Diagnosis-wide analysis of COVID-19 complications: an exposure-crossover study

BACKGROUND:Many studies reporting coronavirus disease 2019 (COVID-19) complications have involved case series or small cohorts that could not establish a causal association with COVID-19 or provide risk estimates in different care settings. We sought to study all possible complications of COVID-19 to confirm previously reported complications and to identify potential complications not yet known.METHODS:Using United States health claims data, we compared the frequency of all International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes occurring before and after the onset of the COVID-19 pandemic in an exposure-crossover design. We included patients who received a diagnosis of COVID-19 between Mar. 1, 2020, and Apr. 30, 2020, and computed risk estimates and odds ratios (ORs) of association with COVID-19 for every ICD-10-CM diagnosis code.RESULTS:Among 70 288 patients with COVID-19, 69 of 1724 analyzed ICD-10-CM diagnosis codes were significantly associated with COVID-19. Disorders showing both strong association with COVID-19 and high absolute risk included viral pneumonia (OR 177.63, 95% confidence interval [CI] 147.19–214.37, absolute risk 27.6%), respiratory failure (OR 11.36, 95% CI 10.74–12.02, absolute risk 22.6%), acute kidney failure (OR 3.50, 95% CI 3.34–3.68, absolute risk 11.8%) and sepsis (OR 4.23, 95% CI 4.01–4.46, absolute risk 10.4%). Disorders showing strong associations with COVID-19 but low absolute risk included myocarditis (OR 8.17, 95% CI 3.58–18.62, absolute risk 0.1%), disseminated intravascular coagulation (OR 11.83, 95% CI 5.26–26.62, absolute risk 0.1%) and pneumothorax (OR 3.38, 95% CI 2.68–4.26, absolute risk 0.4%).INTERPRETATION:We confirmed and provided risk estimates for numerous complications of COVID-19. These results may guide prognosis, treatment decisions and patient counselling.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel strain of coronavirus that has been identified as the cause of the coronavirus disease 2019 (COVID-19) pandemic. As of Nov. 20, 2020, more than 50 million people have received a diagnosis of COVID-19 globally.¹ The clinical spectrum of disease is wide and can range from symptoms typical of the common cold to respiratory failure and death.² Most patients have mild symptoms and can be managed as outpatients, but as many as 20% have a severe form of the disease requiring admission to hospital, commonly presenting with hypoxia secondary to pneumonia.³Studies also show that COVID-19 is associated with a wide variety of nonrespiratory sequelae, including endothelial, thrombotic, cardiac, inflammatory, neurologic and other complications. ^4–9 Whether these associations are causal is not well established, as many of these findings originate from case reports, which are prone to publication bias and cannot provide risk estimates, or from cohort studies that often do not provide relative risk estimates.An alternative strategy for identifying potential complications of COVID-19 is studying all possible complications as captured in International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10 CM) diagnosis codes, which allows for the discovery of unreported complications and can confirm previously identified ones. The objective of our study was to analyze all diagnoses associated with COVID-19, to identify those that could be complications of the disease and to present both the absolute risk and relative odds of any complications identified.     

Macrophominol, a diketopiperazine from cultures of Macrophomina phaseolina

A diketopiperazine named macrophominol was isolated from the phytopathogenic fungus Macrophomina phaseolina.     

Experimental brood parasitism of the magpie (Pica pica)

Egg and chick features were tested on natural magpie (Pica pica) nests. The stimuli best accepted were those of greater size and weight and of a white background and black specks. Stimuli with a shape different from oval and of low weight were the most readily expelled. Relative quantity of eggs in the nests had no strong influence on the expelling response. Chicks of house sparrows, spotless starlings, jackdaws and swallows were readily aceepted and reared by the magpies. Amongst some chicks of other species introduced, a ‘parasitic’ form of behaviour appeardwhich led them to eliminate competitors in the nests.     

On the role of G-protein coupled receptors in cell volume regulation.

Cell volume is determined genetically for each cell lineage, but it is not a static feature of the cell. Intracellular volume is continuously challenged by metabolic reactions, uptake of nutrients, intracellular displacement of molecules and organelles and generation of ionic gradients. Moreover, recent evidence raises the intriguing possibility that changes in cell volume act as signals for basic cell functions such as proliferation, migration, secretion and apoptosis. Cells adapt to volume increase by a complex, dynamic process resulting from the concerted action of volume sensing mechanisms and intricate signaling chains, directed to initiate the multiple adaptations demanded by a change in cell volume, among others adhesion reactions, membrane and cytoskeleton remodeling, and activation of the osmolyte pathways leading to reestablish the water balance between extracellular/intracellular or intracellular/intracellular compartments. In multicellular organisms, a continuous interaction with the external milieu is fundamental for the dynamics of the cell. It is in this sense that the recent surge of interest about the influence on cell volume control by the most extended family of signaling elements, the G proteins, acquires particular importance. As here reviewed, a large variety of G-protein coupled receptors (GPCRs) are involved in this interplay with cell volume regulatory mechanisms, which amplifies and diversifies the volume-elicited signaling chains, providing a variety of routes towards the multiple effectors related to cell volume changes.