Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study

Nikpouraghdam, Mohamad; Farahani, Alireza Jalali; Alishiri, Gholam Hossein; Heydari, Soleyman; Ebrahimnia, Mehdi; Samadinia, Hossein; Sepandi, Mojtaba; Jafari, Nematollah Jonaidi; Izadi, Morteza; Qazvini, Ali; Dorostkar, Ruhollah; Tat, Mahdi; Shahriary, Alireza; Farnoosh, Gholamreza; Zijoud, Seyed Reza Hosseini; Taghdir, Maryam; Alimohamadi, Yousef; Abbaszadeh, Sepideh; Ghaleh, Hadi Esmaeili Gouvarchin; Bagheri, Mahdi

doi:10.1016/j.jcv.2020.104378

Cited by 378 publications

(391 citation statements)

References 25 publications

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“…A history of cardiovascular disease (OR 2.77; p<0.001) and respiratory disease (OR 1.88; p<0.035) showed positive association with mortality in accordance with studies reported in other regions (24,25). Several pathophysiological mechanisms have been proposed that can link increased mortality in COVID-19 infected patients with cardiovascular and respiratory co-morbidities including predisposition to acute respiratory distress syndrome and myocardial injury, although the evidence is still evolving (26).…”

Section: Discussionsupporting

confidence: 83%

Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- A cohort study

Chinnadurai

Ogedengbe

Agarwal

et al. 2020

Preprint

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Background There is a need for more observational studies across different clinical settings to better understand the epidemiology of the novel COVID-19 infection. Evidence on clinical characteristics of COVID-19 infection is scarce in secondary care settings in Western populations.MethodsWe describe the clinical characteristics of all consecutive COVID-19 positive patients (n=215) admitted to the acute medical unit at Fairfield General Hospital (secondary care setting) between 23 March 2020 and 30 April 2020 based on the outcome at discharge (group 1: alive or group 2: deceased). We investigated the risk factors that were associated with mortality using binary logistic regression analysis. Kaplan-Meir (KM) curves were generated by following the outcome in all patients until 12 May 2020. ResultsThe median age of our cohort was 74 years with a predominance of Caucasians (87.4%) and males (62%). Of the 215 patients, 86 (40%) died. A higher proportion of patients who died were frail (group 2: 63 vs group 1: 37%, p<0.001), with a higher prevalence of cardiovascular disease (group 2: 58 vs group 1: 33%, p<0.001) and respiratory diseases (group 2: 38 vs group 1: 25 %, p=0.03). In the multivariate logistic regression models, older age (odds ratio (OR) 1.03; p=0.03), frailty (OR 5.1; p<0.001) and lower estimated glomerular filtration rate (eGFR) on admission (OR 0.98; p=0.01) were strong and independent predictors of inpatient mortality. KM curves showed a clear significantly shorter survival time in the frail older patients. ConclusionOlder age and frailty are strong and independent risk factors associated with mortality in COVID-19 patients hospitalised to an acute medical unit at secondary care level. A holistic approach by incorporating these factors is warranted in the management of patients with COVID-19 infection.

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Section: Discussionsupporting

confidence: 83%

Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- A cohort study

Chinnadurai

Ogedengbe

Agarwal

et al. 2020

Preprint

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“…This inequity could be due to the higher prevalence of male sex among COVID-19 cases, which is reported in the majority of studies worldwide [28]. This sex difference is more prominent in Iran (as reported by Nikpouraghdam et al, the male-to-female ratio in COVID-19 cases was 1.93:1 in Iran) [29]. Moreover, severe cases are more prevalent among male patients, and male sex is reported to be an independent predictor of mortality (OR=1.45, 95% CI: 1.08-1.96) [29].…”

Section: Discussionmentioning

confidence: 90%

The use of intravenous immunoglobulin gamma for the treatment of severe coronavirus disease 2019: A randomised placebo-controlled double-blind clinical trial

Gharebaghi

Nejadrahim

Mousavi

et al. 2020

Preprint

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Background: Coronavirus disease 2019 (COVID-19) has infected people in many countries worldwide. Discovering an effective treatment for this disease, particularly in severe cases, has become the subject of intense scientific investigation. Therefore, the objective of this study was to evaluate the efficacy of intravenous immunoglobulin (IVIg) in patients with severe COVID-19 infection.Methods: This study was conducted as a randomised placebo-controlled double-blind clinical trial. Fifty-nine patients with severe COVID-19 infection who did not respond to initial treatments were randomly assigned into two groups. One group received IVIg (human)—four vials daily for three days (in addition to initial treatment), while the other group received a placebo. Patients’ demographic, clinical, and select laboratory test results, as well as the occurrence of in-hospital mortality, were recorded. Results: Among the total subjects, 30 patients received IVIg and 29 patients received a placebo. Demographics, clinical characteristics, and laboratory tests were not statistically different (P > 0.05) between the two groups. The in-hospital mortality rate was significantly lower in the IVIg group compared to the control group (6 [20.0%] vs. 14 [48.3%], respectively; P = 0.022). Multivariate regression analysis demonstrated that administration of IVIg did indeed have a significant impact on mortality rate (aOR = 0.003 [95% CI: 0.001–0.815]; P = 0.042).Conclusions: Our study demonstrated that the administration of IVIg in patients with severe COVID-19 infection who did not respond to initial treatment could improve their clinical outcome and significantly reduce mortality rate. Further multicenter studies with larger sample sizes are nonetheless required to confirm the appropriateness of this medication as a standard treatment.Trial registration: A study protocol was registered at the Iranian Registry of Clinical Trials (www.IRCT.ir), number IRCT20200501047259N1. It was registered retrospectively on May 17th, 2020.

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“…As reported in a recent meta-analysis, hypertension, diabetes, cardiovascular disease (CVD) were independent risk factors for poor prognosis in COVID-19 patients, while no correlation was found in renal or liver disease (5). However, in another study reported in Iran, the death rate was higher in chronic kidney disease (CKD) patients (16.66%) than those with CVD (10.81%), hypertension (13.55%) or diabetes (9.73%) (6). Few studies have looked into this inconformity and the underlying mechanisms on how these preexisting comorbidities accelerate this process.…”

Section: Introductionmentioning

confidence: 96%

Mediating Effect of Deteriorated Kidney Function in Comorbidity-related Excess Deaths in COVID-19: A Retrospective Cohort Study

Luo

Liu

Xie

et al. 2020

Preprint

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Background In-hospital death risks vary in COVID-19 patients with comorbidities. Kidney function decline is prevalent in this course. Methods To explore the exact role of deteriorated kidney function, we applied a retrospective cohort study including 1266 participants in Wuhan Tongren Hospital between January 27 and March 3, 2020. Demographic characteristics, preexisting comorbidities history, organ function data and outcomes were extracted. Deteriorated kidney function was identified as the decline percentage, assessed by an increase in peak serum creatinine from the baseline. Mediating effect was calculated by mediation analysis. Key Results 1266 hospitalized COVID-19 patients (60±15 years, 47.8% are male) were included, with an overall in-hospital death rate of 4.42% (56/1266). For critical cases, 77.02% had at least one preexisting comorbidity. Patients with comorbidities suffered higher in-hospital death and more severe decline of kidney function. Compared to patients with minor function decline (<10%), significant risk increase was found in those with more severe one (OR 3.57; 95%CI 1.70 to 7.52; P=.001 for moderate with 10-50% decline, and 37.45; 95%CI 18.71 to 74.55; P＜.001 for severe with>50%). More interestingly, the mediation analysis found deteriorated kidney function played as an important mediator between different comorbidities and COVID-19 patients’ in-hospital death, with the mediation effect of 11%, 12%, 16% and 32% respectively for hypertension, COPD, CVD and CKD.Conclusions Deteriorated kidney function is strongly associated with increase of in-hospital death in COVID-19 and partially mediates the facilitating effect of preexisting comorbidities on in-hospital death. Thus, dynamic monitoring kidney function, preventing the deterioration of kidney function might be helpful to improve survival in COVID-19 patients, especially those with preexisting comorbidities.

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Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study

Cited by 378 publications

References 25 publications

Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- A cohort study

Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- A cohort study

The use of intravenous immunoglobulin gamma for the treatment of severe coronavirus disease 2019: A randomised placebo-controlled double-blind clinical trial

Mediating Effect of Deteriorated Kidney Function in Comorbidity-related Excess Deaths in COVID-19: A Retrospective Cohort Study

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