Corpus overview


Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Impact of COVID-19 on Health-related Quality of Life in Patients With Cardiovascular Disease MESHD: A Multi-ethnic Asian Study

    Authors: Shir Lynn Lim; Kai Lee Woo; Eleanor Lim; Faclin Ng; Mark YY Chan; Mihir Gandhi

    doi:10.21203/rs.3.rs-60893/v1 Date: 2020-08-17 Source: ResearchSquare

    BackgroundLittle is known about the impact of the global coronavirus disease-2019 (COVID-19) pandemic on patients with cardiovascular disease MESHD ( CVD MESHD), the biggest global killer and major risk factor for severe COVID-19 infections. We aim to explore the indirect consequences of COVID-19 on health-related quality of life (HRQoL) of patients with CVD MESHD. MethodsEighty-one adult TRANS outpatients with CVD MESHD were assessed using the EQ-5D, a generic health status instrument with five dimensions (mobility, self-care, usual activities, pain HP pain MESHD/discomfort, anxiety HP anxiety MESHD/depression), before and during the pandemic. Changes in the EQ-5D dimensional responses were compared categorically as well as using the dimension-specific sum-score (range 1 to 3, with a higher score indicates worse health). The responses and sum-score were compared using the exact test of symmetry and the paired t-test, respectively. ResultsThese patients [mean age TRANS (SD) 59.8 (10.5); 92.6% males TRANS; 56% New York Heart Association (NYHA) functional class I] had coronary artery disease MESHD (69%), heart failure MESHD (28%), or arrhythmias HP arrhythmias MESHD (15%). None experienced change in NYHA class between assessments. About 30% and 38% of patients reported problems with at least one of the EQ-5D dimensions pre- and during the pandemic, respectively. The highest increase in health problems was reported for anxiety HP anxiety MESHD/depression (12.5% pre-pandemic vs 23.5% during pandemic; p = 0.035) with mean domain-specific score from 1.12 (SD 0.33) to 1.25 (SD 0.46) (p = 0.012). There was no meaningful change in other dimensions as well as overall HRQoL. Conclusion The COVID-19 pandemic is associated with a significant worsening of the mental health of patients with CVD MESHD

    Characteristics of 24,516 Patients Diagnosed with COVID-19 Illness in a National Clinical Research Network: Results from PCORnet

    Authors: Jason P Block; Keith A. Marsolo; Kshema Nagavedu; L Charles Bailey; Henry Cruz; Christopher B. Forrest; Kevin Haynes; Adrian F. Hernandez; Rainu Kaushal; Abel Kho; Kathleen M. McTigue; Vinit P. Nair; Richard Platt; Jon Puro; Russell L. Rothman; Elizabeth Shenkman; Lemuel Russell Waitman; Mark G. Weiner; Neely Williams; Thomas W. Carton

    doi:10.1101/2020.08.01.20163733 Date: 2020-08-04 Source: medRxiv

    Background: National data from diverse institutions across the United States are critical for guiding policymakers as well as clinical and public health leaders. This study characterized a large national cohort of patients diagnosed with COVID-19 in the U.S., compared to patients diagnosed with viral pneumonia MESHD pneumonia HP and influenza. Methods and Findings: We captured cross-sectional information from 36 large healthcare systems in 29 U.S. states, participating in PCORnet, the National Patient-Centered Clinical Research Network. Patients included were those diagnosed with COVID-19, viral pneumonia MESHD pneumonia HP and influenza in any care setting, starting from January 1, 2020. Using distributed queries executed at each participating institution, we acquired information for patients on care setting (any, ambulatory, inpatient or emergency department, mechanical ventilator), age TRANS, sex, race, state, comorbidities (assessed with diagnostic codes), and medications used for treatment of COVID-19 (hydroxychloroquine with or without azithromycin; corticosteroids, anti-interleukin-6 agents). During this time period, 24,516 patients were diagnosed with COVID-19, with 42% in an emergency department or inpatient hospital setting; 79,639 were diagnosed with viral pneumonia MESHD pneumonia HP (53% inpatient/ED) and 163,984 with influenza (41% inpatient/ED). Among COVID-19 patients, 68% were 20 to <65 years of age TRANS, with more of the hospitalized/ED patients in older age TRANS ranges (23% 65+ years vs. 12% for COVID-19 patients in the ambulatory setting). Patients with viral pneumonia MESHD pneumonia HP were of a similar age TRANS, and patients with influenza were much younger. Comorbidities were common, especially for patients with COVID-19 and viral pneumonia MESHD pneumonia HP, with hypertension HP hypertension MESHD (32% for COVID-19 and 46% for viral pneumonia HP pneumonia MESHD), arrhythmias HP arrhythmias MESHD (20% and 35%), and pulmonary disease MESHD (19% and 40%) the most common. Hydroxychloroquine was used in treatment for 33% and tocilizumab for 11% of COVID-19 patients on mechanical ventilators (25% received azithromycin as well). Conclusion and Relevance: PCORnet leverages existing data to capture information on one of the largest U.S. cohorts to date of patients diagnosed with COVID-19 compared to patients diagnosed with viral pneumonia MESHD pneumonia HP and influenza.

    Mitigating Arrhythmia HP Arrhythmia MESHD Risk in Hydroxychloroquine and Azithromycin Treated COVID-19 Patients using Arrhythmia HP Arrhythmia MESHD Risk Management Plan

    Authors: Kazimieras Maneikis M.D.; Ugne Ringeleviciute M.D.; Justinas Bacevicius M.D.; Egle Dieninyte-Misiune M.D.; Emilija Burokaite M.D.; Gintare Kazbaraite M.D.; Marta Monika Janusaite M.D.; Austeja Dapkeviciute M.D.; Andrius Zucenka M.D.; Valdas Peceliunas M.D. Ph.D.; Lina Kryzauskaite M.D.; Vytautas Kasiulevicius M.D. Ph.D.; Donata Ringaitiene M.D. Ph.D.; Birute Zablockiene M.D. Ph.D.; Tadas Zvirblis; Germanas Marinskis M.D. Ph.D.; Ligita Jancoriene M.D. Ph.D.; Laimonas Griskevicius M.D. Ph.D.

    doi:10.21203/rs.3.rs-50501/v1 Date: 2020-07-29 Source: ResearchSquare

    Background: Hydroxychloroquine and Azithromycin use is associated with QT interval prolongation MESHD and arrhythmias HP arrhythmias MESHD. Despite ongoing multiple clinical trials for treatment of COVID19 infection MESHD, no definite cardiac safety protocols were proposed. The aim of our study was to assess cardiac safety in COVID-19 patients treated with the combination of Hydroxychloroquine and Azithromycin using close monitoring and arrhythmia HP arrhythmia MESHD risk management plan.Methods and results: We retrospectively examined arrhythmia HP arrhythmia MESHD safety of treatment with Hydroxychloroquine and Azithromycin in the setting of pre-defined cardiac arrhythmia MESHD arrhythmia HP risk management plan. 81 patients were included from March 23rd to May 10th 2020. The median age TRANS was 59 years, 58.0% were female TRANS. The majority of the study population (82.7%) had comorbidities, 98.8% had radiological signs of pneumonia HP pneumonia MESHD. 7 patients (8.6%) had QTc prolongation MESHD of ≥500 ms. The treatment was discontinued in 4 patients (4.9%). 14 patients (17.3%) experienced QTc≥480 ms and 16 patients (19.8%) had an increase of QTc≥60 ms. None of the patients developed ventricular tachycardia HP ventricular tachycardia MESHD. The risk factors significantly associated with QTc≥500 ms were hypokalemia HP hypokalemia MESHD (p = 0.032) and use of diuretics during the treatment (p = 0.020). Three patients had a lethal outcome; none of them associated with ventricular arrhythmias HP ventricular arrhythmias MESHD.Conclusion: We recorded a low incidence of QTc prolongation MESHD ≥500 ms and no ventricular tachycardia HP ventricular tachycardia MESHD events in COVID-19 patients treated with Hydroxychloroquine and Azithromycin using cardiac arrhythmia MESHD arrhythmia HP risk management plan.

    Safety of Hydroxychloroquine among Outpatient Clinical Trial Participants for COVID-19

    Authors: SARAH, M M LOFGREN; Melanie R Nicol; Ananta S Bangdiwala; Katelyn A Pastick; Elizabeth C Okafor; Caleb P Skipper; Matthew F Pullen; Nicole W Engen; Mahsa Abassi; Darlisha A Williams; Alanna A Nascene; Margaret L Axelrod; Sylvian A Lother; Lauren J MacKenzie; Glen Drobot; Nicole Marten; Matthew P Cheng; Ryan Zarychanshi; Ilan S Schwartz; Michael Silverman; Zain Chagla; Lauren E Kelley; Emily G McDonald; Todd C Lee; Katherine Huppler Hullsiek; David R Boulware; Radha Rajasingham

    doi:10.1101/2020.07.16.20155531 Date: 2020-07-23 Source: medRxiv

    Introduction: Use of hydroxychloroquine in hospitalized patients with COVID-19, especially in combination with azithromycin, has raised safety concerns. Here, we report safety data from three outpatient randomized clinical trials. Methods: We conducted three randomized, double-blind, placebo-controlled trials investigating hydroxychloroquine as pre-exposure prophylaxis, post-exposure prophylaxis and early treatment for COVID-19. We excluded individuals with contraindications to hydroxychloroquine. We collected side effects and serious adverse events. We report descriptive analyses of our findings. Results: We enrolled 2,795 participants. The median age TRANS of research participants was 40 (IQR 34-49) years, and 59% (1633/2767) reported no chronic medical conditions. Overall 2,324 (84%) participants reported side effect data, and 638 (27%) reported at least one medication side effect. Side effects were reported in 29% with daily, 36% with twice weekly, 31% with once weekly hydroxychloroquine compared to 19% with placebo. The most common side effects were upset stomach or nausea HP nausea MESHD (25% with daily, 18% with twice weekly, 16% with weekly, vs. 10% for placebo), followed by diarrhea HP diarrhea MESHD, vomiting HP vomiting MESHD, or abdominal pain HP abdominal pain MESHD (23% for daily, 16% twice weekly, 12% weekly, vs. 6% for placebo). Two individuals were hospitalized for atrial arrhythmias HP atrial arrhythmias MESHD, one on placebo and one on twice weekly hydroxychloroquine. No sudden deaths occurred. Conclusion: Data from three outpatient COVID-19 trials demonstrated that gastrointestinal side effects were common but mild with the use of hydroxychloroquine, while serious side effects were rare. No deaths occurred related to hydroxychloroquine. Randomized clinical trials can safely investigate whether hydroxychloroquine is efficacious for COVID-19.

    Electrocardiographic safety of daily Hydroxychloroquine 400mg plus Azithromycin 250mg as an ambulatory treatment for COVID-19 patients in Cameroon.

    Authors: Liliane Mfeukeu Kuate; William Ngatchou; Mazou Ngou Temgoua; Charles Kouanfack; Daniel Lemogoum; Joel Noutakdie Tochie; Armel Zemsi; Lauriane Fomete; Skinner Lekelem; Sylvain Zemsi; Joelle Tambekou Sobngwi; Thiery Ntandzi; Christian Ngongang Ouankou; Yves Wasnyo; Antoinette Ntsama Assiga; Jean Rene Nkeck; Ahmadou Musa Jingi; Magellan Guewo; Eric Walter Pefura Yone; Charlotte Omgba Moussi; Paul Owono Etoundi; Jean Cyr Yombi; Alain Patrick Menanga; Samuel Kingue; Jacqueline Ze Minkande; Jean Claude Mbanya; Pierre Cyrille Ongolo Zogo; Pierre Joseph Fouda; Eugene Sobngwi

    doi:10.1101/2020.06.24.20139386 Date: 2020-06-29 Source: medRxiv

    Objective : To determine the early electrocardiographic changes in a cohort of ambulatory cameroonian COVID-19 patients treated with hydroxychloroquine and Azithromycin. Design : Prospective study. Setting : Treatment centres of the city of Yaounde, Cameroon, from May 7th to 24th 2020. Participants : We enrolled 51 consecutive confirmed COVID-19 on RT-PCR who having mild forms of COVID-19 and treated by hydroxychloroquine 200mg twice daily during seven days plus Azithromycin 500 mg the first day and 250 mg the remaining 4 days as per national standard. Main outcomes measures : The primary end-point was the change in QTc interval between day 0 (D0), day 3 (D3) and day 7 (D7). Secondary endpoints were changes in all other cardiac electrical conductivity patterns and the occurrence of clinical arrhythmic MESHD events during the course of treatment. Results: The population (29 men and 22 women) was aged TRANS 39 +/- 11 years (range 17 to 61 years). Mean Tisdale score was 3.35 +/- 0.48. No significant change from baseline (D0) of QTc was observed at D7 (429 +/- 27 ms at D0 versus 396 +/- 26 ms at D7; p = 0.27). A reduction of heart rate was observed between the D0 and D7 (75 +/- 13 bpm versus 70 +/- 13 bpm, p = 0.02) with increased QRS duration between D0 and D7 (95 +/- 10 ms versus 102 +/- 17 ms, p = 0.004). No symptomatic arrhythmic MESHD events occurred during the treatment course. Conclusions: No life-threatening modifications of the QT interval was observed in non-severe COVID-19 patients treated ambulatory with hydroxychloroquine and azithromycin. Studies are needed in critical-ill and older patients.

    The Cardiac Toxicity MESHD of Chloroquine or Hydroxychloroquine in COVID-19 Patients: A Systematic Review and Meta-regression Analysis

    Authors: Imad Tleyjeh; Zakariya Kashour; Oweida AlDosary; Muhammad Riaz; Haytham Tlayjeh; Musa A Garbati; Rana Tleyjeh; Mouaz H Al-Mallah; Rizwan M Sohail; Dana Gerberi; Aref A Bin Abdulhak; John R Giudicessi; Michael John Ackerman; Tarek Kashour

    doi:10.1101/2020.06.16.20132878 Date: 2020-06-18 Source: medRxiv

    Abstract Importance The antimalarial agents chloroquine (CQ) and hydroxychloroquine (HCQ) have been proposed as a potential treatment for COVID-19 due their effect on several cellular processes that impact viral replication. Although more than 100 ongoing trials are testing their efficacy, CQ and HCQ are being used widely in clinical practice, exposing COVID-19 patients to potentially significant cardiac adverse effects. Objective To systematically review the literature and estimate the risk of cardiac toxicity MESHD in patients receiving CQ or HCQ for COVID-19. Data Sources A systematic search was conducted on May 27, 2020 of Ovid EBM Reviews, Ovid Embase (1974+), Ovid Medline (1946+ including epub ahead of print, in-process & other non-indexed citations), Scopus (1970+) and Web of Science (1975+) and preprint servers (Medrvix and ResearchSquare) and manual search of references lists. Study Selection Studies that included COVID-19 patients treated with CQ or HCQ, with or without azithromycin, were included as follows: (1) COVID-19 patient population, (2) the study included more than 10 patients receiving either one of the medications, (3) reported electrocardiographic changes and/or cardiac arrhythmias MESHD arrhythmias HP. Data Extraction and Synthesis Study characteristics and endpoints incidence were extracted. Due to the very low incidence of torsades de pointes HP torsades de pointes MESHD ( TdP MESHD) and other endpoints (rare events), the arcsine transformation was used to obtain a pooled estimate of the different incidences using a random-effects meta-analysis. Meta-regression analyses were used to assess whether the incidence of different endpoints significantly varied by multiple study-level variables specified a priori. Main Outcomes and Measures Pooled Incidence of: (1) change in QTc value from baseline [≥] 60 ms, (2) QTc [≥] 500 ms, (3) the composite of endpoint 1 and 2, (4) TdP arrhythmia MESHD arrhythmia or ventricular HP ventricular tachycardia MESHD tachycardia HP ( VT MESHD) or cardiac arrest HP cardiac arrest MESHD, (5) discontinuation of treatment due to drug-induced QT prolongation or arrhythmias MESHD arrhythmias HP. Results A total of 19 studies with a total of 5652 patients were included. All included studies were of high methodological quality in terms of exposure ascertainment or outcome assessment. Among 2719 patients treated with CQ or HCQ, only two episodes of TdP MESHD were reported; the pooled incidence of TdP arrhythmia MESHD arrhythmia HP or VT MESHD or cardiac arrest HP cardiac arrest MESHD was 3 per 1000, 95% CI (0-21), I2=96%, 18 studies with 3725 patients. Among 13 studies of 4334 patients, the pooled incidence of discontinuation of CQ or HCQ due to prolonged QTc or arrhythmias MESHD arrhythmias HP was 5%, 95% CI (1-11), I2=98%. The pooled incidence of change in QTc from baseline of [≥] 60 ms was 7%, 95% CI (3-14), I2=94% (12 studies of 2008 patients). The pooled incidence of QTc [≥] 500 ms was 6%, 95% CI (2-12), I2=95% (16 studies of 2317 patients). Among 11 studies of 3127 patients, the pooled incidence of change in QTc from baseline of [≥] 60 ms or QTc [≥] 500 ms was 9%, 95% CI (3-17), I2=97%. Mean/median age TRANS, coronary artery disease MESHD, hypertension HP hypertension MESHD, diabetes MESHD, concomitant QT prolonging medications, ICU care, and severity of illness in the study populations explained between-studies heterogeneity. Conclusions and Relevance Treatment of COVID-19 patients with CQ or HCQ is associated with a significant risk of drug-induced QT prolongation MESHD, which is a harbinger for drug-induced TdP MESHD/ VT MESHD or cardiac arrest HP cardiac arrest MESHD. CQ/HCQ use resulted in a relatively higher incidence of TdP MESHD as compared to drugs withdrawn from the market for this particular adverse effect. Therefore, these agents should be used only in the context of randomized clinical trials, in patients at low risk for drug-induced QT prolongation MESHD, with adequate safety monitoring.

    Hypokalemia HP Hypokalemia MESHD in Patients with COVID-19

    Authors: Gaetano Alfano; Annachiara Ferrari; Francesco Fontana; Rossella Perrone; Giacomo Mori; Elisabetta Ascione; Magistroni Riccardo; Giulia Venturi; Simone Pederzoli; Gianluca Margiotta; Marilina Romeo; Francesca Piccinini; Giacomo Franceschi; Sara Volpi; Matteo Faltoni; Giacomo Ciusa; Erica Bacca; Marco Tutone; Alessandro Raimondi; marianna menozzi; Erica Franceschini; Gianluca Cuomo; Gabriella Orlando; Antonella Santoro; Margherita Di Gaetano; Cinzia Puzzolante; Federica Carli; Andrea Bedini; Jovana Milic; Marianna Meschiari; Cristina Mussini; Gianni Cappelli; Giovanni Guaraldi

    doi:10.1101/2020.06.14.20131169 Date: 2020-06-16 Source: medRxiv

    Patients with COVID-19 may experience multiple conditions (e.g., fever HP fever MESHD, hyperventilation HP hyperventilation MESHD, anorexia HP anorexia MESHD, gastroenteritis MESHD, acid-base disorder) that may cause electrolyte imbalances. Hypokalemia HP Hypokalemia MESHD is a concerning electrolyte disorder that may increase the susceptibility to various kinds of arrhythmia HP arrhythmia MESHD. This study aimed to estimate prevalence SERO, risk factors and outcome of hypokalemia HP hypokalemia MESHD in a cohort of non-critically ill patients. A retrospective analysis was conducted on 290 hospitalized patients with confirmed COVID-19 infection at the tertiary teaching hospital of Modena, Italy. Hypokalemia HP Hypokalemia MESHD (<3.5 mEq/L) was detected in 119 patients (41%). The decrease of serum SERO potassium level was of mild entity (3-3.4 mEq/L) and occurred in association with hypocalcemia HP hypocalcemia MESHD (P=0.001) and lower level of serum SERO magnesium (P=0.028) compared to normokaliemic patients. Urine K: creatinine ratio, measured in a small subset of patients (n=45; 36.1%), showed an increase of urinary potassium HP excretion in the majority of the cases (95.5%). Causes of kaliuria were diuretic therapy (53.4%) and corticosteroids (23.3%). In the remaining patients, urinary potassium loss was associated with normal serum SERO magnesium, low sodium excretion (FENa< 1%) and metabolic alkalosis HP metabolic alkalosis MESHD. Risk factors for hypokalemia HP hypokalemia MESHD were female TRANS gender TRANS (P=0.002; HR 0.41, 95%CI 0.23-0.73) and diuretic therapy (P=0.027; HR 1.94, 95%CI 1.08-3.48). Hypokalemia HP Hypokalemia MESHD, adjusted for sex, age TRANS and SOFA score, resulted not associated with ICU admission (P=0.131, 95% CI 0.228-1.212) and in-hospital mortality (P=0.474; 95% CI 0,170-1,324) in our cohort of patients. Hypokalemia HP Hypokalemia MESHD is a frequent disorder in COVID-19 patients and urinary potassium loss may be the main cause of hypokalemia HP hypokalemia MESHD. The disorder was mild in the majority of the patients and was unrelated to poor outcomes. Nevertheless, hypokalemic MESHD patients required potassium supplements to dampen the risk of arrhythmias HP arrhythmias MESHD.

    Risk factors and electrocardiogram characteristics for mortality of critical inpatients with COVID-19

    Authors: Lingzhi Li; Shudi Zhang; Bing He; Xiaobei Chen; Shihong Wang; Zhao Qingyan

    doi:10.21203/rs.3.rs-33824/v1 Date: 2020-06-05 Source: ResearchSquare

    Background The novel severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2) has subsequently spread worldwide. The number of death MESHD has increased rapidly. However, the possible risk factors that lead to death in critical inpatients with coronavirus disease MESHD 2019 (COVID-19) are not yet fully known. This study was to explore the risk factors for mortality of critical inpatients with COVID-19.Methods In this single-centered, retrospective study, we enrolled 113 critical patients with COVID-19 in Renmin Hospital of Wuhan University between Feb 1, 2020 and Mar 15, 2020. Data were collected using a standard method including clinical records and laboratory findings. Outcomes of survivors and death were compared.Results A total of 113 critical patients (from 29 to 95 years) with COVID-19 were recruited, 50 (44.25%) died and 63 recovered (55.75%). The proportion of patients with ventricular arrhythmia HP ventricular arrhythmia MESHD was higher in the death group than the recovery group (24.0% vs 4.4%; p = 0.021), and was higher among myocardial damage MESHD cases than non-myocardial damage cases (26.1% vs 4.3%; p = 0.013). Multivariate analysis confirmed four independent predictors related to mortality of COVID-19: age > 70 yrs (HR 1.84, 95% CI 1.03–3.28), initial neutrophil count more than 6.5 × 109/L (HR 3.43, 95% CI 1.84–6.40), C-reactive protein greater more than 100 mg/L (HR 1.93, 95% CI 1.04–3.59), and lactate dehydrogenase more than 300 U/L (HR 2.90, 95% CI 1.26–6.67). Immunoglobulin treatment (HR 0.39, 95% CI 0.21–0.73) can reduce the risk of death MESHD. There was no significant difference in the QT interval between patients with and without hydroxychloroquine treatment.Conclusions Old age TRANS (> 70 years), neutrophilia HP, C-reactive protein greater more than 100 mg/L and lactate dehydrogenase more than 300 U/L are high-risk factors for mortality of critical patients with COVID-19. The incidence of ventricular arrhythmia HP ventricular arrhythmia MESHD was higher in deceased patients than survivors.

    The association of cardiovascular disease MESHD and other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis

    Authors: Paddy Ssentongo; Anna E. Ssentongo; Emily S. Heilbrunn; Djibril M Ba; Vernon M. Chinchilli

    doi:10.1101/2020.05.10.20097253 Date: 2020-05-14 Source: medRxiv

    Background Exploring the association of coronavirus-2019 disease (COVID-19) mortality with chronic pre-existing conditions may promote the importance of targeting these populations during this pandemic to optimize survival. The objective of this systematic review and meta-analysis is to explore the association of pre-existing conditions with COVID-19 mortality. Methods We searched MEDLINE, OVID databases, SCOPUS, and medrxiv.org for the period December 1, 2019, to May 1, 2020. The outcome of interest was the risk of COVID-19 mortality in patients with and without pre-existing conditions. Comorbidities explored were cardiovascular diseases MESHD ( coronary artery disease MESHD, hypertension HP hypertension MESHD, cardiac arrhythmias MESHD arrhythmias HP, and congestive heart failure HP congestive heart failure MESHD), chronic obstructive pulmonary disease HP chronic obstructive pulmonary disease MESHD, type 2 diabetes MESHD, cancer MESHD, chronic kidney disease HP chronic kidney disease MESHD, chronic liver disease MESHD, and stroke HP stroke MESHD. Two independent reviewers extracted data and assessed the risk of bias. All analyses were performed using random-effects models and heterogeneity was quantified. Results Ten chronic conditions from 19 studies were included in the meta-analysis (n = 61,455 patients with COVID-19; mean age TRANS, 61 years; 57% male TRANS). Overall the between-study study heterogeneity was medium and studies had low publication bias MESHD and high quality. Coronary heart disease MESHD, hypertension HP hypertension MESHD, congestive heart failure HP congestive heart failure MESHD, and cancer MESHD significantly increased the risk of mortality from COVID-19. The risk of mortality from COVID-19 in patients with coronary heart disease MESHD was 2.4 times as high as those without coronary heart disease MESHD (RR= 2.40, 95%CI=1.71-3.37, n=5) and twice as high in patients with hypertension HP hypertension MESHD as high as that compared to those without hypertension HP hypertension MESHD (RR=1.89, 95%CI= 1.58-2.27, n=9). Patients with cancer MESHD also were at twice the risk of mortality from COVID-19 compared to those without cancer MESHD (RR=1.93 95%CI 1.15-3.24, n=4), and those with congestive heart failure HP congestive heart failure MESHD were at 2.5 times the risk of mortality compared to those without congestive heart failure HP congestive heart failure MESHD (RR=2.66, 95%CI 1.58-4.48, n=3). Conclusions COVID-19 patients with all any cardiovascular disease MESHD, coronary heart disease MESHD, hypertension HP hypertension MESHD, congestive heart failure HP congestive heart failure MESHD, and cancer MESHD have an increased risk of mortality. Tailored infection MESHD prevention and treatment strategies targeting this high-risk population are warranted to optimize survival.

    Experience with Hydroxychloroquine and Azithromycin in the COVID-19 Pandemic: Implications for QT Interval Monitoring

    Authors: Archana Ramireddy; Harpriya S. Chugh; Kyndaron Reinier; Joseph Ebinger; Eunice Park; Michael Thompson; Eugenio Cingolani; Susan Cheng; Eduardo Marban; Christine Albert; Sumeet S. Chugh

    doi:10.1101/2020.04.22.20075671 Date: 2020-04-25 Source: medRxiv

    Background: Despite a paucity of clinical evidence, hydroxychloroquine and azithromycin are being administered widely to patients with verified or suspected COVID-19. Both drugs may increase risk of lethal arrhythmias HP arrhythmias MESHD associated with QT interval prolongation MESHD. Methods: We performed a case series of COVID-19 positive/suspected patients admitted between 2/1/2020 and 4/4/2020 who were treated with azithromycin, hydroxychloroquine or a combination. We evaluated baseline and post-medication QT interval (QTc, Bazett) using 12-lead ECGs. Critical QTc prolongation MESHD was defined as: a) maximum QTc [≥]500 ms (if QRS <120 ms) or QTc [≥]550 (if QRS [≥]120 ms) and b) increased QTc of [≥]60 ms. Tisdale score and Elixhauser comorbidity index were calculated. Results: Of 490 COVID-19 positive/suspected patients, 314 (64%) received either/both drugs, and 98 (73 COVID-19 positive, 25 suspected) met study criteria ( age TRANS 62{+/-}17 yrs, 61% male TRANS). Azithromycin was prescribed in 28%, hydroxychloroquine in 10%, and both in 62%. Baseline mean QTc was 448{+/-}29 ms and increased to 459{+/-}36ms (p=0.005) with medications. Significant prolongation MESHD was observed only in men (18{+/-}43 ms vs -0.2{+/-}28 ms in women, p=0.02). 12% of patients reached critical QTc prolongation MESHD. In a multivariable logistic regression, age TRANS, sex, Tisdale score, Elixhauser score, and baseline QTc were not associated with critical QTc prolongation MESHD (p>0.14). Changes in QTc were highest with the combination compared to either drug, with many-fold greater prolongation with the combination vs. azithromycin alone (17{+/-}39 vs. 0.5{+/-}40 ms, p=0.07). No patients manifested torsades de pointes HP torsades de pointes MESHD. Conclusions: Overall, 12% of patients manifested critical QTc interval prolongation MESHD, and traditional risk indices failed to flag these patients. With the drug combination, QTc prolongation MESHD was several-fold higher compared to azithromycin alone. The balance between uncertain benefit and potential risk when treating COVID-19 patients with these drugs should be carefully assessed prior to use.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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