14 research outputs found
Derivation and Validation of a Predictive Score for Disease Worsening in Patients with COVID-19: The COMPASS-COVID-19 Prospective Observational Cohort Study
Endothelial dysfunction in conduit arteries and in microcirculation. Novel therapeutic approaches
The vascular endothelium not only is a single monolayer of cells between
the vessel lumen and the intimal wall, but also plays an important role
by controlling vascular function and structure mainly via the production
of nitric oxide (NO). The so called “cardiovascular risk factors”
are associated with endothelial dysfunction, that reduces NO
bioavailability, increases oxidative stress, and promotes inflammation
contributing therefore to the development of atherosclerosis. The
significant role of endothelial dysfunction in the development of
atherosclerosis emphasizes the need for efficient therapeutic
interventions.
During the last years statins, angiotensin-converting enzyme inhibitors,
angiotensin-receptor antagonists, antioxidants, beta-blockers and
insulin sensitizers have been evaluated for their ability to restore
endothelial function (Briasoulis et al., 2012). As there is not a
straightforward relationship between therapeutic interventions and
improvement of endothelial function but rather a complicated
interrelationship between multiple cellular and sub-cellular targets,
research has been focused on the understanding of the underlying
mechanisms. Moreover, the development of novel diagnostic invasive and
non-invasive methods has allowed the early detection of endothelial
dysfunction expanding the role of therapeutic interventions and our
knowledge.
In the current review we present the available data concerning the
contribution of endothelial dysfunction to atherogenesis and review the
methods that assess endothelial function with a view to understand the
multiple targets of therapeutic interventions. Finally we focus on the
classic and novel therapeutic approaches aiming to improve endothelial
dysfunction and the underlying mechanisms. (C) 2014 Elsevier Inc. All
rights reserved
Derivation and Validation of a Predictive Score for Disease Worsening in Patients with COVID-19
International audienceThe prospective observational cohort study COMPASS-COVID-19 aimed to develop a risk assessment model for early identification of hospitalized COVID-19 patients at risk for worsening disease. Patients with confirmed COVID-19 (n = 430) hospitalized between March 18 and April 21, 2020 were divided in derivation (n = 310) and validation (n = 120) cohorts. Two groups became evident: (1) good prognosis group (G-group) with patients hospitalized at the conventional COVID-19 ward and (2) Worsening disease group (W-group) with patients admitted to the intensive care unit (ICU) from the emergency departments. The study end point was disease worsening (acute respiratory failure, shock, myocardial dysfunction, bacterial or viral coinfections, and acute kidney injury) requiring ICU admission. All patients were routinely evaluated for full blood count, prothrombin time, fibrinogen, D-dimers, antithrombin (AT), and protein C activity. Data from the first hospitalization day at the conventional ward or the ICU were analyzed. Cardiovascular risk factors and comorbidities were routinely registered. Obesity, hypertension, diabetes and male gender, increased fibrinogen and D-dimers, thrombocytopenia, AT deficiency, lymphopenia, and an International Society on Thrombosis and Haemostasis (ISTH) score for compensated disseminated intravascular coagulation score (cDIC-ISTH) ≥5 were significant risk factors for worsening disease. The COMPASS-COVID-19 score was derived from multivariate analyses and includes obesity, gender, hemoglobin, lymphocyte, and the cDIC-ISTH score (including platelet count, prothrombin time, D-dimers, AT, and protein C levels). The score has a very good discriminating capacity to stratify patients at high and low risk for worsening disease, with an area under the receiver operating characteristic curve value of 0.77, a sensitivity of 81%, and a specificity of 60%. Application of the COMPASS-COVID-19 score at the validation cohort showed 96% sensitivity. The COMPASS-COVID-19 score is an accurate clinical decision-making tool for an easy identification of COVID-19 patients being at high risk for disease worsening
Clinical Reasoning: A 51-year-old man with cervical pain and progressively deteriorating gait
Prevention and management of venous thromboembolism. International Consensus Statement. Guidelines according to scientific evidence
This document aims to provide a clear and concise summary of the evidence regarding the efficacy or harm of various methods available to prevent and manage venous thromboembolism (VTE) and to provide recommendations based on such evidence
Identification of Very Low-Risk Subgroups of Patients with Primary Mediastinal Large B-Cell Lymphoma Treated with R-CHOP
Background R-CHOP can cure approximately 75% of patients with primary
mediastinal large B-cell lymphoma (PMLBCL), but prognostic factors have
not been sufficiently evaluated yet. R-da- EPOCH is potentially more
effective but also more toxic than R-CHOP. Reliable prognostic
classification is needed to guide treatment decisions.
Materials and Methods We analyzed the impact of clinical prognostic
factors on the outcome of 332 PMLBCL patients <= 65 years treated with
R-CHOP +/- radiotherapy in a multicenter setting in Greece and Cyprus.
Results With a median follow-up of 69 months, 5-year freedom from
progression (FFP) was 78% and 5-year lymphoma specific survival (LSS)
was 89%. On multivariate analysis, extranodal involvement (E/IV) and
lactate dehydrogenase (LDH) >= 2 times upper limit of normal (model A)
were significantly associated with FFP; E/IV and bulky disease (model B)
were associated with LSS. Both models performed better than the
International Prognostic Index (IPI) and the age-adjusted IPI by
Harrel’s C rank parameter and Akaike information criterion. Both models
A and B defined high-risk subgroups (13%-27% of patients [pts]) with
approximately 19%-23% lymphoma-related mortality. They also defined
subgroups composing approximately one-fourth or one-half of the
patients, with 11% risk of failure and only 1% or 4% 5-year
lymphoma-related mortality.
Conclusion The combination of E/IV with either bulky disease or LDH >= 2
times upper limit of normal defined high-risk but not very-high-risk
subgroups. More importantly, their absence defined subgroups comprising
approximately one-fourth or one-half of the pts, with 11% risk of
failure and minimal lymphoma-related mortality, who may not need more
intensive treatment such as R-da-EPOCH.
Implications for Practice By analyzing the impact of baseline clinical
characteristics on outcomes of a large cohort of patients with primary
mediastinal large B-cell lymphoma homogeneously treated with R-CHOP with
or without radiotherapy, we developed novel prognostic indices which can
aid in deciding which patients can be adequately treated with R-CHOP and
do not need more intensive regimens such as R-da-EPOCH. The new indices
consist of objectively determined characteristics (extranodal disease or
stage IV, bulky disease, and markedly elevated serum lactate
dehydrogenase), which are readily available from standard initial
staging procedures and offer better discrimination compared with
established risk scores (International Prognostic Index [IPI] and
age-adjusted IPI)
The COVID-19 Pandemic and the Need for an Integrated and Equitable Approach: An International Expert Consensus Paper
International audienceBackground One year after the declaration of the coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO) and despite the implementation of mandatory physical barriers and social distancing, humanity remains challenged by a long-lasting and devastating public health crisis. Management Non-pharmacological interventions (NPIs) are efficient mitigation strategies. The success of these NPIs is dependent on the approval and commitment of the population. The launch of a mass vaccination program in many countries in late December 2020 with mRNA vaccines, adenovirus-based vaccines, and inactivated virus vaccines has generated hope for the end of the pandemic. Current Issues The continuous appearance of new pathogenic viral strains and the ability of vaccines to prevent infection and transmission raise important concerns as we try to achieve community immunity against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and its variants. The need of a second and even third generation of vaccines has already been acknowledged by the WHO and governments. Perspectives There is a critical and urgent need for a balanced and integrated strategy for the management of the COVID-19 outbreaks organized on three axes: (1) Prevention of the SARS-CoV-2 infection, (2) Detection and early diagnosis of patients at risk of disease worsening, and (3) Anticipation of medical care (PDA). Conclusion The “PDA strategy” integrated into state policy for the support and expansion of health systems and introduction of digital organizations (i.e., telemedicine, e-Health, artificial intelligence, and machine-learning technology) is of major importance for the preservation of citizens' health and life world-wide
The COVID-19 Pandemic and the Need for an Integrated and Equitable Approach: An International Expert Consensus Paper
Background One year after the declaration of the coronavirus disease
2019 (COVID-19) pandemic by the World Health Organization (WHO) and
despite the implementation of mandatory physical barriers and social
distancing, humanity remains challenged by a long-lasting and
devastating public health crisis.
Management Non-pharmacological interventions (NPIs) are efficient
mitigation strategies. The success of these NPIs is dependent on the
approval and commitment of the population. The launch of a mass
vaccination program in many countries in late December 2020 with mRNA
vaccines, adenovirus-based vaccines, and inactivated virus vaccines has
generated hope for the end of the pandemic.
Current Issues The continuous appearance of new pathogenic viral strains
and the ability of vaccines to prevent infection and transmission raise
important concerns as we try to achieve community immunity against
severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and
its variants. The need of a second and even third generation of vaccines
has already been acknowledged by the WHO and governments.
Perspectives There is a critical and urgent need for a balanced and
integrated strategy for the management of the COVID-19 outbreaks
organized on three axes: (1) P revention of the SARS-CoV-2 infection,
(2) Detection and early diagnosis of patients at risk of disease
worsening, and (3) Anticipation of medical care (PDA).
Conclusion The “PDA strategy” integrated into state policy for the
support and expansion of health systems and introduction of digital
organizations (i.e., telemedicine, e-Health, artificial intelligence,
and machine-learning technology) is of major importance for the
preservation of citizens’ health and life world-wide
Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine.
COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH
Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine
COVID-19 is also manifested with hypercoagulability, pulmonary
intravascular coagulation, microangiopathy, and venous thromboembolism
(VTE) or arterial thrombosis. Predisposing risk factors to severe
COVID-19 are male sex, underlying cardiovascular disease, or
cardiovascular risk factors including noncontrolled diabetes mellitus or
arterial hypertension, obesity, and advanced age. The VAS-European
Independent Foundation in Angiology/Vascular Medicine draws attention to
patients with vascular disease (VD) and presents an integral strategy
for the management of patients with VD or cardiovascular risk factors
(VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary
health care network for patients with VD-CVR for identification of
patients with VD-CVR in the community and patients' education for
disease symptoms, use of eHealth technology, adherence to the
antithrombotic and vascular regulating treatments, and (2) close medical
follow-up for efficacious control of VD progression and prompt
application of physical and social distancing measures in case of new
epidemic waves. For patients with VD-CVR who receive home treatment for
COVID-19, VAS recommends assessment for (1) disease worsening risk and
prioritized hospitalization of those at high risk and (2) VTE risk
assessment and thromboprophylaxis with rivaroxaban, betrixaban, or
low-molecular-weight heparin (LMWH) for those at high risk. For
hospitalized patients with VD-CVR and COVID-19, VAS recommends (1)
routine thromboprophylaxis with weight-adjusted intermediate doses of
LMWH (unless contraindication); (2) LMWH as the drug of choice over
unfractionated heparin or direct oral anticoagulants for the treatment
of VTE or hypercoagulability; (3) careful evaluation of the risk for
disease worsening and prompt application of targeted antiviral or
convalescence treatments; (4) monitoring of D-dimer for optimization of
the antithrombotic treatment; and (5) evaluation of the risk of VTE
before hospital discharge using the IMPROVE-D-dimer score and prolonged
post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH