0.52 to 0.62) group.InterpretationACE inhibitors and ARBs are associated with reduced risks of COVID-19 disease after adjusting for a wide range of variables. Neither ACE inhibitors nor ARBs are associated with significantly increased risks of receiving ICU care. Variations between different ethnic groups raise the possibility of ethnic-specific effects of ACE inhibitors/ARBs on COVID-19 disease susceptibility and severity which deserves further study.

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“…56 Understanding the mechanisms underlying different prognosis in children is essential for designing targeted therapies for COVID-19. targeting the CRS and hyperinflammatory status of lung destruction via anti-IL-6R antibodies, [218][219][220][221][222][223][224][225][226][227][228][229][230][231][232][233][234][235][236][237] IL-1R antagonists, [238][239][240] JAK-STAT inhibitors, 241 or inhibition of entrance by anti CD147 antibodies 237 and destruction of the virus via protective antibody delivered with convalescent plasma 51,54,66,133,134,242 (Table 2). Eculizumab targets complement protein C5 preventing activation of complement terminal complex, which was used off label in patients with SARS-CoV-2 infection and severe pneumonia or ARDS and is now evaluated in an ongoing trail (SOLID-C19).…”

Section: Kids Versus Adults: Mechanisms Explaining the Clinical Difmentioning

confidence: 99%

Immunology of COVID‐19: Mechanisms, clinical outcome, diagnostics, and perspectives—A report of the European Academy of Allergy and Clinical Immunology (EAACI)

Sokołowska

Łukasik

Agache

et al. 2020

Allergy

156

167

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With the worldwide spread of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) resulting in declaration of a pandemic by the World Health Organization (WHO) on March 11, 2020, the SARS-CoV-2-induced coronavirus disease-19 (COVID-19) has become one of the main challenges of our times. The high infection rate and the severe disease course led to major safety and social restriction measures worldwide. There is an urgent need of unbiased expert knowledge guiding the development of efficient treatment and prevention strategies. This report summarizes current immunological data on mechanisms associated with the SARS-CoV-2 infection and COVID-19 development and progression to the most severe forms. We characterize the differences between adequate innate and adaptive immune response in mild disease and the deep immune dysfunction in the severe multiorgan disease. The similarities of the human immune response to SARS-CoV-2 and the SARS-CoV and MERS-CoV are underlined. We also summarize known and potential SARS-CoV-2 receptors on epithelial barriers, immune cells, endothelium and clinically involved organs such as lung, gut, kidney, cardiovascular, and neuronal system. Finally, we discuss the known and potential mechanisms underlying the involvement of comorbidities, gender, and age in development of COVID-19. Consequently, we highlight the knowledge gaps and urgent research requirements to provide a quick roadmap for ongoing and needed COVID-19 studies.

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Clinical presentation and initial management critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Brescia, Italy

Cited by 149 publications

References 7 publications

Obesity is a risk factor for developing critical condition in COVID‐19 patients: A systematic review and meta‐analysis

Obesity is a risk factor for developing critical condition in COVID‐19 patients: A systematic review and meta‐analysis

Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: cohort study including 8.3 million people

Immunology of COVID‐19: Mechanisms, clinical outcome, diagnostics, and perspectives—A report of the European Academy of Allergy and Clinical Immunology (EAACI)

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