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    Risk Factors for COVID-19-associated hospitalization: COVID-19-Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System

    Authors: Jean Y. Ko; Melissa L. Danielson; Machell Town; Gordana Derado; Kurt J. Greenland; Pam Daily Kirley; Nisha B. Alden; Kimberly Yousey-Hindes; Evan J. Anderson; Patricia A. Ryan; Sue Kim; Ruth Lynfield; Salina M. Torres; Grant R. Barney; Nancy M. Bennett; Melissa Sutton; H. Keipp Talbot; Mary Hill; Aron J. Hall; Alicia M. Fry; Shikha Garg; Lindsay Kim; - COVID-NET Investigation Group

    doi:10.1101/2020.07.27.20161810 Date: 2020-07-29 Source: medRxiv

    Background: Identification of risk factors for COVID-19-associated hospitalization is needed to guide prevention and clinical care. Objective: To examine if age TRANS, sex, race/ethnicity, and underlying medical conditions is independently associated with COVID-19-associated hospitalizations. Design: Cross-sectional. Setting: 70 counties within 12 states participating in the Coronavirus Disease MESHD 2019-Associated Hospitalization Surveillance Network (COVID-NET) and a population-based sample of non-hospitalized adults TRANS residing in the COVID-NET catchment area from the Behavioral Risk Factor Surveillance System. Participants: U.S. community-dwelling adults TRANS ([≥]18 years) with laboratory-confirmed COVID-19-associated hospitalizations, March 1- June 23, 2020. Measurements: Adjusted rate ratios (aRR) of hospitalization by age TRANS, sex, race/ethnicity and underlying medical conditions ( hypertension HP hypertension MESHD, coronary artery disease MESHD, history of stroke HP stroke MESHD, diabetes MESHD, obesity HP obesity MESHD [BMI [≥]30 kg/m2], severe obesity HP obesity MESHD [BMI[≥]40 kg/m2], chronic kidney disease HP chronic kidney disease MESHD, asthma HP asthma MESHD, and chronic obstructive pulmonary disease HP chronic obstructive pulmonary disease MESHD). Results: Our sample included 5,416 adults TRANS with COVID-19-associated hospitalizations. Adults TRANS with (versus without) severe obesity HP obesity MESHD (aRR:4.4; 95%CI: 3.4, 5.7), chronic kidney disease HP chronic kidney disease MESHD (aRR:4.0; 95%CI: 3.0, 5.2), diabetes MESHD (aRR:3.2; 95%CI: 2.5, 4.1), obesity HP obesity MESHD (aRR:2.9; 95%CI: 2.3, 3.5), hypertension HP hypertension MESHD (aRR:2.8; 95%CI: 2.3, 3.4), and asthma HP asthma MESHD (aRR:1.4; 95%CI: 1.1, 1.7) had higher rates of hospitalization, after adjusting for age TRANS, sex, and race/ethnicity. In models adjusting for the presence of an individual underlying medical condition, higher hospitalization rates were observed for adults TRANS [≥]65 years, 45-64 years (versus 18-44 years), males TRANS (versus females TRANS), and non-Hispanic black and other race/ethnicities (versus non-Hispanic whites). Limitations: Interim analysis limited to hospitalizations with underlying medical condition data. Conclusion: Our findings elucidate groups with higher hospitalization risk that may benefit from targeted preventive and therapeutic interventions.

    Unusual Presentation of Kawasaki Disease MESHD with Multisystem Inflammation MESHD and Antibodies SERO Against Severe Acute Respiratory Syndrome MESHD Coronavirus 2: A Case Report

    Authors: Haena Kim; Jung Yeon Shim; Jae-Hoon Ko; Aram Yang; Jae Won Shim; Deok Soo Kim; Hye Lim Jung; Ji Hee Kwak; In Suk Sol

    doi:10.21203/rs.3.rs-41276/v1 Date: 2020-07-12 Source: ResearchSquare

    Background: Since mid-April 2020, cases of multisystem inflammatory syndrome MESHD in children TRANS (MIS-C) associated with coronavirus disease MESHD (COVID-19) that mimic Kawasaki disease MESHD ( KD MESHD) have been reported in Europe and North America. However, no cases have been in East Asia, where KD MESHD is more prevalent.Case presentation: A previously healthy 11-year-old boy was admitted with a 4-day history of fever HP fever MESHD and abdominal pain HP abdominal pain MESHD. He had no contact history to any patient with COVID-19. Blood SERO acute inflammatory markers were highly elevated. He was treated with antibiotics for suspected bacterial enteritis MESHD, but he suddenly developed hypotension HP hypotension MESHD. Inotropics and intravenous immunoglobulin were administered to manage septic shock MESHD shock HP. On hospitalization day 6, he developed signs and symptoms of KD MESHD (conjunctival injection, strawberry tongue HP, cracked lip MESHD, and coronary artery dilatation MESHD dilatation HP) in addition to pleural/pericardial effusion MESHD pericardial effusion HP and mesenteric lymphadenitis HP lymphadenitis MESHD. The results of microbiologic tests, including reverse-transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2), were negative. Fluorescent immunoassay SERO and enzyme-linked immunosorbent assay SERO revealed abundant IgG antibodies SERO against SARS-CoV-2 in his serum SERO, but no IgM antibodies SERO. He was discharged successfully on day 13.Conclusion: MIS-C may occur in children TRANS with a previously asymptomatic TRANS COVID-19 infection MESHD. A high index of suspicion is required for this novel syndrome in unusual cases of KD MESHD or KD shock syndrome MESHD shock HP syndrome with multisystem inflammation MESHD, even when there is no clear history of contact or symptoms of COVID-19.

    Causally Associations of Blood SERO Lipids Levels with COVID-19 Risk: Mendelian Randomization Study

    Authors: Kun Zhang; Yan Guo; Zhuo-Xin Wang; Jing-Miao Ding; Shi Yao; Hao Chen; Dong-Lin Zhu; Kun Zhang; Wei Huang; Shan-Shan Dong; Tie-Lin Yang

    doi:10.1101/2020.07.07.20147926 Date: 2020-07-07 Source: medRxiv

    Background: Coronavirus disease 2019 (COVID-19) is a global pandemic caused by the severe acute respiratory syndrome coronavirus 2 MESHD (SARS-Cov-2). It has been found that coronary artery disease MESHD ( CAD MESHD) is a comorbid condition for COVID-19. As the risk factors of CAD MESHD, whether blood SERO lipids levels are causally related to increasing susceptibility and severity of COVID-19 is still unknown. Design: We performed two-sample Mendelian Randomization (MR) analyses to explore whether dyslipidemia MESHD, low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol (HDL-c), triglyceride (TG) and total cholesterol (TC) were causally related to COVID-19 risk and severity. The GWAS summary data of blood SERO lipids involving in 188,578 individuals and dyslipidemia MESHD in a total of 53,991 individuals were used as exposures, respectively. Two COVID-19 GWASs including 1,221 infected patients and 1,610 severe patients defined as respiratory failure HP respiratory failure MESHD were employed as outcomes. Based on the MR estimates, we further carried out gene-based and gene-set analysis to explain the potential mechanism for causal effect. Results: The MR results showed that dyslipidemia MESHD was casually associated with the susceptibility of COVID-19 and induced 27% higher odds for COVID-19 infection MESHD (MR-IVW OR = 1.27, 95% CI: 1.08 to 1.49, p-value = 3.18 x 10-3). Moreover, the increasing level of blood SERO TC will raise 14 % higher odds for the susceptibility of COVID-19 (MR-IVW OR = 1.14, 95% CI: 1.04 to 1.25, p-value = 5.07 x 10-3). Gene-based analysis identified that ABO gene was associated with TC and the gene-set analysis found that immune processes were involved in the risk effect of TC. Conclusions: We obtained three conclusions: 1) Dyslipidemia MESHD is casually associated with the susceptibility of COVID-19; 2) TC is a risk factor for the susceptibility of COVID-19; 3) The different susceptibility of COVID-19 in specific blood SERO group may be partly explained by the TC concentration in diverse ABO blood SERO groups.

    Red blood SERO cell distribution width (RDW) in Hospitalized COVID-19 Patients

    Authors: Preethi Ramachandran; Mahesh Gajendran; Abhilash Perisetti; Karim Osama Elkholy; Abhishek Chakraborti; Giuseppe Lippi; Hemant Goyal

    doi:10.1101/2020.06.29.20143081 Date: 2020-07-03 Source: medRxiv

    Introduction: Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 MESHD (SARS-CoV-2), is causing dramatic morbidity and mortality worldwide. The Red Blood SERO Cell Distribution Width (RDW) has been strongly associated with increased morbidity and mortality in multiple diseases. Objective: To assess if elevated RDW is associated with unfavorable outcomes in hospitalized COVID-19. Methods: We retrospectively studied clinical outcomes of hospitalized COVID-19 patients for their RDW values. In-hospital mortality was defined as primary outcome, while septic shock MESHD shock HP, need for mechanical ventilation, and length of stay (LOS) were secondary outcomes. Results- A total of 294 COVID-19 patients were finally studied. Overall prevalence SERO of increased RDW was 49.7% (146/294). RDW was associated with increased risk of in-hospital mortality (aOR, 4.5; 95%CI, 1.4-14.3) and septic shock MESHD shock HP (aOR, 4.6; 95%CI, 1.4-15.1) after adjusting for anemia HP anemia MESHD, ferritin, and lactate. The association remained unchanged even after adjusting for other clinical confounders such as age TRANS, sex, body mass index, coronary artery disease MESHD, hypertension HP hypertension MESHD, diabetes mellitus HP diabetes mellitus MESHD, and chronic obstructive pulmonary disease HP chronic obstructive pulmonary disease MESHD. No association was found instead with mechanical ventilation and median LOS. Conclusion: Elevated RDW in hospitalized COVID-19 patients is associated with a significantly increased risk of mortality and septic shock MESHD shock HP.

    Identifying main and interaction effects of risk factors to predict intensive care admission in patients hospitalized with COVID-19: a retrospective cohort study in Hong Kong

    Authors: Jiandong Zhou; Gary Tse; Sharen Lee; Tong Liu; William KK Wu; zhidong cao; Dajun Zeng; Ian CK Wong; Qingpeng Zhang; Bernard MY Cheung

    doi:10.1101/2020.06.30.20143651 Date: 2020-07-02 Source: medRxiv

    Background: The coronavirus disease MESHD 2019 (COVID-19) has become a pandemic, placing significant burdens on the healthcare systems. In this study, we tested the hypothesis that a machine learning approach incorporating hidden nonlinear interactions can improve prediction for Intensive care unit (ICU) admission. Methods: Consecutive patients admitted to public hospitals between 1st January and 24th May 2020 in Hong Kong with COVID-19 diagnosed by RT-PCR were included. The primary endpoint was ICU admission. Results: This study included 1043 patients (median age TRANS 35 (IQR: 32-37; 54% male TRANS). Nineteen patients were admitted to ICU (median hospital length of stay (LOS): 30 days, median ICU LOS: 16 days). ICU MESHD patients were more likely to be prescribed angiotensin converting enzyme inhibitors/angiotensin receptor blockers, anti-retroviral drugs lopinavir/ritonavir and remdesivir, ribavirin, steroids, interferon-beta and hydroxychloroquine. Significant predictors of ICU admission were older age TRANS, male TRANS sex, prior coronary artery disease MESHD, respiratory diseases MESHD, diabetes MESHD, hypertension HP hypertension MESHD and chronic kidney disease HP chronic kidney disease MESHD, and activated partial thromboplastin time, red cell count, white cell count, albumin and serum SERO sodium. A tree-based machine learning model identified most informative characteristics and hidden interactions that can predict ICU admission. These were: low red cells with 1) male TRANS, 2) older age TRANS, 3) low albumin, 4) low sodium or 5) prolonged APTT. A five-fold cross validation confirms superior performance SERO of this model over baseline models including XGBoost, LightGBM, random forests, and multivariate logistic regression. Conclusions: A machine learning model including baseline risk factors and their hidden interactions can accurately predict ICU admission in COVID-19.

    Clinical characteristics of Covid-19 patients with re-positive test results: an observational study

    Authors: Ying Su; Ling-Shuang Zhu; Yong Gao; Yuncheng Li; Zhanlu Xiong; Bo Hu; Jiao Yuan; Zhao Zhang; Xiaoxiong Wu; Chunchen Feng; Fanjun Cheng; Yang Jin; Yu Zhang; Youming Lu; Hongbo Wang; Ling-Qiang Zhu

    doi:10.1101/2020.06.23.20138149 Date: 2020-06-23 Source: medRxiv

    Background: With coronavirus disease MESHD 2019 (Covid-19) ravaging the global, concern has been aroused whether discharged Covid-19 patients with reappeared positive nucleic acid test results are infected again. Objective: To analyze the clinical characteristics of discharged Covid-19 patients with reappeared positive nucleic acid test results and to track clinical outcomes of them. Methods: We extracted clinical data on 938 Covid-19 patients from Wuhan Union Hospital (West Branch), and we obtained information about residual symptoms and nucleic acid tests after discharge through follow-up study. We evaluated the relationship of clinical characteristics and reappeared positive results. Each patient had at least 44 days of follow-up. Results: Of 938 discharged patients, a total of 58 (6.2%) had reappeared positive nucleic acid test results and 880 remain negative. Among patients over the age TRANS of 50, the factors we found to be associated with re-positive results were coronary artery disease MESHD (14.1%, vs. 5.5% among those without coronary artery disease MESHD; odds ratio, 2.81; 95% confidence interval [CI], 1.28 to 6.15), and hypertension HP hypertension MESHD (9.5%, vs. 4.9% among those without hypertension HP hypertension MESHD; odds ratio, 2.05; 95% CI, 1.10 to 3.82). As of May 11, 2020, 54 (93.1%) re-positive patients turned negative again while two patients remained positive, and two patients was lost to the second follow-up. Conclusion: Coexisting diseases including coronary artery disease MESHD and hypertension HP hypertension MESHD were substantial risk factors for re-positive outcomes among patients over 50. And most re-positive patients tended to return negative eventually.

    Mendelian randomization analysis to characterize causal association between coronary artery disease MESHD and COVID-19

    Authors: Lang Wu; Jingjing Zhu; Chong Wu

    doi:10.1101/2020.05.29.20117309 Date: 2020-05-30 Source: medRxiv

    Observational studies have suggested that having coronary artery disease MESHD increases the risk of Coronavirus disease MESHD 2019 (COVID-19) susceptibility and severity, but it remains unclear if this association is causal. Inferring causation is critical to facilitate the development of appropriate policies and/or individual decisions to reduce the incidence and burden of COVID-19. We applied Two-sample Mendelian randomization analysis and found that genetically predicted CAD was significantly associated with higher risk of COVID-19: the odds ratio was 1.29 (95% confidence interval 1.11 to 1.49; P = 0.001) per unit higher log odds of having CAD.

    Prevalence SERO and Impact of Myocardial Injury MESHD in Patients Hospitalized with COVID-19 Infection

    Authors: Anuradha Lala; Kipp W Johnson; Adam J Russak; Ishan Paranjpe; Shan Zhao; Sulaiman Solani; Akhil Vaid; Fayzan Chaudhry; Jessica K De Freitas; Zahi A Fayad; Sean P Pinney; Matthew Levin; Alexander Charney; Emilia Bagiella; Jagat Narula; Benjamin S Glicksberg; Girish Nadkarni; James Januzzi; Donna M Mancini; Valentin Fuster

    doi:10.1101/2020.04.20.20072702 Date: 2020-04-24 Source: medRxiv

    Background: The degree of myocardial injury MESHD, reflected by troponin elevation, and associated outcomes among hospitalized patients with Coronavirus Disease MESHD (COVID-19) in the US are unknown. Objectives: To describe the degree of myocardial injury MESHD and associated outcomes in a large hospitalized cohort with laboratory-confirmed COVID-19. Methods: Patients with COVID-19 admitted to one of five Mount Sinai Health System hospitals in New York City between February 27th and April 12th, 2020 with troponin-I (normal value <0.03ng/mL) measured within 24 hours of admission were included (n=2,736). Demographics, medical history, admission labs, and outcomes were captured from the hospital EHR. Results: The median age TRANS was 66.4 years, with 59.6% men. Cardiovascular disease MESHD ( CVD MESHD) including coronary artery disease MESHD, atrial fibrillation HP atrial fibrillation MESHD, and heart failure MESHD, was more prevalent in patients with higher troponin concentrations, as were hypertension HP hypertension MESHD and diabetes MESHD. A total of 506 (18.5%) patients died during hospitalization. Even small amounts of myocardial injury MESHD (e.g. troponin I 0.03-0.09ng/mL, n=455, 16.6%) were associated with death MESHD (adjusted HR: 1.77, 95% CI 1.39-2.26; P<0.001) while greater amounts (e.g. troponin I>0.09 ng/dL, n=530, 19.4%) were associated with more pronounced risk (adjusted HR 3.23, 95% CI 2.59-4.02). Conclusions: Myocardial injury MESHD is prevalent among patients hospitalized with COVID-19, and is associated with higher risk of mortality. Patients with CVD MESHD are more likely to have myocardial injury MESHD than patients without CVD MESHD. Troponin elevation likely reflects non- ischemic MESHD or secondary myocardial injury MESHD.

    Incidence of Cardiac Injury MESHD and Associated Poor Outcomes in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis 

    Authors: Fengwei Zou; Zhiyong Qian

    doi:10.21203/rs.3.rs-24567/v1 Date: 2020-04-22 Source: ResearchSquare

    Background: Increasing number of studies have indicated a link between c oronavirus disease MESHD2019 (COVID-19) and acute c ardiac injury. MESHD However, there is currently no consensus on the incidence of c ardiac injury MESHDand its associated prognosis in COVID-19 patients. Methods: We searched PubMed and Embase for studies that evaluated c ardiac injury MESHDin hospitalized COVID-19 patients. Demographic information, co-morbidities, and relevant laboratory values were extracted and a meta-analysis was performed.Results: Ten studies with 1637 patients were included in this meta-analysis. The overall incidence of c ardiac injury MESHDwas 23.2% (380/1637) in hospitalized COVID-19 patients. The incidence was higher (58.5%) in patients who were critically ill, admitted to the intensive care unit (ICU) or died. The composite mortality rate of patients with c ardiac injury MESHDwas 75.1% (251/334). C ardiac injury MESHDwas significantly associated with increased mortality (OR=21.71, 95% CI 9.16-51.46) in those patients. When combining death with ICU admission and patients who were critically ill, patients with c ardiac injury MESHDwas again strongly associated with worse outcomes (OR=22.18, 95% CI 11.68-42.10). In subgroup analyses, hospitalized COVID-19 patients who were older and had history of hypertension HP ypertension, MESHD c oronary artery disease, MESHD c hronic obstructive respiratory disease, MESHD and d iabetes MESHDwere associated with increased risk of developing c ardiac injury. MESHD Conclusion: C ardiac injury MESHDis common in hospitalized COVID-19 patients and is significantly associated with poor outcomes. Patients who are older and have hypertension HP ypertension, MESHD d iabetes, MESHD c oronary artery diseases MESHD diseases and chronic obstructive pulmonary HP bstructive pulmonary diseases MESHDare prone to develop c ardiac injury. MESHD When appropriate, early screening, triage and cardiac monitoring are needed for these patients. 

    Cardiovascular Diseases MESHD and COVID-19 Mortality and Intensive Care Unit Admission: A Systematic Review and Meta-analysis

    Authors: Amirhossein Hessami; Amir Shamshirian; Keyvan Heydari; Fatemeh Pourali; Reza Alizadeh-Navaei; Mahmood Moosazadeh; Saeed Abrotan; Layla Shojaei; Sogol Sedighi; Danial Shamshirian; Nima Rezaei

    doi:10.1101/2020.04.12.20062869 Date: 2020-04-16 Source: medRxiv

    Background: High rate of cardiovascular disease MESHD ( CVD MESHD) have been reported among patients with novel coronavirus disease MESHD (COVID-19). Meanwhile there were controversies among different studies about CVD MESHD burden in COVID-19 patients. Hence, we aimed to study CVD MESHD burden among COVID-19 patients, using a systematic review and meta-analysis. Methods: We have systematically searched databases including PubMed, Embase, Cochrane Library, Scopus, Web of Science as well as medRxiv pre-print database. Hand searched was also conducted in journal websites and Google Scholar. Meta-analyses were carried out for Odds Ratio (OR) of mortality and Intensive Care Unit (ICU) admission for different CVDs. We have also performed a descriptive meta-analysis on different CVDs. Results: Fifty-six studies entered into meta-analysis for ICU admission and mortality outcome and 198 papers for descriptive outcomes, including 159,698 COVID-19 patients. Results of meta-analysis indicated that acute cardiac injury MESHD, (OR: 13.29, 95% CI 7.35-24.03), hypertension HP hypertension MESHD (OR: 2.60, 95% CI 2.11-3.19), heart Failure MESHD (OR: 6.72, 95% CI 3.34-13.52), arrhythmia HP arrhythmia MESHD (OR: 2.75, 95% CI 1.43-5.25), coronary artery disease MESHD (OR: 3.78, 95% CI 2.42-5.90), and cardiovascular disease MESHD (OR: 2.61, 95% CI 1.89-3.62) were significantly associated with mortality. Arrhythmia HP Arrhythmia MESHD (OR: 7.03, 95% CI 2.79-17.69), acute cardiac injury MESHD (OR: 15.58, 95% CI 5.15-47.12), coronary heart disease MESHD (OR: 2.61, 95% CI 1.09-6.26), cardiovascular disease MESHD (OR: 3.11, 95% CI 1.59-6.09), and hypertension HP hypertension MESHD (OR: 1.95, 95% CI 1.41-2.68) were also significantly associated with ICU admission in COVID-19 patients. Conclusion: Findings of this study revealed a high burden of CVDs among COVID-19 patients, which was significantly associated with mortality and ICU admission. Proper management of CVD MESHD patients with COVID-19 and monitoring COVID-19 patients for acute cardiac conditions is highly recommended to prevent mortality and critical situations.

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