bims-covirf Biomed News
on COVID19 risk factors
Issue of 2020‒07‒05
twenty-four papers selected by
Catherine Rycroft
BresMed
  1. Indicators of Critical Illness and Predictors of Mortality in COVID-19 Patients.
  2. Predicting severe outcomes in COVID-19.
  3. Factors Associated with Hospitalization and Disease Severity in a Racially and Ethnically Diverse Population of COVID-19 Patients.
  4. The timeline and risk factors of clinical progression of COVID-19 in Shenzhen, China.
  5. Effect of Underlying Comorbidities on the Infection and Severity of COVID-19 in Korea: a Nationwide Case-Control Study.
  6. The association between obesity, type 2 diabetes, and hypertension with severe COVID-19 on admission among Mexicans.
  7. Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data.
  8. Unequal impact of structural health determinants and comorbidity on COVID-19 severity and lethality in older Mexican adults: Considerations beyond chronological aging.
  9. The association of hypertension with the severity and mortality of COVID-19 patients: evidence based on adjusted effect estimates.
  10. Obesity as a Potential Predictor of Disease Severity in Young COVID-19 Patients: A Retrospective Study.
  11. Obesity aggravates COVID-19: a systematic review and meta-analysis.
  12. Is BMI higher in younger patients with COVID-19? Association between BMI and COVID-19 hospitalization by age.
  13. The Risk of Diabetes on Clinical Outcomes in Patients with Coronavirus Disease 2019: A Retrospective Cohort Study.
  14. Role of vitamin D in preventing of COVID-19 infection, progression and severity.
  15. Sex and gender differences in the outcome of patients with COVID-19.
  16. Association between obesity and clinical prognosis in patients infected with SARS-CoV-2.
  17. Risk of COVID-19 in Patients With Cancer.
  18. Cerebrovascular disease is associated with the risk of mortality in coronavirus disease 2019.
  19. GI symptoms and fever increase the risk of severe illness and death in patients with COVID-19.
  20. ABO Phenotype and Death in Critically Ill Patients with COVID-19.
  21. Association of Digestive Symptoms and Hospitalization in Patients With SARS-CoV-2 Infection.
  22. Association of particulate matter pollution and case fatality rate of COVID-19 in 49 Chinese cities.
  23. Low serum 25-hydroxyvitamin D (25[OH]D) levels in patients hospitalised with COVID-19 are associated with greater disease severity.
  24. Serum ferritin as an independent risk factor for severity in COVID-19 patients.
  1. Infect Drug Resist. 2020 ;13 1995-2000
    Indicators of Critical Illness and Predictors of Mortality in COVID-19 Patients.
    Mohamed H Aly, Sayed S Rahman, Waleed A Ahmed, Mansour H Alghamedi, Abudlrahman A Al Shehri, Amna M Alkalkami, Mohammed H Hassan.
      COVID-19 is an emerging disease all over the world and spreading at an unpredicted rate, resulting in significant influences on global economies and public health. Clinical, laboratory, and imaging characteristics have been partially described in some observational studies. Not enough systematic reviews on predictors of critical illness and mortality in COVID 19 have been published to date. In this review, we had illustrated the prognostic predictors of COVID-19 by gathering published information on the risk factors related to the outcomes of SARS-CoV-2 infections.
    Keywords:  COVID 2019; SARS-CoV-2; critical illness; mortality; predictors
    DOI:  https://doi.org/10.2147/IDR.S261159
  2. J Allergy Clin Immunol Pract. 2020 Jun 29. pii: S2213-2198(20)30674-7. [Epub ahead of print]
    Predicting severe outcomes in COVID-19.
    Brian Lipworth, Rory Chan, Chris RuiWen Kuo.
      
    Keywords:  C reactive protein; COVID-19; Cytokine; Inflammation; Interleukin-6; Oxygenation; SARS-CoV-2; Ventilation
    DOI:  https://doi.org/10.1016/j.jaip.2020.06.039
  3. medRxiv. 2020 Jun 27. pii: 2020.06.25.20137323. [Epub ahead of print]
    Factors Associated with Hospitalization and Disease Severity in a Racially and Ethnically Diverse Population of COVID-19 Patients.
    Angelico Mendy, Senu Apewokin, Anjanette A Wells, Ardythe L Morrow.
      BACKGROUND: The coronavirus disease (COVID-19) first identified in Wuhan in December 2019 became a pandemic within a few months of its discovery. The impact of COVID-19 is due to both its rapid spread and its severity, but the determinants of severity have not been fully delineated.OBJECTIVE: Identify factors associated with hospitalization and disease severity in a racially and ethnically diverse cohort of COVID-19 patients.
    METHODS: We analyzed data from COVID-19 patients diagnosed at the University of Cincinnati health system from March 13, 2020 to May 31, 2020. Severe COVID-19 was defined as admission to intensive care unit or death. Logistic regression modeling adjusted for covariates was used to identify the factors associated with hospitalization and severe COVID-19.
    RESULTS: Among the 689 COVID-19 patients included in our study, 29.2% were non-Hispanic White, 25.5% were non-Hispanic Black, 32.5% were Hispanic, and 12.8% were of other race/ethnicity. About 31.3% of patients were hospitalized and 13.2% had severe disease. In adjusted analyses, the sociodemographic factors associated with hospitalization and/or disease severity included older age, non-Hispanic Black or Hispanic race/ethnicity (compared to non-Hispanic White), and smoking. The following comorbidities: diabetes, hypercholesterolemia, asthma, COPD, chronic kidney disease, cardiovascular diseases, osteoarthritis, and vitamin D deficiency were associated with hospitalization and/or disease severity. Hematological disorders such as anemia, coagulation disorders, and thrombocytopenia were associated with both hospitalization and disease severity.
    CONCLUSION: This study confirms race and ethnicity as predictors of severe COVID-19. It also finds clinical risk factors for hospitalization and severe COVID-19 not previously identified such a vitamin D deficiency, hypercholesterolemia, osteoarthritis, and anemia.
    DOI:  https://doi.org/10.1101/2020.06.25.20137323
  4. J Transl Med. 2020 Jul 03. 18(1): 270
    The timeline and risk factors of clinical progression of COVID-19 in Shenzhen, China.
    Fang Wang, Mengyuan Qu, Xuan Zhou, Kai Zhao, Changxiang Lai, Qiyuan Tang, Wenjie Xian, Ruikun Chen, Xuan Li, Zhiyu Li, Qing He, Lei Liu.
      BACKGROUND: The novel coronavirus disease 2019 (COVID-19) broke out globally. Early prediction of the clinical progression was essential but still unclear. We aimed to evaluate the timeline of COVID-19 development and analyze risk factors of disease progression.METHODS: In this retrospective study, we included 333 patients with laboratory-confirmed COVID-19 infection hospitalized in the Third People's Hospital of Shenzhen from 10 January to 10 February 2020. Epidemiological feature, clinical records, laboratory and radiology manifestations were collected and analyzed. 323 patients with mild-moderate symptoms on admission were observed to determine whether they exacerbated to severe-critically ill conditions (progressive group) or not (stable group). We used logistic regression to identify the risk factors associated with clinical progression.
    RESULTS: Of all the 333 patients, 70 (21.0%) patients progressed into severe-critically ill conditions during hospitalization and assigned to the progressive group, 253 (76.0%) patients belonged to the stable group, another 10 patients were severe before admission. we found that the clinical features of aged over 40 (3.80 [1.72, 8.52]), males (2.21 [1.20, 4.07]), with comorbidities (1.78 [1.13, 2.81]) certain exposure history (0.38 [0.20, 0.71]), abnormal radiology manifestations (3.56 [1.13, 11.40]), low level of T lymphocytes (0.99 [0.997, 0.999]), high level of NLR (0.99 [0.97, 1.01]), IL-6 (1.05 [1.03, 1.07]) and CRP (1.67 [1.12, 2.47]) were the risk factors of disease progression by logistic regression.
    CONCLUSIONS: The potential risk factors of males, older age, with comorbidities, low T lymphocyte level and high level of NLR, CRP, IL-6 can help to predict clinical progression of COVID-19 at an early stage.
    Keywords:  COVID-19; Clinical progression; Pneumonia; Retrospective analysis; Risk factor
    DOI:  https://doi.org/10.1186/s12967-020-02423-8
  5. J Korean Med Sci. 2020 Jun 29. 35(25): e237
    Effect of Underlying Comorbidities on the Infection and Severity of COVID-19 in Korea: a Nationwide Case-Control Study.
    Wonjun Ji, Kyungmin Huh, Minsun Kang, Jinwook Hong, Gi Hwan Bae, Rugyeom Lee, Yewon Na, Hyoseon Choi, Seon Yeong Gong, Yoon Hyeong Choi, Kwang Pil Ko, Jeong Soo Im, Jaehun Jung.
      BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an emerging threat worldwide. It remains unclear how comorbidities affect the risk of infection and severity of COVID-19.METHODS: This is a nationwide retrospective case-control study of 219,961 individuals, aged 18 years or older, whose medical costs for COVID-19 testing were claimed until May 15, 2020. COVID-19 diagnosis and infection severity were identified from reimbursement data using diagnosis codes and on the basis of respiratory support use, respectively. Odds ratios (ORs) were estimated using multiple logistic regression, after adjusting for age, sex, region, healthcare utilization, and insurance status.
    RESULTS: The COVID-19 group (7,341 of 219,961) was young and had a high proportion of female. Overall, 13.0% (954 of 7,341) of the cases were severe. The severe COVID-19 group had older patients and a proportion of male ratio than did the non-severe group. Diabetes (odds ratio range [ORR], 1.206-1.254), osteoporosis (ORR, 1.128-1.157), rheumatoid arthritis (ORR, 1.207-1.244), substance use (ORR, 1.321-1.381), and schizophrenia (ORR, 1.614-1.721) showed significant association with COVID-19. In terms of severity, diabetes (OR, 1.247; 95% confidential interval, 1.009-1.543), hypertension (ORR, 1.245-1.317), chronic lower respiratory disease (ORR, 1.216-1.233), chronic renal failure, and end-stage renal disease (ORR, 2.052-2.178) were associated with severe COVID-19.
    CONCLUSION: We identified several comorbidities associated with COVID-19. Health care workers should be more careful while diagnosing and treating COVID-19 when patients have the abovementioned comorbidities.
    Keywords:  COVID-19; Comorbidity; Risk Factor; SARS-CoV-2; Severity
    DOI:  https://doi.org/10.3346/jkms.2020.35.e237
  6. Obesity (Silver Spring). 2020 Jul 01.
    The association between obesity, type 2 diabetes, and hypertension with severe COVID-19 on admission among Mexicans.
    Edgar Denova-Gutiérrez, Hugo Lopez-Gatell, Jose L Alomia-Zegarra, Ruy López-Ridaura, Christian A Zaragoza-Jimenez, Dwigth D Dyer-Leal, Ricardo Cortés-Alcala, Tania Villa-Reyes, Rosaura Gutiérrez-Vargas, Kathia Rodríguez-González, Carlos Escondrillas-Maya, Tonatiuh Barrientos-Gutiérrez, Juan A Rivera, Simón Barquera.
      OBJECTIVE: To explore the association between obesity, type 2 diabetes, hypertension, and severe COVID-19 on admission.METHODS: In the present study, a total of 23,593 patient samples were evaluated by a laboratory from the Mexican Institute of Epidemiological Diagnosis and Reference (InDRE, for its acronym in Spanish). Of these: 18,443 were negative for COVID-19, 3,844 were positive for COVID-19, and 1,306 were positive for other respiratory viruses. Severe types of respiratory disease were defined by the presence of pneumonia and other organ failure that requires intensive care. Multivariable logistic regression models were used to explore factors associated with severe COVID-19 on admission.
    RESULTS: Patients who tested positive for COVID-19 had a higher proportion of obesity (17.4%), diabetes (14.5%), and hypertension (18.9%), compared to those without a confirmed diagnosis. Compared to non-obese patients, those with obesity showed a 1.43-fold higher odds of developing severe COVID-19 on admission, while subjects with diabetes and hypertension showed a 1.87-fold and 1.77-fold higher odds of developing severe COVID-19 on admission, respectively.
    CONCLUSION: Obesity, diabetes, and hypertension were significantly associated with severe COVID-19 on admission and the association of obesity was stronger in patients < 50 y.
    Keywords:  COVID-19; Hypertension; Mexican population; Obesity; Type 2 Diabetes
    DOI:  https://doi.org/10.1002/oby.22946
  7. Wellcome Open Res. 2020 ;5 88
    Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data.
    Robert W Aldridge, Dan Lewer, Srinivasa Vittal Katikireddi, Rohini Mathur, Neha Pathak, Rachel Burns, Ellen B Fragaszy, Anne M Johnson, Delan Devakumar, Ibrahim Abubakar, Andrew Hayward.
      Background: International and UK data suggest that Black, Asian and Minority Ethnic (BAME) groups are at increased risk of infection and death from COVID-19. We aimed to explore the risk of death in minority ethnic groups in England using data reported by NHS England. Methods: We used NHS data on patients with a positive COVID-19 test who died in hospitals in England published on 28th April, with deaths by ethnicity available from 1st March 2020 up to 5pm on 21 April 2020. We undertook indirect standardisation of these data (using the whole population of England as the reference) to produce ethnic specific standardised mortality ratios (SMRs) adjusted for age and geographical region. Results: The largest total number of deaths in minority ethnic groups were Indian (492 deaths) and Black Caribbean (460 deaths) groups. Adjusting for region we found a lower risk of death for White Irish (SMR 0.52; 95%CIs 0.45-0.60) and White British ethnic groups (0.88; 95%CIs 0.86-0.0.89), but increased risk of death for Black African (3.24; 95%CIs 2.90-3.62), Black Caribbean (2.21; 95%CIs 2.02-2.41), Pakistani (3.29; 95%CIs 2.96-3.64), Bangladeshi (2.41; 95%CIs 1.98-2.91) and Indian (1.70; 95%CIs 1.56-1.85) minority ethnic groups. Conclusion: Our analysis adds to the evidence that BAME people are at increased risk of death from COVID-19 even after adjusting for geographical region. We believe there is an urgent need to take action to reduce the risk of death for BAME groups and better understand why some ethnic groups experience greater risk. Actions that are likely to reduce these inequities include ensuring adequate income protection (so that low paid and zero-hours contract workers can afford to follow social distancing recommendations), reducing occupational risks (such as ensuring adequate personal protective equipment), reducing barriers in accessing healthcare and providing culturally and linguistically appropriate public health communications.
    Keywords:  COVID-19; Mortality; SARS-CoV-2; minority ethnic groups
    DOI:  https://doi.org/10.12688/wellcomeopenres.15922.1
  8. J Gerontol A Biol Sci Med Sci. 2020 Jun 29. pii: glaa163. [Epub ahead of print]
    Unequal impact of structural health determinants and comorbidity on COVID-19 severity and lethality in older Mexican adults: Considerations beyond chronological aging.
    Omar Yaxmehen Bello-Chavolla, Armando González-Díaz, Neftali Eduardo Antonio-Villa, Carlos A Fermín-Martínez, Alejandro Márquez-Salinas, Arsenio Vargas-Vázquez, Jessica Paola Bahena-López, Carmen García-Peña, Carlos A Aguilar-Salinas, Luis Miguel Gutiérrez-Robledo.
      BACKGROUND: COVID-19 has had a disproportionate impact on older adults. Mexico's population is younger, yet COVID-19's impact on older adults is comparable to countries with older population structures. Here, we aim to identify health and structural determinants that increase susceptibility to COVID-19 in older Mexican adults beyond chronological aging.METHODS: We analyzed confirmed COVID-19 cases in older adults using data from the General Directorate of Epidemiology of Mexican Ministry of Health. We modeled risk factors for increased COVID-19 severity and mortality, using mixed models to incorporate multilevel data concerning healthcare access and marginalization. We also evaluated structural factors and comorbidity profiles compared to chronological age for COVID-19 mortality risk prediction.
    RESULTS: We analyzed 20,804 confirmed SARS-CoV-2 cases in adults aged ≥60 years. Male sex, smoking, diabetes, and obesity were associated with pneumonia, hospitalization and ICU admission in older adults, CKD and COPD were associated with hospitalization. High social lag indexes and access to private care were predictors of COVID-19 severity and mortality. Age was not a predictor of COVID-19 severity in individuals without comorbidities and combination of structural factors and comorbidities were better predictors of COVID-19 lethality and severity compared to chronological age alone. COVID-19 baseline lethality hazards were heterogeneously distributed across Mexican municipalities, particularly when comparing urban and rural areas.
    CONCLUSIONS: Structural factors and comorbidity explain excess risk for COVID-19 severity and mortality over chronological age in older Mexican adults. Clinical decision-making related to COVID-19 should focus away from chronological aging onto more a comprehensive geriatric care approach.
    Keywords:  COVID-19; Human Aging; Inequality; Mexico; Mortality; SARS-CoV-2
    DOI:  https://doi.org/10.1093/gerona/glaa163
  9. J Infect. 2020 Jun 25. pii: S0163-4453(20)30441-2. [Epub ahead of print]
    The association of hypertension with the severity and mortality of COVID-19 patients: evidence based on adjusted effect estimates.
    Xuan Liang, Li Shi, Ying Wang, Wenwei Xiao, Guangcai Duan, Haiyan Yang, Yadong Wang.
      
    Keywords:  COVID-19; hypertension; mortality; severity
    DOI:  https://doi.org/10.1016/j.jinf.2020.06.060
  10. Obesity (Silver Spring). 2020 Jun 29.
    Obesity as a Potential Predictor of Disease Severity in Young COVID-19 Patients: A Retrospective Study.
    Ming Deng, Yongjian Qi, Liping Deng, Huawei Wang, Yancheng Xu, Zhen Li, Zhe Meng, Jun Tang, Zhe Dai.
      OBJECTIVE: To explore the indicators for severity in young COVID-19 patients age between 18 to 40.METHODS: This retrospective cohort study includes 65 consecutively admitted COVID-19 patients age between 18 to 40 in Zhongnan Hospital of Wuhan University. Among them, 53 were moderate cases, 12 were severe or critical cases. Epidemiological, clinical and laboratory characteristics and treatment data were collected. A multivariate logistic regression analysis was implemented to explore risk factors.
    RESULTS: The severe/critical cases have obviously higher BMI (average 29.23 vs. 22.79kg/m2 ) and lower liver CT value (average 50.00 vs. 65.00mU) than moderate cases group. The severe/critical cases have higher fasting glucose, alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , and creatinine (Cr) compared with moderate cases (All P<0.01) . More severe/critical cases (58.33% vs. 1.92%) have positive urine protein. The severe/critical cases will experience a significant process of serum albumin decline. Logistic regression analysis showed that male, high body mass index (especially obesity), elevated fasting blood glucose and urinary protein positive are all risk factors for severe young COVID-19 patients.
    CONCLUSION: Obesity is an important predictor of severity in young COVID-19 patients. The main mechanism is related to the damage of liver and kidney.
    Keywords:  COVID-19; Kidney; Liver disease; Obesity
    DOI:  https://doi.org/10.1002/oby.22943
  11. J Med Virol. 2020 Jun 30.
    Obesity aggravates COVID-19: a systematic review and meta-analysis.
    Jun Yang, Jiahui Hu, Chunyan Zhu.
      OBJECTIVE: Obesity and COVID-19 are both world epidemics now. There may be some potential relationships between them, but we knew little. This work was to explore the relationship through literature searching, systematic review, and meta-analysis.METHODS: Pubmed, Embase, WOS, Cochrane, CNKI, Wanfang, and Sinomed databases were searched to collect the literature concerning obesity and COVID-19. Systematic review and meta-analysis were conducted after literature screening, quality assessment, and data extraction.
    RESULTS: 180 articles were initially searched after duplicate removal and 9 were finally included in our analysis. Results show that severe COVID-19 patients have higher BMI than non-severe ones(WMD =2.67, 95%CI[1.52-3.82]); COVID-19 patients with obesity were more severe and have a worse outcome than those without(OR=2.31, 95%CI[1.3-4.12]).
    CONCLUSION: Obesity may aggravate COVID-19. This article is protected by copyright. All rights reserved.
    Keywords:  COVID-19; meta-analysis; obesity; risk factor; systematic review
    DOI:  https://doi.org/10.1002/jmv.26237
  12. Obesity (Silver Spring). 2020 Jul 01.
    Is BMI higher in younger patients with COVID-19? Association between BMI and COVID-19 hospitalization by age.
    Ajay Bhasin, Hannah Nam, Chen Yeh, Jungwha Lee, David Liebovitz, Chad Achenbach.
      OBJECTIVE: Obesity has been found to be a risk factor for hospitalization with COVID-19. We were interested in understanding whether patients hospitalized with COVID-19 differed in BMI at older versus younger ages, and if trends were independent of diabetes and hypertension.METHODS: We performed a cross-sectional analysis of patients hospitalized with moderate to severe COVID-19 at Northwestern Memorial Hospital from March 19th , 2020 until April 4th , 2020. We compared patients hospitalized with COVID-19 above and below the age of 50, and to those hospitalized without COVID-19.
    RESULTS: We found patients younger than 50 years of age hospitalized with COVID-19 without diabetes or hypertension had mean BMI greater than those older than 50 years of age, with BMI 43.1 (95%CI 34.5 - 51.7) kg/m2 vs 30.1 (95%CI 27.7 - 32.5) kg/m2 (p=0.02). Furthermore, BMI appears to inversely correlate with increasing age amongst patients hospitalized with COVID-19. We did not detect the same difference or trend for patients hospitalized without COVID-19.
    CONCLUSION: We found younger patients (age <50 years) with COVID-19 had higher mean BMI than older patients with COVID-19, with and without diabetes and hypertension. This trend did not exist in patients without COVID-19 hospitalized during the same time-period.
    Keywords:  Age; COVID-19; Diabetes; Hypertension; Obesity
    DOI:  https://doi.org/10.1002/oby.22947
  13. Diabetes Metab J. 2020 Jun;44(3): 405-413
    The Risk of Diabetes on Clinical Outcomes in Patients with Coronavirus Disease 2019: A Retrospective Cohort Study.
    Seung Min Chung, Yin Young Lee, Eunyeong Ha, Ji Sung Yoon, Kyu Chang Won, Hyoung Woo Lee, Jian Hur, Kyung Soo Hong, Jong Geol Jang, Hyun Jung Jin, Eun Young Choi, Kyeong Cheol Shin, Jin Hong Chung, Kwan Ho Lee, June Hong Ahn, Jun Sung Moon.
      BACKGROUND: To determine the role of diabetes mellitus (DM) in the coronavirus disease 2019 (COVID-19), we explored the clinical characteristics of patients with DM and compared risk factors such as age, glycemic control, and medications to those without DM.METHODS: This was a retrospective cohort study of 117 confirmed patients with COVID-19 which conducted at a tertiary hospital in Daegu, South Korea. The primary outcome was defined as the severe and critical outcome (SCO), of which the composite outcomes of acute respiratory distress syndrome, septic shock, intensive care unit care, and 28-day mortality. We analyzed what clinical features and glycemic control-related factors affect the prognosis of COVID-19 in the DM group.
    RESULTS: After exclusion, 110 participants were finally included. DM patients (n=29) was older, and showed higher blood pressure compared to non-DM patients. DM group showed higher levels of inflammation-related biomarkers and severity score, and highly progressed to SCO. After adjustment with other risk factors, DM increased the risk of SCO (odds ratio [OR], 10.771; P<0.001). Among the DM patients, SCO was more prevalent in elderly patients of ≥70 years old and age was an independent risk factor for SCO in patients with DM (OR, 1.175; P=0.014), while glycemic control was not. The use of medication did not affect the SCO, but the renin-angiotensin system inhibitors showed protective effects against acute cardiac injury (OR, 0.048; P=0.045).
    CONCLUSION: The COVID-19 patients with DM had higher severity and resulted in SCO. Intensive and aggressive monitoring of COVID-19 clinical outcomes in DM group, especially in elderly patients is warranted.
    Keywords:  Aged; COVID-19; Diabetes mellitus; Prognosis; Risk factors; Severe acute respiratory syndrome coronavirus 2
    DOI:  https://doi.org/10.4093/dmj.2020.0105
  14. J Infect Public Health. 2020 Jun 20. pii: S1876-0341(20)30531-1. [Epub ahead of print]
    Role of vitamin D in preventing of COVID-19 infection, progression and severity.
    Nurshad Ali.
      The outbreak of COVID-19 has created a global public health crisis. Little is known about the protective factors of this infection. Therefore, preventive health measures that can reduce the risk of infection, progression and severity are desperately needed. This review discussed the possible roles of vitamin D in reducing the risk of COVID-19 and other acute respiratory tract infections and severity. Moreover, this study determined the correlation of vitamin D levels with COVID-19 cases and deaths in 20 European countries as of 20 May 2020. A significant negative correlation (p=0.033) has been observed between mean vitamin D levels and COVID-19 cases per one million population in European countries. However, the correlation of vitamin D with COVID-19 deaths of these countries was not significant. Some retrospective studies demonstrated a correlation between vitamin D status and COVID-19 severity and mortality, while other studies did not find the correlation when confounding variables are adjusted. Several studies demonstrated the role of vitamin D in reducing the risk of acute viral respiratory tract infections and pneumonia. These include direct inhibition with viral replication or with anti-inflammatory or immunomodulatory ways. In the meta-analysis, vitamin D supplementation has been shown as safe and effective against acute respiratory tract infections. Thus, people who are at higher risk of vitamin D deficiency during this global pandemic should consider taking vitamin D supplements to maintain the circulating 25(OH)D in the optimal levels (75-125nmol/L). In conclusion, there is not enough evidence on the association between vitamin D levels and COVID-19 severity and mortality. Therefore, randomized control trials and cohort studies are necessary to test this hypothesis.
    Keywords:  COVID-19; Infections; SARS-CoV-2; Vitamin D; Vitamin D supplementation
    DOI:  https://doi.org/10.1016/j.jiph.2020.06.021
  15. J Med Virol. 2020 Jun 30.
    Sex and gender differences in the outcome of patients with COVID-19.
    Shahab Falahi, Azra Kenarkoohi.
      The SARS-CoV-2 pandemic is a new wave of emerging infections that the world is struggling with. There are many unanswered questions in this regard, including Gender-specific outcome in COVID-19. Gender and age are major risk factors for SARS-CoV-2 infection. In addition to the effect of these factors on the prevalence of SARS-CoV-2, the clinical outcome varies according to both of them. This article is protected by copyright. All rights reserved.
    DOI:  https://doi.org/10.1002/jmv.26243
  16. Infect Dis Poverty. 2020 Jun 29. 9(1): 80
    Association between obesity and clinical prognosis in patients infected with SARS-CoV-2.
    Shao-Hang Cai, Wei Liao, Shu-Wei Chen, Li-Li Liu, Si-Yao Liu, Zhi-Dan Zheng.
      BACKGROUND: It is well established that obesity is a disease of sustained low-grade inflammation. However, it is currently unknown if obesity plays a role in the clinical manifestations and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients. In this study, we aimed to investigate whether obesity played a role in clinical manifestations and prognosis in patients infected with SARS-CoV-2.METHODS: This is a retrospective multicenter clinical study. A total of 96 patients hospitalized with SARS-CoV-2 infection were enrolled from Dongguan People's Hospital, Nanfang hospital and the First Affiliated Hospital of Xiamen University between 23 January and 14 February 2020. Demographic and clinical data were extracted from medical records. Acute respiratory distress syndrome (ARDS) was defined as oxygenation index (PaO2/FiO2) ≤ 300 mmHg. We grouped patients through the body mass index (BMI). Associations were examined using the t test, χ2 test and multivariate logistic forward regression test.
    RESULTS: Patients with BMI <  24 were significantly younger (P = 0.025) with lower creatine kinase (P = 0.013), lower diastolic pressure blood (P = 0.035), lower serum creatinine (P = 0.012), lower lactate dehydrogenase (P = 0.001) and higher platelet count (P = 0.002). The BMI level was 20.78 ± 3.15 in patients without pneumonia compared with the patients with pneumonia (23.81 ± 3.49, P = 0.001). For patients without ARDS, an average BMI level of 22.65 ± 3.53 was observed, significantly lower than patients with ARDS (24.57 ± 3.59, P = 0.022). The mean BMI was 22.35 ± 3.56 in patients experienced with relieving the clinical symptoms or stable condition by radiographic tests, lower than patients with disease exacerbation with 24.89 ± 3.17 (P = 0.001). In addition, lymphocyte count (r = - 0.23, P = 0.027) and platelet count (r = - 0.44, P < 0.001) were negatively correlated with BMI. While hemoglobin (r = 0.267, P = 0.008), creatine kinase (r = 0.331, P = 0.001), serum creatinine (r = 0.424, P < 0.001) and lactate dehydrogenase (r = 0.343, P = 0.001) were significantly positive correlated with BMI. Multivariate analysis showed that older age (OR = 1.046, P = 0.009) and BMI ≥ 24 (OR = 1.258, P = 0.005) were independent risk factors associated ICU admission while BMI ≥ 24 (OR = 4.219, P = 0.007) was independent risk factor associated with radiographic disease exacerbation.
    CONCLUSIONS: Our study found BMI was significantly associated with clinical manifestations and prognosis of patients with SARS-CoV-2 infection. For patients with increased risk, clinicians should intervene promptly to avoid disease progression.
    Keywords:  Acute respiratory distress syndrome; Body mass index; Obesity; Pneumonia; Prognosis; SARS-CoV-2
    DOI:  https://doi.org/10.1186/s40249-020-00703-5
  17. JAMA Oncol. 2020 Jul 02.
    Risk of COVID-19 in Patients With Cancer.
    Andrew Robinson, Bishal Gyawali, Christopher M Booth.
      
    DOI:  https://doi.org/10.1001/jamaoncol.2020.2586
  18. Neurol Sci. 2020 Jun 30.
    Cerebrovascular disease is associated with the risk of mortality in coronavirus disease 2019.
    Ying Wang, Li Shi, Yadong Wang, Guangcai Duan, Haiyan Yang.
      
    DOI:  https://doi.org/10.1007/s10072-020-04542-y
  19. Gut. 2020 Jun 30. pii: gutjnl-2020-321751. [Epub ahead of print]
    GI symptoms and fever increase the risk of severe illness and death in patients with COVID-19.
    Jue Liu, Liyuan Tao, Xia Liu, Hongyan Yao, Shicheng Yu, Qiqi Wang, Jiaojiao Zhang, Zhancheng Gao, Rongmeng Jiang, Wenzhan Jing, Min Liu.
      
    Keywords:  epidemiology; gastroduodenal motility; infectious disease
    DOI:  https://doi.org/10.1136/gutjnl-2020-321751
  20. Br J Haematol. 2020 Jul 01.
    ABO Phenotype and Death in Critically Ill Patients with COVID-19.
    Rebecca Karp Leaf, Hanny Al-Samkari, Samantha K Brenner, Shruti Gupta, David E Leaf.
      Blood groups are inherited traits that vary across populations, likely due to both founder effects and natural selection. A link between blood groups and susceptibility to infectious disease has been well-described, with notable examples being H. Pylori and Plasmodium falciparum infection. Blood group antigens may influence disease susceptibility by several mechanisms, including serving as receptors or decoys for infectious organisms and modifying immune response in the form of anti-ABO antibodies.
    Keywords:  ABO; Blood groups; COVID-19
    DOI:  https://doi.org/10.1111/bjh.16984
  21. Am J Gastroenterol. 2020 Jul;115(7): 1129-1132
    Association of Digestive Symptoms and Hospitalization in Patients With SARS-CoV-2 Infection.
    George Cholankeril, Alexander Podboy, Vasiliki Irene Aivaliotis, Edward A Pham, Sean P Spencer, Donghee Kim, Aijaz Ahmed.
      INTRODUCTION: High rates of concurrent gastrointestinal manifestations have been noted in patients with corona virus disease 2019 (COVID-19); however, the association between these digestive manifestations and need for hospitalization has not been established.METHODS: This is a retrospective review of consecutive patients diagnosed with COVID-19. A total of 207 patients were identified; 34.5% of patients noted concurrent gastrointestinal symptoms, with 90% of gastrointestinal symptoms being mild.
    RESULTS: In a multivariate regression model controlled for demographics and disease severity, an increased risk of hospitalization was noted in patients with any digestive symptom (adjusted odds ratio 4.84, 95% confidence interval: 1.68-13.94).
    DISCUSSION: The presence of digestive symptoms in COVID-19 is associated with a need for hospitalization.
    DOI:  https://doi.org/10.14309/ajg.0000000000000712
  22. Sci Total Environ. 2020 Jun 20. pii: S0048-9697(20)33918-8. [Epub ahead of print]741 140396
    Association of particulate matter pollution and case fatality rate of COVID-19 in 49 Chinese cities.
    Ye Yao, Jinhua Pan, Weidong Wang, Zhixi Liu, Haidong Kan, Yang Qiu, Xia Meng, Weibing Wang.
      The COVID-19 epidemic, caused by the SARS-CoV-2 virus, has resulted in 3352 deaths in China as of April 12, 2020. This study aimed to investigate the associations between particulate matter (PM) concentrations and the case fatality rate (CFR) of COVID-19 in 49 Chinese cities, including the epicenter of Wuhan. We used the Global Moran's I to analyze spatial distribution and autocorrelation of CFRs, and then we used multivariate linear regression to analyze the associations between PM2.5 and PM10 concentrations and COVID-19 CFR. We found positive associations between PM pollution and COVID-19 CFR in cities both inside and outside Hubei Province. For every 10 μg/m3 increase in PM2.5 and PM10 concentrations, the COVID-19 CFR increased by 0.24% (0.01%-0.48%) and 0.26% (0.00%-0.51%), respectively. PM pollution distribution and its association with COVID-19 CFR suggests that exposure to such may affect COVID-19 prognosis.
    Keywords:  CFR; COVID-19; Cross-sectional study; Particulate matter pollution
    DOI:  https://doi.org/10.1016/j.scitotenv.2020.140396
  23. Clin Endocrinol (Oxf). 2020 Jul 03.
    Low serum 25-hydroxyvitamin D (25[OH]D) levels in patients hospitalised with COVID-19 are associated with greater disease severity.
    Grigorios Panagiotou, Su Ann Tee, Yasir Ihsan, Waseem Athar, Gabriella Marchitelli, Donna Kelly, Christopher S Boot, Nadia Stock, James Macfarlane, Adrian R Martineau, Graham Burns, Richard Quinton.
      OBJECTIVES: Vitamin D deficiency (VDD) has been proposed to play a role in Coronavirus Disease 2019 (COVID-19) pathophysiology. We aim to evaluate our implementation of a local protocol for treatment of VDD among patients hospitalized for COVID-19; to assess the prevalence of VDD among COVID-19 inpatients, and examine potential associations with disease severity and fatality.DESIGN AND PARTICIPANTS: We conducted a retrospective interim audit of a local clinical care pathway for 134 inpatients with COVID-19. Prevalence of VDD, compliance with local treatment protocol and relationship of baseline serum 25(OH)D with markers of COVID-19 severity and fatality were analysed.
    RESULTS: 55.8% of eligible patients received Colecalciferol replacement, albeit not all according to the suggested protocol. Patients admitted to ITU were younger than those managed on medical wards (61.1 years ± 11.8 vs. 76.4 years ± 14.9, respectively, p<0.001), with greater prevalence of hypertension, higher baseline respiratory rate, National Early Warning Score-2 and C-Reactive protein level. While mean serum 25(OH)D levels were comparable (p=0.3), only 19% of ITU patients had 25(OH)D levels greater than 50 nmol/L vs. 39.1% of non-ITU patients (p=0.02). However, there was no association with fatality, potentially due to small sample size and prompt diagnosis and treatment of VDD.
    CONCLUSIONS: Higher prevalence of VDD was observed in patients requiring ITU admission compared to patients managed on medical wards. Larger prospective studies and/or clinical trials are needed to validate and extend our observations.
    Keywords:  Coronavirus; Covid-19; acute respiratory distress syndrome; colecalciferol; vitamin D
    DOI:  https://doi.org/10.1111/cen.14276
  24. J Infect. 2020 Jun 24. pii: S0163-4453(20)30434-5. [Epub ahead of print]
    Serum ferritin as an independent risk factor for severity in COVID-19 patients.
    Zhi Lin, Fei Long, Yong Yang, Xiangyu Chen, Linyong Xu, Minghua Yang.
      
    DOI:  https://doi.org/10.1016/j.jinf.2020.06.053
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