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COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study

BACKGROUND: A subset of patients with severe COVID-19 develop a hyperinflammatory syndrome, which might contribute to morbidity and mortality. This study explores a specific phenotype of COVID-19-associated hyperinflammation (COV-HI), and its associations with escalation of respiratory support and s...

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Autores principales: Manson, Jessica J, Crooks, Colin, Naja, Meena, Ledlie, Amanda, Goulden, Bethan, Liddle, Trevor, Khan, Emon, Mehta, Puja, Martin-Gutierrez, Lucia, Waddington, Kirsty E, Robinson, George A, Ribeiro Santos, Liliana, McLoughlin, Eve, Snell, Antonia, Adeney, Christopher, Schim van der Loeff, Ina, Baker, Kenneth F, Duncan, Christopher J A, Hanrath, Aidan T, Lendrem, B Clare, De Soyza, Anthony, Peng, Junjie, J'Bari, Hajar, Greenwood, Mandy, Hawkins, Ellie, Peckham, Hannah, Marks, Michael, Rampling, Tommy, Luintel, Akish, Williams, Bryan, Brown, Michael, Singer, Mervyn, West, Joe, Jury, Elizabeth C, Collin, Matthew, Tattersall, Rachel S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Ltd. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442426/
https://www.ncbi.nlm.nih.gov/pubmed/32864628
http://dx.doi.org/10.1016/S2665-9913(20)30275-7
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author Manson, Jessica J
Crooks, Colin
Naja, Meena
Ledlie, Amanda
Goulden, Bethan
Liddle, Trevor
Khan, Emon
Mehta, Puja
Martin-Gutierrez, Lucia
Waddington, Kirsty E
Robinson, George A
Ribeiro Santos, Liliana
McLoughlin, Eve
Snell, Antonia
Adeney, Christopher
Schim van der Loeff, Ina
Baker, Kenneth F
Duncan, Christopher J A
Hanrath, Aidan T
Lendrem, B Clare
De Soyza, Anthony
Peng, Junjie
J'Bari, Hajar
Greenwood, Mandy
Hawkins, Ellie
Peckham, Hannah
Marks, Michael
Rampling, Tommy
Luintel, Akish
Williams, Bryan
Brown, Michael
Singer, Mervyn
West, Joe
Jury, Elizabeth C
Collin, Matthew
Tattersall, Rachel S
author_facet Manson, Jessica J
Crooks, Colin
Naja, Meena
Ledlie, Amanda
Goulden, Bethan
Liddle, Trevor
Khan, Emon
Mehta, Puja
Martin-Gutierrez, Lucia
Waddington, Kirsty E
Robinson, George A
Ribeiro Santos, Liliana
McLoughlin, Eve
Snell, Antonia
Adeney, Christopher
Schim van der Loeff, Ina
Baker, Kenneth F
Duncan, Christopher J A
Hanrath, Aidan T
Lendrem, B Clare
De Soyza, Anthony
Peng, Junjie
J'Bari, Hajar
Greenwood, Mandy
Hawkins, Ellie
Peckham, Hannah
Marks, Michael
Rampling, Tommy
Luintel, Akish
Williams, Bryan
Brown, Michael
Singer, Mervyn
West, Joe
Jury, Elizabeth C
Collin, Matthew
Tattersall, Rachel S
author_sort Manson, Jessica J
collection PubMed
description BACKGROUND: A subset of patients with severe COVID-19 develop a hyperinflammatory syndrome, which might contribute to morbidity and mortality. This study explores a specific phenotype of COVID-19-associated hyperinflammation (COV-HI), and its associations with escalation of respiratory support and survival. METHODS: In this retrospective cohort study, we enrolled consecutive inpatients (aged ≥18 years) admitted to University College London Hospitals and Newcastle upon Tyne Hospitals in the UK with PCR-confirmed COVID-19 during the first wave of community-acquired infection. Demographic data, laboratory tests, and clinical status were recorded from the day of admission until death or discharge, with a minimum follow-up time of 28 days. We defined COV-HI as a C-reactive protein concentration greater than 150 mg/L or doubling within 24 h from greater than 50 mg/L, or a ferritin concentration greater than 1500 μg/L. Respiratory support was categorised as oxygen only, non-invasive ventilation, and intubation. Initial and repeated measures of hyperinflammation were evaluated in relation to the next-day risk of death or need for escalation of respiratory support (as a combined endpoint), using a multi-level logistic regression model. FINDINGS: We included 269 patients admitted to one of the study hospitals between March 1 and March 31, 2020, among whom 178 (66%) were eligible for escalation of respiratory support and 91 (34%) patients were not eligible. Of the whole cohort, 90 (33%) patients met the COV-HI criteria at admission. Despite having a younger median age and lower median Charlson Comorbidity Index scores, a higher proportion of patients with COV-HI on admission died during follow-up (36 [40%] of 90 patients) compared with the patients without COV-HI on admission (46 [26%] of 179). Among the 178 patients who were eligible for full respiratory support, 65 (37%) met the definition for COV-HI at admission, and 67 (74%) of the 90 patients whose respiratory care was escalated met the criteria by the day of escalation. Meeting the COV-HI criteria was significantly associated with the risk of next-day escalation of respiratory support or death (hazard ratio 2·24 [95% CI 1·62–2·87]) after adjustment for age, sex, and comorbidity. INTERPRETATION: Associations between elevated inflammatory markers, escalation of respiratory support, and survival in people with COVID-19 indicate the existence of a high-risk inflammatory phenotype. COV-HI might be useful to stratify patient groups in trial design. FUNDING: None.
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spelling pubmed-74424262020-08-24 COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study Manson, Jessica J Crooks, Colin Naja, Meena Ledlie, Amanda Goulden, Bethan Liddle, Trevor Khan, Emon Mehta, Puja Martin-Gutierrez, Lucia Waddington, Kirsty E Robinson, George A Ribeiro Santos, Liliana McLoughlin, Eve Snell, Antonia Adeney, Christopher Schim van der Loeff, Ina Baker, Kenneth F Duncan, Christopher J A Hanrath, Aidan T Lendrem, B Clare De Soyza, Anthony Peng, Junjie J'Bari, Hajar Greenwood, Mandy Hawkins, Ellie Peckham, Hannah Marks, Michael Rampling, Tommy Luintel, Akish Williams, Bryan Brown, Michael Singer, Mervyn West, Joe Jury, Elizabeth C Collin, Matthew Tattersall, Rachel S Lancet Rheumatol Articles BACKGROUND: A subset of patients with severe COVID-19 develop a hyperinflammatory syndrome, which might contribute to morbidity and mortality. This study explores a specific phenotype of COVID-19-associated hyperinflammation (COV-HI), and its associations with escalation of respiratory support and survival. METHODS: In this retrospective cohort study, we enrolled consecutive inpatients (aged ≥18 years) admitted to University College London Hospitals and Newcastle upon Tyne Hospitals in the UK with PCR-confirmed COVID-19 during the first wave of community-acquired infection. Demographic data, laboratory tests, and clinical status were recorded from the day of admission until death or discharge, with a minimum follow-up time of 28 days. We defined COV-HI as a C-reactive protein concentration greater than 150 mg/L or doubling within 24 h from greater than 50 mg/L, or a ferritin concentration greater than 1500 μg/L. Respiratory support was categorised as oxygen only, non-invasive ventilation, and intubation. Initial and repeated measures of hyperinflammation were evaluated in relation to the next-day risk of death or need for escalation of respiratory support (as a combined endpoint), using a multi-level logistic regression model. FINDINGS: We included 269 patients admitted to one of the study hospitals between March 1 and March 31, 2020, among whom 178 (66%) were eligible for escalation of respiratory support and 91 (34%) patients were not eligible. Of the whole cohort, 90 (33%) patients met the COV-HI criteria at admission. Despite having a younger median age and lower median Charlson Comorbidity Index scores, a higher proportion of patients with COV-HI on admission died during follow-up (36 [40%] of 90 patients) compared with the patients without COV-HI on admission (46 [26%] of 179). Among the 178 patients who were eligible for full respiratory support, 65 (37%) met the definition for COV-HI at admission, and 67 (74%) of the 90 patients whose respiratory care was escalated met the criteria by the day of escalation. Meeting the COV-HI criteria was significantly associated with the risk of next-day escalation of respiratory support or death (hazard ratio 2·24 [95% CI 1·62–2·87]) after adjustment for age, sex, and comorbidity. INTERPRETATION: Associations between elevated inflammatory markers, escalation of respiratory support, and survival in people with COVID-19 indicate the existence of a high-risk inflammatory phenotype. COV-HI might be useful to stratify patient groups in trial design. FUNDING: None. Elsevier Ltd. 2020-10 2020-08-21 /pmc/articles/PMC7442426/ /pubmed/32864628 http://dx.doi.org/10.1016/S2665-9913(20)30275-7 Text en © 2020 Elsevier Ltd. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Articles
Manson, Jessica J
Crooks, Colin
Naja, Meena
Ledlie, Amanda
Goulden, Bethan
Liddle, Trevor
Khan, Emon
Mehta, Puja
Martin-Gutierrez, Lucia
Waddington, Kirsty E
Robinson, George A
Ribeiro Santos, Liliana
McLoughlin, Eve
Snell, Antonia
Adeney, Christopher
Schim van der Loeff, Ina
Baker, Kenneth F
Duncan, Christopher J A
Hanrath, Aidan T
Lendrem, B Clare
De Soyza, Anthony
Peng, Junjie
J'Bari, Hajar
Greenwood, Mandy
Hawkins, Ellie
Peckham, Hannah
Marks, Michael
Rampling, Tommy
Luintel, Akish
Williams, Bryan
Brown, Michael
Singer, Mervyn
West, Joe
Jury, Elizabeth C
Collin, Matthew
Tattersall, Rachel S
COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study
title COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study
title_full COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study
title_fullStr COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study
title_full_unstemmed COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study
title_short COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study
title_sort covid-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442426/
https://www.ncbi.nlm.nih.gov/pubmed/32864628
http://dx.doi.org/10.1016/S2665-9913(20)30275-7
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