Risk factors for severe and critically ill COVID-19 patients: a review

Gao, Yuwei; Ding, Mei; Zhang, Jinjin; Azkur, Ahmet Kürşat; Azkur, Dilek; Gan, Hui; Sun, Yuming; Fu, Wei; Li, Wei; Liang, Huiling; Cao, Ye; Yan, Qi; Cao, Chao; Gao, Hongyu; Brüggen, Marie‐Charlotte; Veen, Willem van de; Sokołowska, Milena; Akdiş, Mübeccel

doi:10.22541/au.160217176.66860225/v1

Cited by 111 publications

(162 citation statements)

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“…Severe liver disease is a serious condition with a reduced life expectancy and is associated with immune deficiency. In line with our findings, severe liver disease has previously been reported to be associated with a several-fold increase in mortality in both COVID-19 (36) and influenza (37). Malignancy was not associated with ICU admission for influenza or COVID-19 in our study.…”

Section: Discussionsupporting

confidence: 93%

Critical Influenza and COVID-19—A Comparative Nationwide Case-Control Study

Larsson

Eriksson

Oldner

2022

Critical Care Explorations

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IMPORTANCE: Refined knowledge of risk factors for critical influenza and COVID-19 may lead to improved understanding of pathophysiology and better pandemic preparedness. OBJECTIVES: To compare risk-factor profiles of patients admitted to intensive care with critical influenza and COVID-19. DESIGN, SETTING, AND PATIENTS: A nationwide retrospective matched case-control study, including all adults admitted to an ICU in Sweden with influenza or COVID-19 between 2014 and September 2020 and a matched control population (ratio 1:5, patients:controls). MEASUREMENTS AND MAIN RESULTS: Admission to an ICU. The study included 1,873 influenza and 2,567 COVID-19 ICU patients, and 9,365 and 12,835 controls, respectively, matched on sex, age, and geographical region. Influenza patients were older and less likely male, and carried a larger burden of comorbidity and a higher Simplified Acute Physiology Score III score, whereas short-term mortalities were similar when compared to COVID-19 patients. The risk-factor profiles at ICU admission were largely comparable including socioeconomic, psychiatric, and several somatic variables. Hypertension was a strong risk factor in critical COVID-19 patients compared with influenza. Nonglucocorticoid immunosuppressive therapy was associated with critical influenza but not COVID-19. Premorbid medication with statins and renin-angiotensin-aldosterone system inhibitors reduced the risk for both conditions, the opposite was a seen for glucocorticoid medication. Notably, medication with betablockers, oral anticoagulation, and platelet inhibitors reduced the risk of critical COVID-19 but not influenza. CONCLUSIONS: The risk-factor profiles for critical influenza and COVID-19 were largely comparable; however, some important differences were noted. Hypertension was a stronger risk factor for developing critical COVID-19, whereas the use of betablockers, oral anticoagulants, and platelet inhibitors all reduced the risk of ICU admission for COVID-19 but not influenza. Findings possibly reflected differences in pathophysiological mechanisms between these conditions.

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Section: Discussionsupporting

confidence: 93%

Critical Influenza and COVID-19—A Comparative Nationwide Case-Control Study

Larsson

Eriksson

Oldner

2022

Critical Care Explorations

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“…Increasing amounts of data are showing hat COVID-19 severity is related to sex. [23][24][25] A retrospective cohort study in China showed that male sex is a major risk factor for higher disease severity and mortality. 26 A web-based COVID-19 survey in Italy that included 6873 participants (mean age, 47.9 AE 14.1 years; 65.8% women) showed that women had lower odds than men of a positive nasopharyngeal swab test (adjusted OR, 0.75; 95% CI, 0.66-0.85) and of having a severe infection (adjusted OR, 0.46; 95% CI, 0.37-0.57).…”

Section: Discussionmentioning

confidence: 99%

Factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19: a retrospective case series

Yin

et al. 2022

J Int Med Res

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Objective To identify factors associated with high-flow nasal cannula (HFNC) therapy failure in patients with severe COVID-19. Methods We retrospectively examined clinical and laboratory data upon admission, treatments, and outcomes of patients with severe COVID-19. Sequential Organ Failure Assessment (SOFA) scores were also calculated. Results Of 54 patients with severe COVID-19, HFNC therapy was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC therapy failure was more common in patients aged ≥60 years and in men. Compared with patients with successful HFNC therapy, patients with HFNC therapy failure had higher percentages of fatigue, anorexia, and cardiovascular disease; a longer time from symptom onset to diagnosis; higher SOFA scores; a higher body temperature, respiratory rate, and heart rate; more complications, including acute respiratory distress syndrome, septic shock, myocardial damage, and acute kidney injury; a higher C-reactive protein concentration, neutrophil count, and prothrombin time; and a lower arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2). However, male sex, a low PaO2/FiO2, and a high SOFA score were the only independent factors significantly associated with HFNC therapy failure. Conclusions Male sex, a low PaO2/FiO2, and a high SOFA score were independently associated with HFNC therapy failure in patients with severe COVID-19.

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“…All patients were evaluated medically, including severe COVID‐19 risk factors (at least one of the following: age>59, hypertension, coronary heart disease, diabetes, obesity, active neoplastic disease) 22 . Additionally, in a randomly chosen subgroup of 79 participants, the basal serum tryptase concentration was analysed.…”

Section: Methodsmentioning

confidence: 99%

Protocol of safe vaccination against COVID‐19 in patients with high risk of allergic reactions

Romantowski

Kruszewski

Solarski³

et al. 2022

Clinical & Translational All

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Background Sars‐CoV‐2 infections are hazardous, especially to the elderly and patients with comorbidities. With no efficient treatment available, newly developed vaccines are the only way to change the course of the pandemic. However, reports of allergic reactions resulted in some patients and practicing physicians being concerned about the safety of vaccine administration, particularly in people with severe anaphylactic reactions to multiple or unknown factors in their medical history. This study aimed to develop an allergic work‐up protocol based on skin prick tests (SPT), intradermal testing (IDT) and intramuscular provocations, and desensitisation which may contribute to diagnosis and management of anti‐COVID‐19 vaccine allergy. Methods Two hundred and eighty‐five patients were enrolled. Two hundred and five of them entered the study based on severe anaphylactic reaction to unknown or multiple factors in their medical history which disqualified them for standard treatment. Another 80 patients were enrolled after developing an allergic reaction to the first dose of one such vaccine. In all subjects, SPT and IDT were performed. Serum tryptase was assessed in 79 patients randomly chosen from the study group. Results Two hundred and seventy‐seven patients with negative tests were given a vaccine without complications. Seven patients had positive skin tests. In two cases, tests confirmed Comirnaty allergy, while the other five confirmed solely skin sensitisation with no exposure prior to the study. Six patients with positive tests received titrated challenge using desensitisation protocol with a reasonable tolerance. One patient did not consent to desensitisation and one patient resigned despite negative tests. Overall, 283 (99%) patients were vaccinated using this newly developed protocol. Patients with adverse reactions to the first dose of the vaccine before the study had a significantly lower basal serum tryptase concentration (p = 0.001). Conclusion Skin tests with anti‐COVID‐19 vaccines are a useful tool in the vaccination protocol. This protocol enables safe immunisation of high‐allergy‐risk patients even in cases of positive skin tests.

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Risk factors for severe and critically ill COVID-19 patients: a review

Cited by 111 publications

References 0 publications

Critical Influenza and COVID-19—A Comparative Nationwide Case-Control Study

Critical Influenza and COVID-19—A Comparative Nationwide Case-Control Study

Factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19: a retrospective case series

Protocol of safe vaccination against COVID‐19 in patients with high risk of allergic reactions

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