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MeSH Disease

COVID-19 (491)

Fever (101)

Pneumonia (94)

Death (80)

Hypertension (72)


HGNC Genes

SARS-CoV-2 proteins

ProteinN (7)

ProteinS (2)

ORF1ab (1)

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    Effect of COVID-19 MESHD on Lipid Profile and its Correlation with Acute Phase Reactants

    Authors: Jahanzeb Malik; Uzma Ishaq; Talha Laique; Amna Ashraf; Asmara Malik; Mommana Ali Rathore; Syed Muhammad Jawad Zaidi; Muhammad Javaid; Asad Mehmood

    doi:10.1101/2021.04.13.21255142 Date: 2021-04-14 Source: medRxiv

    Background and Objective Coronavirus disease 2019 MESHD ( COVID-19 MESHD) manifests as multiple clinical and pathological organ dysfunctions. It also disrupts metabolic profile due to the release of pro-inflammatory cytokines causing a systemic inflammation reaction MESHD. However, the development and correlation of dyslipidemia MESHD with acute phase reactants is unknown. This investigation was performed to assess the pathological alterations of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein (HDL), triglycerides, and total cholesterol levels in COVID-19 MESHD patients. Methods This was a prospective study performed on real-world patients to assess serum levels of LDL-C, HDL, TG, TC on COVID-19 MESHD patients (mild: 319; moderate: 391; critical: 357) hospitalized at our center between April 2020 through January 2021. Age- and gender-matched controls who had their lipid profiles in the same period were included as the control group. Results LDL-C, HDL, TG, and TC levels were significantly lower in COVID-19 MESHD patients when compared with the control group (P < 0.001, 0.047, 0.045, < 0.001, respectively). All parameters decreased gradually with COVID-19 MESHD disease severity (LDL-C: median (IQR), mild: 98 (91,134); moderate: 97 (81,113); critical: 68 (68,83); HDL: mild: 45 (37,50); moderate: 46 (41,50); critical: 40 (37,46); TG: mild: 186 (150,245); moderate: 156 (109,198); critical: 111 (98,154); TC: mild: 224 (212,238); moderate: 212 (203,213); critical: 154 (125,187)). LDL-C, TC, and TG were inversely correlated with acute phase reactants ( interleukin-6 HGNC ( IL-6 HGNC), Procalcitonin, C-reactive protein HGNC ( CRP HGNC), and D-dimers). Logistic regression demonstrated lipid profile, thyroid profile, and acute phase reactants as predictors of severity of COVID-19 MESHD disease. Conclusion Hypolipidemia MESHD develops in increasing frequency with severe COVID-19 MESHD disease. It inversely correlates with levels of acute-phase reactants, indicating SARS-COV-2 as the causative agent for alteration in lipid and thyroid levels.

    Clinical Characteristics and Outcomes of Critically ill Mechanically Ventilated MESHD COVID-19 MESHD Patients Receiving interleukin-6 HGNC Receptor Antagonists and/or Corticosteroid Therapy, the INTERACT study: A Multicenter International Observational Study

    Authors: Marwa R Amer; Mohammed Bawazeer; Khalid Maghrabi; Ahmed Mohamed Kamal; Abid Butt; Talal Dahhan; Eiad Kseibi; Mohammed Abujazar; Razan Alghunaim; Muath Rabee; Maal Abualkhair; Ali Al-Janoubi; Abeer AlFirm; Syed Moazzum Khurshid; Ognjen Gajic; Allan J. Walkey; Jarrod M Mosier; Igor Borisovich Zabolotskikh; Oscar Y Gavidia; Santiago Y. Teruel; Michael A. Bernstein; Karen Boman; Vishakha K. Kumar; Vikas Bansal; Rahul Kashyap

    doi:10.1101/2021.04.12.21255323 Date: 2021-04-13 Source: medRxiv

    Objectives: To compare the clinical characteristics and outcomes of critically ill coronavirus disease MESHD ( COVID-19 MESHD) patients requiring mechanical ventilation (MV), receiving interleukin 6 receptor ( IL6R HGNC) antagonists, steroids, or a combination of both. Design: An international, multicenter, observational study derived from the COVID-2019 Viral Infection and Respiratory Illness University Study (VIRUS) registry and conducted through the Discovery Network, the Society of Critical Care Medicine. Marginal structural modeling was used to adjust for time-dependent confounders, and observations were weighted using the inverse probability of treatment weight. Sensitivity analysis was conducted to emulate a target trial design. Setting: 168 hospitals in 16 countries. Patients: adult ICU patients ( > 18 years) requiring MV for COVID-19 MESHD between March 01, 2020, and January 10, 2021. Intervention: None. Measurements and Main Results: A total of 860 patients met eligibility criteria: 589 received steroids, 170 IL-6R HGNC antagonists, and 101 combination therapy, and the groups were balanced after adjustment. The median daily steroid dose was 7.5 mg dexamethasone or equivalent (IQR: 6 to 14 mg); 80.8% received low-dose and 19.2% high-dose steroids (> 15 mg/day of dexamethasone or equivalent). The median C-reactive protein HGNC level was > 75 mg/L in majority of our cohort. The use of IL6R HGNC antagonists alone or in combination was not associated with a significant difference in ventilator free days ( VFD MESHD) compared to steroids alone (adjusted incidence rate ratio [95% CI]): IL6R HGNC antagonists (1.12 [0.88,1.4]), combination (0.83 [0.6,1.14]). Patients treated with low or high-dose steroids had non-significant differences in VFD MESHD compared to IL6R HGNC antagonists (beta= 0.62, 95% CI -1.54, 2.78 for low-dose steroid; beta= -1.19, 95% CI -3.85, 1.47 for high-dose steroid). The use of IL6R HGNC antagonists alone or in combination was not associated with a significant difference in 28 day mortality compared to steroids alone (adjusted odds ratio [95% CI]): IL6R HGNC antagonists alone (0.68 [0.44,1.07]), combination (1.07 [0.67,1.7]). There was no difference in hospital mortality compared to steroids alone (aOR 0.68, 95% CI 0.43,1.09 for IL6R HGNC antagonist, aOR 1.23, 95 % CI 0.72,2.11 for combination). The findings of sensitivity analysis were consistent with the primary analysis. The rate of liver dysfunction MESHD was higher in the IL6R HGNC antagonist (p=0.038), while the rate of bacteremia MESHD did not differ among the three groups. Conclusions: We observed no difference in outcomes between mechanically ventilated adult ICU patients who received IL6R HGNC antagonists, steroids, or combination therapy and those who received IL6R HGNC antagonists or low or high dose steroids. Further trials are needed to evaluate high-dose steroids as substitutes for IL6R HGNC antagonists in resource-limited settings.

    Making sense of non-randomized comparative treatment studies in times of Covid-19 MESHD: A case study of tocilizumab

    Authors: Ruth R C Owen; Nawab Qizilbash; Sara Velazquez Diaz; Jose Maria Castellano Vazquez; Stuart J Pocock

    doi:10.1101/2021.04.06.21254612 Date: 2021-04-07 Source: medRxiv

    BACKGROUND Tocilizumab (TCZ) is an interleukin-6 HGNC inhibitor and the second established effective drug for the treatment of hospitalized patients with Covid-19 MESHD. In this study, we sought to validate the recent positive findings from the randomised clinical trial RECOVERY and to evaluate the challenges in the analysis and interpretation of non-randomized comparative effectiveness studies in Covid-19 MESHD. METHODS We performed a retrospective cohort study using an openly available database of hospitalised Covid-19 MESHD patients in Spain. The primary outcome was all-cause in-hospital mortality at 28 days. We used multivariable Fine and Gray competing risk models which adjusted for both fixed and time-variant confounders to investigate the effect of TCZ on the primary outcome. RESULTS We analysed 2547 patients hospitalised with Covid-19 MESHD between 1st January and 28th June 2020. Patients in the TCZ group tended to have more severe Covid-19 MESHD at admission, as measured by biomarkers of disease severity including CRP HGNC, D-dimer and LDH. At 28 days, 91 out of 440 TCZ patients had died compared to 267 out of 2107 patients in the control group. In multivariable analysis, there was no evidence of an association between TCZ and the primary outcome (adjusted hazard ratio 1.20, 95% CI 0.86 to 1.64, P=0.26). CONCLUSIONS Our observational study failed to find a benefit of TCZ on all-cause in-hospital mortality in Covid-19 MESHD patients compared with randomized trials, highlighting the impact that unmeasured confounding and other sources of bias can have in a retrospective observational setting. For future observational studies, we recommend prospective data collection to ensure all variables have the necessary quality, completeness and timing for reliable treatment evaluation.

    Clinical Evidence for Improved Outcomes with Histamine Antagonists and Aspirin in 22,560 COVID-19 MESHD Patients

    Authors: Cameron Mura; Saskia Preissner; Susanne Nahles; Max Heiland; Philip E. Bourne; Robert Preissner

    doi:10.1101/2021.03.29.21253914 Date: 2021-04-05 Source: medRxiv

    COVID-19 MESHD has spurred much interest in the therapeutic potential of repurposed drugs. A family of acid-reducing drugs, known as histamine H2 receptor HGNC antagonists (H2RA), competitively bind the H2R and block its stimulation by histamine; examples of such drugs are famotidine (e.g., Pepcid) and ranitidine (e.g., Zantac). A dense web of functionalities between histamine and H2RAs, on the one hand, and downstream cellular pathways, on the other hand, links disparate physiological pathways in gastrointestinal contexts (e.g., acid reduction) to the dysregulated inflammatory cascades (cytokine storm) underlying the pathophysiology of COVID-19 MESHD. Is famotidine beneficial in treating COVID-19 MESHD? This question remains unresolved, though not for lack of effort: over 10 studies have examined the potential therapeutic value of famotidine in COVID-19 MESHD, but have found conflicting results (pro-famotidine, anti-famotidine, and neutral). Given the contradictory reports, we have undertaken the new analysis reported herein. Notably, studies published thus far rest upon substantially smaller datasets than drawn upon in the pre-sent work. We analyzed a cohort of 22,560 COVID-19 MESHD patients taking H1/H2 receptor antagonists, focusing on 1,379 severe cases requiring respiratory support. We analyzed outcomes for treatment with the H1RAs loratadine (e.g., Claritin) and cetirizine (e.g., Zyrtec), the H2RA famotidine, aspirin, and a famotidine & aspirin combination. For cases that reached the point of respiratory support, we found a significantly reduced fatality risk for famotidine treatment. We did not detect a benefit from dual-histamine receptor blockade (concurrently targeting H1 and H2 receptors). Notably, famotidine combined with aspirin did exhibit a significant synergistic survival benefit (odds ratio of 0.55). The relative risk for death MESHD decreased by 32.5%--an immense benefit, given the more than 2.6 million COVID-19 MESHD-related deaths thus far. We found lower levels of serum markers for severe disease (e.g., C-reactive protein HGNC) in famotidine users, consistent with prior findings by others and with a role for famotidine in attenuating cytokine release. The large, international, multi-center retrospective study reported here, sampling over 250,000 COVID-19 MESHD cases, hopefully helps clarify the possible value of clinically-approved histamine antagonists such as famotidine. Given these findings, alongside the cost-effectiveness and mild side-effects of popular drugs like famotidine and aspirin, we suggest that further prospective clinical trials, perhaps utilizing the aspirin combination reported here, are advisable.

    Validity of markers and indexes of systemic inflammation MESHD in predicting mortality in COVID 19 infection : A hospital based cross sectional study

    Authors: Archana Baburao; shylaja Shamsunder; Rinki Das

    doi:10.1101/2021.03.30.21254635 Date: 2021-03-31 Source: medRxiv

    Background COVID-19 MESHD is an ongoing global pandemic. It is a systemic infection MESHD with a significant impact on the hematopoietic and the immune system. In this study we aimed to evaluate the different inflammatory markers and indexes of systemic inflammatory response in predicting the mortality in patients with COVID 19. Methods In this cross sectional study, various inflammatory markers like D-dimer, CRP HGNC, serum ferritin, LDH and CBC derived indexes of inflammation MESHD were analyzed in predicting mortality in COVID 19 infection. Results We enrolled 302 COVID 19 patients who had a mean age of 54.51 yrs with 210 (69.5%) males. Among them 21% were asymptomatic and fever MESHD was the commonest among symptomatic patients. Majority of patients (66.7%) had no comorbidities and 20% had multiple comorbidities. On analyzing different hematological variables, survivors had statistically significant higher hemoglobin count, lymphocytes, monocytes, eosinophil and platelet count and lower leukocyte, neutrophil count. Inflammatory markers D-dimer, serum ferritin and LDH were significantly elevated among non survivors. Among the indexes of inflammation MESHD, only NLR showed significant higher values among non survivors. All the inflammatory markers were able to predict mortality among the COVID 19 infected cases with a sensitivity and specificity of 85% and 65% for d dimer levels, 85% and 72% for serum ferritin, 85% and 72% for LDH, 85% and 51% for CRP HGNC levels respectively. Among the indexes of inflammation MESHD, validity of NLR was best in predicting mortality with 85% sensitivity and 51% specificity. Conclusion Abnormalities MESHD in peripheral blood parameters and increase in inflammatory markers are common findings in COVID 19 infection. NLR was best at predicting mortality followed by D-dimer and serum ferritin levels

    Development and validation of the RCOS prognostic index: a bedside multivariable logistic regression model to predict hypoxaemia or death MESHD in patients with of SARS-CoV-2 infection MESHD

    Authors: Gerardo Alvarez-Uria; Sumanth Gandra; Venkata R Gurram; Raghu P Reddy; Manoranjan Midde; Praveen Kumar; Ketty E Arce

    doi:10.1101/2021.03.29.21254393 Date: 2021-03-30 Source: medRxiv

    Previous COVID-19 MESHD prognostic models have been developed in hospital settings, and are not applicable to COVID-19 MESHD cases in the general population. There is an urgent need for prognostic scores aimed to identify patients at high risk of complications at the time of COVID-19 MESHD diagnosis. The RDT COVID-19 MESHD Observational Study ( RCOS MESHD) collected clinical data from patients with COVID-19 MESHD admitted regardless of the severity of their symptoms in a general hospital in India. We aimed to develop and validate a simple bedside prognostic score to predict the risk of hypoxaemia or death MESHD. 4035 patients were included in the development cohort and 2046 in the validation cohort. The primary outcome occurred in 961 (23.8%) and 548 (26.8%) patients in the development and validation cohorts, respectively. The final model included 12 variables: age, systolic blood pressure, heart rate, respiratory rate, aspartate transaminase, lactate dehydrogenase, urea, C-reactive protein HGNC, sodium, lymphocyte count, neutrophil count and neutrophil/lymphocyte ratio. In the validation cohort, the area under the receiver operating characteristic curve (AUROCC) was 0.907 (95% CI, 0.892-0.922) and the Brier Score was 0.098. The decision curve analysis showed good clinical utility in hypothetical scenarios where admission of patients was decided according to the prognostic index. When the prognostic index was used to predict mortality in the validation cohort, the AUROCC was 0.947 (95% CI, 0.925-0.97) and the Brier score was 0.0188. If our results are validated in other settings, the RCOS prognostic index could help improve the decision making in the current COVID-19 pandemic MESHD, especially in resource limited-settings.

    IL-6 HGNC and D-Dimer at Admission Predicts Cardiac Injury MESHD and Early Mortality during SARS-CoV-2 Infection MESHD

    Authors: Daoyuan Si; Beibei Du; Bo Yang; Lina Jin; Lujia Ni; Qian Zhang; Zhongfan Zhang; Mohammed Ali Azam; Patrick F.H Lai; Stephane Masse; Huan Sun; Xingtong Wang; Slava Epelman; Patrick R Lawler; Ping Yang; Kumaraswamy Nanthakumar

    doi:10.1101/2021.03.22.21254077 Date: 2021-03-29 Source: medRxiv

    BACKGROUND: We recently described mortality of cardiac injury MESHD in COVID-19 MESHD patients. Admission activation of immune, thrombotic MESHD biomarkers and their ability to predict cardiac injury MESHD and mortality patterns in COVID-19 MESHD is unknown. METHODS: This retrospective cohort study included 170 COVID-19 MESHD patients with cardiac injury MESHD at admission to Tongji Hospital in Wuhan from January 29-March 8, 2020. Temporal evolution of inflammatory cytokines, coagulation markers, clinical, treatment and mortality were analyzed. RESULTS: Of 170 patients, 60 (35.3%) died early (<21d) and 61 (35.9%) died after prolonged stay. Admission lab work that correlated with early death MESHD were elevate levels of interleukin 6 HGNC ( IL-6 HGNC) (p<0.0001), Tumor Necrosis Factor-a HGNC Tumor Necrosis Factor-a MESHD ( TNF-a HGNC) (p=0.0025), and C-reactive protein HGNC ( CRP HGNC) (p<0.0001). We observed the trajectory of biomarker changes after admission, and determined that early mortality had a rapidly increasing D-dimer, gradually decreasing platelet and lymphocyte counts. Multivariate and simple linear regression models showed that death risk was determined by immune and thrombotic MESHD pathway activation. Increasing cTnI HGNC levels were associated with those of increasing IL-6 HGNC (p=0.03) and D-dimer (p=0.0021). Exploratory analyses suggested that patients that received heparin has lower early mortality compared to those who did not (p =0.07), despite similar risk profile. CONCLUSIONS: In COVID-19 MESHD patients with cardiac injury MESHD, admission IL-6 HGNC and D-dimer predicted subsequent elevation of cTnI HGNC and early death MESHD, highlighting the need for early inflammatory cytokine-based risk stratification in patients with cardiac injury MESHD.

    Increased angiotensin-converting enzyme 2 HGNC, sRAGE and immune activation, but lowered calcium and magnesium in COVID-19 MESHD: association with chest CT abnormalities MESHD and lowered peripheral oxygen saturation.

    Authors: Hussein Al-Hakeim; Hawraa Al-Jassas; Gerwyn Morris; Michael Maes

    doi:10.1101/2021.03.26.21254383 Date: 2021-03-26 Source: medRxiv

    Background. The characterization of new biomarkers of COVID-19 MESHD is extremely important. Few studies measured the soluble receptor for advanced glycation end product (sRAGE), angiotensin-converting enzyme 2 HGNC ( ACE2 HGNC), calcium and magnesium in COVID-19 MESHD. Aims: To measure sRAGE, ACE2 HGNC, interleukin (IL)-6 HGNC, IL-10 HGNC, CRP HGNC, calcium, magnesium, and albumin in COVID-19 MESHD patients in association with peripheral oxygen saturation (SpO2) and chest CT scan abnormalities (CCTA) including ground glass opacities. Methods. This study measured sRAGE, ACE2 HGNC, IL-6 HGNC, IL-10 HGNC, CRP HGNC using ELISA techniques, and calcium, magnesium, and albumin using a spectrophotometric method in 60 COVID-19 MESHD patients and 30 healthy controls. Results. COVID-19 MESHD is characterized by significantly increased IL-6 HGNC, CRP HGNC, IL-10 HGNC, sRAGE, ACE2 HGNC, and lowered levels of SpO2, albumin, magnesium and calcium. Neural networks showed that a combination of calcium, IL-6 HGNC, CRP HGNC, and sRAGE yielded an accuracy of 100% in detecting COVID-19 MESHD patients with calcium being the most important predictor followed by IL-6 HGNC, and CRP HGNC. COVID-19 MESHD patients with CCTAs showed lower SpO2 and albumin levels than those without CCTAs. SpO2 was significantly and inversely correlated with IL-6 HGNC, IL-10 HGNC, CRP HGNC, sRAGE, and ACE2 HGNC, and positively with albumin, magnesium and calcium. Patients with positive IgG results showed a significant elevation in the serum level of IL-6 HGNC, sRAGE, and ACE2 HGNC compared to the negatively IgG patient subgroup. Conclusion. The results show that immune-inflammatory and RAGE HGNC pathway biomarkers may be used as external validating criterion for the diagnosis COVID-19 MESHD. Those pathways coupled with lowered SpO2, calcium and magnesium are drug targets that may help to reduce the consequences of COVID-19 MESHD.

    Chagas disease MESHD and SARS-CoV-2 coinfection MESHD does not lead to worse in-hospital outcomes: results from the Brazilian COVID-19 MESHD Registry

    Authors: Israel Molina Romero; Milena Soriano Marcolino; Magda Carvalho Pires; Lucas Emanuel Ferreira Ramos; Rafael Tavares Silva; Milton Henriques Guimaraes Junior; Isaias Jose Ramos de Oliveira; Rafael Lima Rodrigues de Carvalho; Aline Gabrielle Souza Nunes; Ana Lara Rodrigues Monteiro de Barros; Ana Luiza Bahia Alves Scotton; Angelica Aparecida Coelho Madureira; Barbara Lopes Farace; Cintia Alcantara de Carvalho; Fernanda d'Athayde Rodrigues; Fernando Anschau; Fernando Antonio Botoni; Guilherme Fagundes Nascimento; Helena Duani; Henrique Cerqueira Guimaraes; Joice Coutinho de Alvarenga; Leila Beltrami Moreira; Liege Barella Zandona; Luana Fonseca de Almeida; Luana Martins Oliveira; Luciane Kopittke; Luis Cesar de Castro; Luisa Elem Almeida Santos; Maderson Alvares de Souza Cabral; Maria Angelica Pires Ferreira; Natalia da Cunha Severino Sampaio; Neimy Ramos de Oliveira; Saionara Cristina Francisco; Sofia Jarjour Tavares Starling Lopes; Tatiani Oliveira Fereguetti; Veridiana Baldon dos Santos; Victor Eliel Bastos de Carvalho; Yuri Carlotto Ramires; Antonio Luiz Pinho Ribeiro; Freddy Antonio Brito Moscoso; Rogerio Moura; CarIsi Anne Polanczyk; Maria do Carmo Pereira Nunes

    doi:10.1101/2021.03.22.21254078 Date: 2021-03-26 Source: medRxiv

    Objective: Chagas disease MESHD ( CD MESHD) continues to be a major public health burden in Latina America, where co-infection MESHD with SARS-CoV-2 can occur. However, information on the interplay between COVID-19 MESHD and Chagas disease MESHD is lacking. Our aim was to assess clinical characteristics and in-hospital outcomes of patients with CD MESHD and COVID-19 MESHD, and to compare it to non- CD MESHD patients. Methods: Patients with COVID-19 MESHD diagnosis were selected from the Brazilian COVID-19 MESHD Registry, a prospective multicenter cohort, from March to September, 2020. CD MESHD diagnosis was based on hospital record at the time of admission. Study data were collected by trained hospital staff using Research Electronic Data Capture (REDCap) tools. Genetic matching for sex, age, hypertension MESHD, DM MESHD and hospital was performed in a 4:1 ratio. Results: Of the 7,018 patients who had confirmed infection with SARS-CoV-2 in the registry, 31 patients with CD MESHD and 124 matched controls were included. Overall, the median age was 72 (64.-80) years-old and 44.5% were male. At baseline, heart failure MESHD (25.8% vs. 9.7%) and atrial fibrillation MESHD (29.0% vs. 5.6%) were more frequent in CD MESHD patients than in the controls (p<0.05 for both). C-reactive protein HGNC levels were lower in CD MESHD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). Seventy-two (46.5%) patients required admission to the intensive care unit. In-hospital management, outcomes and complications were similar between the groups. Conclusions: In this large Brazilian COVID-19 MESHD Registry, CD MESHD patients had a higher prevalence of atrial fibrillation MESHD and chronic heart failure MESHD compared with non- CD MESHD controls, with no differences in-hospital outcomes. The lower C-reactive protein HGNC levels in CD MESHD patients require further investigation.

    Epicardial adipose tissue thickness is associated with increased severity and mortality related to SARS-CoV-2 infection MESHD

    Authors: Roopa Mehta; Omar Yaxmehen Bello-Chavolla; Leonardo Mancillas-Adame; Marcela Rodríguez-Flores; Natalia Ramírez-Pedraza; Bethsabel Rodríguez-Encinas; Carolina Isabel Pérez-Carrión; María Isabel Jasso-Ávila; Jorge Valladares-Garcia; Pablo Esteban Vanegas-Cedillo; Diana Hernández-Juárez; Arsenio Vargas-Vázquez; Neftali Eduardo Antonio-Villa; Monica Chapa-Ibarguengoitia; Paloma Almeda-Vald és; Daniel Elias-Lopez; Arturo Galindo-Fraga; Alfonso Gulias-Herrero; Alfredo Ponce de Leon; Jose Sifuentes-Osornio; Carlos A. Aguilar-Salinas

    doi:10.1101/2021.03.14.21253532 Date: 2021-03-24 Source: medRxiv

    BACKGROUND: Obesity, in particular, visceral adipose tissue has been linked to adverse COVID-19 MESHD outcomes. The amount of epicardial adipose MESHD tissue (EAT) may have relevant implications given its proximity to the heart and lungs. Here, we explored the role of EAT in increasing the risk for COVID-19 MESHD adverse outcomes. METHODS: We included 748 patients with COVID-19 MESHD attending a reference centre in Mexico City. EAT thickness, sub-thoracic and pericardial fat were measured using thoracic CT scans. We explored the association of each thoracic adipose tissue compartment with critical COVID-19 MESHD and mortality according to the presence or absence of obesity MESHD. Mediation analyses evaluated the role of EAT in facilitating the effect of age, body mass index and cardiac troponin levels with adverse COVID-19 MESHD outcomes. RESULTS: EAT thickness was associated with increased risk of COVID-19 MESHD mortality (HR 1.18, 95%CI 1.01-1.39) independent of age, gender, comorbid conditions and BMI. Increased EAT was associated with lower SpO2 and PaFi index and higher levels of cardiac troponins, D-dimer, C-reactive protein, and 4C HGNC severity score, independent of obesity MESHD. EAT mediated 13.1% (95%CI 3.67-28.0%) and 5.1% (95%CI 0.19-14.0%) of the effect of age and 19.4% (95%CI 4.67-63.0%) and 12.8% (95%CI 0.03-46.0%) of the effect of BMI on requirement for intubation and mortality, respectively. EAT also mediated the effect of increased cardiac troponins on myocardial infarction MESHD during COVID-19 MESHD. CONCLUSION: EAT is an independent risk factor for severe COVID-19 MESHD and mortality independent of obesity MESHD. EAT partly mediates the effect of age and BMI and increased cardiac troponins on adverse COVID-19 MESHD outcomes.

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SARS-CoV-2 Proteins


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