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Risk Factors for COVID-19 Infection

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A special issue of Viruses (ISSN 1999-4915). This special issue belongs to the section "SARS-CoV-2 and COVID-19".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 35604

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Dr. Matthaios Speletas

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Department of Immunology and Histocompatibility, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
Interests: diagnosis, treatment and follow-up of adult patients with antibody deficiencies; B cells in normal and malignant hematopoiesis; inflammation and immunoregulation

Special Issue Information

Dear Colleagues,

The coronavirus disease 2019 (COVID-19) pandemic represents one of the greatest challenges in modern medicine. Several aspects remain unsolved considering the spread of infection, the prognosis of the disease, and the response to anti-SARS-CoV-2 vaccination, all of which present a challenge for both the scientific community and authorities implementing measures to reduce the disease. For example, approximately 20% of infected patients exhibit a severe respiratory illness requiring hospitalization, and one quarter of these patients progress to severe acute respiratory distress syndrome (SARS), thus requiring ICU care. Clinical and epidemiological data demonstrate that elderly patients, in addition to individuals with a medical history of diabetes and/or cardiovascular disease and/or primary or secondary immunosuppression, etc., comprise the population groups which are most vulnerable to the development of serious sequelae of the disease and a poor outcome. However, recent data suggest that, although on a smaller-scale, younger individuals without pre-existing medical conditions can also have serious sequelae with an increase in morbidity and fatality rates. Clearly, understanding the risk factors involved in the pathogenesis of severe COVID-19, or the inadequate immune responses after vaccination, will provide the appropriate and necessary data for the prioritization of timely treatment. Moreover, it will illuminate the mechanisms involved in the poor prognosis of viral infections, providing new therapeutic targets for addressing similar future pandemics.

The aim of this Special Issue of "Viruses" will focus on the responsible risk factors for both the poor prognosis of COVID-19 and the inadequate immune responses after anti-SARS-CoV-2 vaccination. We consider that your contribution to this effort will be invaluable.

Dr. Matthaios Speletas
Guest Editor

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Published Papers (12 papers)

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11 pages, 282 KiB

Open AccessArticle

Pre-Pandemic Cross-Reactive Immunity against SARS-CoV-2 among Central and West African Populations

by Marc Souris, Léon Tshilolo, Daniel Parzy, Line Lobaloba Ingoba, Francine Ntoumi, Rachel Kamgaing, Moussa Ndour, Destin Mbongi, Balthazar Phoba, Marie-Anasthasie Tshilolo, René Mbungu, Martin Samuel Sosso, Nadine Fainguem, Tandakha Ndiaye Dieye, Massamba Sylla, Pierre Morand and Jean-Paul Gonzalez

Viruses 2022, 14(10), 2259; https://0-doi-org.brum.beds.ac.uk/10.3390/v14102259 - 14 Oct 2022

Cited by 10 | Viewed by 1801

Abstract

For more than two years after the emergence of COVID-19 (Coronavirus Disease-2019), significant regional differences in morbidity persist. These differences clearly show lower incidence rates in several regions of the African and Asian continents. The work reported here aimed to test the hypothesis of a pre-pandemic natural immunity acquired by some human populations in central and western Africa, which would, therefore, pose the hypothesis of an original antigenic sin with a virus antigenically close to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). To identify such pre-existing immunity, sera samples collected before the emergence of COVID-19 were tested to detect the presence of IgG reacting antibodies against SARS-CoV-2 proteins of major significance. Sera samples from French blood donors collected before the pandemic served as a control. The results showed a statistically significant difference of antibodies prevalence between the collected samples in Africa and the control samples collected in France. Given the novelty of our results, our next step consists in highlighting neutralizing antibodies to evaluate their potential for pre-pandemic protective acquired immunity against SARS-CoV-2. In conclusion, our results suggest that, in the investigated African sub-regions, the tested populations could have been potentially and partially pre-exposed, before the COVID-19 pandemic, to the antigens of a yet non-identified Coronaviruses. Full article

(This article belongs to the Special Issue Risk Factors for COVID-19 Infection)

12 pages, 1914 KiB

Open AccessArticle

Obesity and Dysmetabolic Factors among Deceased COVID-19 Adults under 65 Years of Age in Italy: A Retrospective Case-Control Study

by Loreta A. Kondili, Maria Giovanna Quaranta, Mauro Viganò, Xhimi Tata, Franca D’Angelo, Cinzia Lo Noce, Luigi Palmieri, Graziano Onder, Federico D’Amico, Elvira Inglese, Massimo Puoti, Alessio Aghemo and Maria Elena Tosti

Viruses 2022, 14(9), 1981; https://0-doi-org.brum.beds.ac.uk/10.3390/v14091981 - 07 Sep 2022

Cited by 3 | Viewed by 1573

Abstract

Background: Italy has witnessed high levels of COVID-19 deaths, mainly at the elderly age. We assessed the comorbidity and the biochemical profiles of consecutive patients ≤65 years of age to identify a potential risk profile for death. Methods: We retrospectively analyzed clinical data from consecutive hospitalized-for-COVID-19 patients ≤65 years, who were died (593 patients) or discharged (912 patients) during February–December 2020. Multivariate logistic regression identified the mortality risk factors. Results: Overweight (adjusted odds ratio (adjOR) 5.53, 95% CI 2.07–14.76), obesity (adjOR 8.58, CI 3.30–22.29), dyslipidemia (adjOR 10.02, 95% CI 1.06–94.22), heart disease (adjOR 17.68, 95% CI 3.80–82.18), cancer (adjOR 13.28, 95% CI 4.25–41.51) and male sex (adjOR 5.24, 95% CI 2.30–11.94) were associated with death risk in the youngest population. In the older population (46-65 years of age), the overweight and obesity were also associated with the death risk, however at a lower extent: the adjORs varyied from 1.49 to 2.36 for overweight patients and from 3.00 to 4.07 for obese patients. Diabetes was independently associated with death only in these older patients. Conclusion: Overweight, obesity and dyslipidemia had a pivotal role in increasing young individuals’ death risk. Their presence should be carefully evaluated for prevention and/or prompt management of SARS-CoV2 infection in such high-risk patients to avoid the worst outcomes. Full article

(This article belongs to the Special Issue Risk Factors for COVID-19 Infection)

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9 pages, 500 KiB

Open AccessArticle

Risk Factors for Slow Viral Decline in COVID-19 Patients during the 2022 Omicron Wave

by Xin Li, Anthony Raymond Tam, Wing-Ming Chu, Wan-Mui Chan, Jonathan Daniel Ip, Allen Wing-Ho Chu, Syed Muhammad Umer Abdullah, Cyril Chik-Yan Yip, Kwok-Hung Chan, Samson Sai-Yin Wong, Vincent Chi-Chung Cheng, Kwok-Yung Yuen, Ivan Fan-Ngai Hung and Kelvin Kai-Wang To

Viruses 2022, 14(8), 1714; https://0-doi-org.brum.beds.ac.uk/10.3390/v14081714 - 04 Aug 2022

Cited by 5 | Viewed by 2332

Abstract

Formulating termination of isolation (de-isolation) policies requires up-to-date knowledge about viral shedding dynamics. However, current de-isolation policies are largely based on viral load data obtained before the emergence of Omicron variant. In this retrospective cohort study involving adult patients hospitalised for COVID-19 between January and February 2022, we sought to determine SARS-CoV-2 viral shedding kinetics and to investigate the risk factors associated with slow viral decline during the 2022 Omicron wave. A total of 104 patients were included. The viral load was highest (Ct value was lowest) on days 1 post-symptom-onset (PSO) and gradually declined. Older age, hypertension, hyperlipidaemia and chronic kidney disease were associated with slow viral decline in the univariate analysis on both day 7 and day 10 PSO, while incomplete or no vaccination was associated with slow viral decline on day 7 PSO only. However, older age was the only risk factor that remained statistically significant in the multivariate analysis. In conclusion, older age is an independent risk factor associated with slow viral decline in this study conducted during the Omicron-dominant 2022 COVID-19 wave. Transmission-based precaution guidelines should take age into consideration when determining the timing of de-isolation. Full article

(This article belongs to the Special Issue Risk Factors for COVID-19 Infection)

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36 pages, 2649 KiB

Open AccessArticle

COVID-19 Severity and Mortality in Two Pandemic Waves in Poland and Predictors of Poor Outcomes of SARS-CoV-2 Infection in Hospitalized Young Adults

by Laura Ziuzia-Januszewska, Marcin Januszewski, Joanna Sosnowska-Nowak, Mariusz Janiszewski, Paweł Dobrzyński, Alicja A. Jakimiuk and Artur J. Jakimiuk

Viruses 2022, 14(8), 1700; https://0-doi-org.brum.beds.ac.uk/10.3390/v14081700 - 31 Jul 2022

Cited by 7 | Viewed by 2454

Abstract

SARS-CoV-2 variants pose a significant threat to global public health. However, their influence on disease severity, especially among young adults who may exhibit different clinical characteristics, is debatable. In this retrospective study of 229 young adults hospitalized with COVID-19, we investigated the differences between Poland’s second and third waves of the pandemic. To identify potential predictors of severe COVID-19 in young adults, we analyzed patient characteristics and laboratory findings between survivors and non-survivors and we performed logistic regression to assess the risk of death, mechanical ventilation, and intensive care unit treatment. We found no increase in COVID-19 severity comparing the third and second waves of the pandemic, indicating that the alpha variant had no influence on disease severity. In addition, we found that factors, such as obesity, comorbidities, lung involvement, leukocytosis, neutrophilia, lymphopenia, higher IG count, the neutrophil-to-lymphocyte ratio, C-reactive protein, procalcitonin, interleukin-6, D-Dimer, lactate dehydrogenase, high-sensitive troponin I, creatine kinase-myocardial band, myoglobin, N-terminal-pro-B-type natriuretic peptide, creatinine, urea and gamma-glutamyl transferase, lower estimated glomerular filtration rate, albumin, calcium and vitamin D3, possibly a decrease in red blood cell counts, hemoglobin and hematocrit, and an increase in creatine kinase during hospitalization may be associated with poor outcomes of COVID-19. Full article

(This article belongs to the Special Issue Risk Factors for COVID-19 Infection)

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11 pages, 1269 KiB

Open AccessArticle

SARS-CoV-2 Infection in Health Care Workers of Trieste (North-Eastern Italy), 1 October 2020–7 February 2022: Occupational Risk and the Impact of the Omicron Variant

by Luca Cegolon, Federico Ronchese, Francesca Ricci, Corrado Negro and Francesca Larese-Filon

Viruses 2022, 14(8), 1663; https://0-doi-org.brum.beds.ac.uk/10.3390/v14081663 - 28 Jul 2022

Cited by 24 | Viewed by 2641

Abstract

Vaccination coverage against COVID-19 among health care workers (HCWs) of the University Health Agency Giuliano-Isontina (ASUGI) of Trieste (North-eastern Italy) by 1 January 2022 was 90.4% with at least one vaccine dose, 84.9% with at least 2 doses, and 75.1% with 3 doses, 98.2% with Comirnaty (Pfizer BioNtech, New York, NY, USA) versus 1.8% with Spikevax (Moderna, Cambridge, MA, USA). From 1 October 2020 to 7 February 2022, 1652 SARS-CoV-2 infections were notified in HCWs of ASUGI Trieste. Although the overall risk of SARS-CoV-2 contagion increased over time, the rate of occupational infections progressively declined, from 42.5% during the second COVID-19 wave to 15.6% in the fifth. Between 1 January–7 February 2022 (a period dominated by the Omicron variant), albeit no COVID-19-associated hospitalizations were recorded in HCWs of ASUGI Trieste, 669 SARS-CoV-2 infections were counted against 367 cases observed from 1 October to 31 December 2020, the 3 months preceding the implementation of the vaccination campaign against COVID-19. Job tasks and health care settings turned out to be the most significant risk factors for SARS-CoV-2 infection. However, the effect of workplace prevailed over job task on the biological risk, with greater rates of SARS-CoV-2 infections observed among HCWs operating in areas with higher levels of circulation of the virus, particularly COVID-19 dedicated units. Full article

(This article belongs to the Special Issue Risk Factors for COVID-19 Infection)

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11 pages, 1195 KiB

Open AccessArticle

Anti-SARS-CoV-2 Titers Predict the Severity of COVID-19

by Antonios Kritikos, Sophie Gabellon, Jean-Luc Pagani, Matteo Monti, Pierre-Yves Bochud, Oriol Manuel, Alix Coste, Gilbert Greub, Matthieu Perreau, Giuseppe Pantaleo, Antony Croxatto and Frederic Lamoth

Viruses 2022, 14(5), 1089; https://0-doi-org.brum.beds.ac.uk/10.3390/v14051089 - 18 May 2022

Cited by 8 | Viewed by 2663

Abstract

Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 is associated with a wide spectrum of disease, ranging from asymptomatic infection to acute respiratory distress syndrome. Some biomarkers may predict disease severity. Among them, the anti-SARS-CoV-2 antibody response has been related to severe disease. The aim of this study was to assess the correlation between the anti-SARS-CoV-2 serological response and COVID-19 outcome. Demographic, clinical, and biological data from nasopharyngeal-PCR confirmed COVID-19 hospitalized patients were prospectively collected between April and August 2020 at our institution. All patients had serial weekly serology testing for a maximum of three blood samples or until discharge. Two different serological assays were used: a chemiluminescent assay and an in-house developed Luminex immunoassay. Kinetics of the serological response and correlation between the antibody titers and outcome were assessed. Among the 70 patients enrolled in the study, 22 required invasive ventilation, 29 required non-invasive ventilation or oxygen supplementation, and 19 did not require any oxygen supplementation. Median duration of symptoms upon admission for the three groups were 13, 8, and 9 days, respectively. Antibody titers gradually increased for up to 3 weeks since the onset of symptoms for patients requiring oxygen supplementation with significantly higher antibody titers for patients requiring invasive ventilation. Antibody titers on admission were also significantly higher in severely ill patients and serology performed well in predicting the necessity of invasive ventilation (AUC: 0.79, 95% CI: 0.67–0.9). Serology testing at admission may be a good indicator to identify severe COVID-19 patients who will require invasive mechanical ventilation. Full article

(This article belongs to the Special Issue Risk Factors for COVID-19 Infection)

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10 pages, 589 KiB

Open AccessArticle

Soluble IL-2R Levels at Baseline Predict the Development of Severe Respiratory Failure and Mortality in COVID-19 Patients

by Nikolaos K. Gatselis, Vasiliki Lygoura, Aggeliki Lyberopoulou, George Giannoulis, Anna Samakidou, Antonia Vaiou, George Vatidis, Katerina Antoniou, Aggelos Stefos, Sarah Georgiadou, Dimitrios Sagris, Dafni Sveroni, Despoina Stergioula, Stella Gabeta, George Ntaios and George N. Dalekos

Viruses 2022, 14(4), 787; https://0-doi-org.brum.beds.ac.uk/10.3390/v14040787 - 10 Apr 2022

Cited by 6 | Viewed by 2007

Abstract

Risk stratification of coronavirus disease-19 (COVID-19) patients by simple markers is critical to guide treatment. We studied the predictive value of soluble interleukin-2 receptor (sIL-2R) for the early identification of patients at risk of developing severe clinical outcomes. sIL-2R levels were measured in 197 patients (60.9% males; median age 61 years; moderate disease, n = 65; severe, n = 132, intubated and/or died, n = 42). All patients received combined immunotherapies (anakinra ± corticosteroids ± intravenous immunoglobulin ± tocilizumab) according to our local treatment algorithm. The endpoint was the composite event of intubation due to severe respiratory failure (SRF) or mortality. Median (interquartile range) sIL-2R levels were significantly higher in patients with severe disease, compared with those with moderate disease (6 (6.2) vs. 5.2 (3.4) ng/mL, p = 0.017). sIL-2R was the strongest laboratory predictive factor for intubation/death (hazard ratio 1.749, 95%CI 1.041–2.939, p = 0.035) after adjustment for other known risk factors. Youden’s index revealed optimal sIL-2R cut-off for predicting intubation/death at 9 ng/mL (sensitivity: 67%; specificity: 86%; positive and negative predictive value: 57% and 91%, respectively). Delta sIL-2R between the day of event or discharge minus admission date was higher in patients that intubated/died than in those who did not experience an event (2.91 (10.42) vs. 0.44 (2.88) ng/mL; p = 0.08)). sIL-2R on admission and its dynamic changes during follow-up may reflect disease severity and predict the development of SRF and mortality. Full article

(This article belongs to the Special Issue Risk Factors for COVID-19 Infection)

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12 pages, 781 KiB

Open AccessArticle

Social Support Mediates the Association between Attachment Style and Psychological Distress during COVID-19 in Israel

by Tal Adar, May Davidof and Odelia Elkana

Viruses 2022, 14(4), 693; https://0-doi-org.brum.beds.ac.uk/10.3390/v14040693 - 27 Mar 2022

Cited by 6 | Viewed by 2825

Abstract

Aim: The aim of this study was to examine the relationships between attachment style, social support, and psychological distress (i.e., depression and anxiety) during the COVID-19 lockdown of the third wave in Israel. Specifically, we examined whether social support mediates the well-documented relationship between attachment style and psychological distress. Methods: An online survey was administered from 3 January to 6 February, 2021, while a strict lockdown was in place. The sample included 288 Israelis ranging between the ages of 18–78, recruited by snowball sampling. Psychological distress was evaluated by Patients Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder questionnaire (GAD-7); attachment style by the Experiences in Close Relationships (ECR-36), and social support by the Multi-dimensional Perceived Social Support (MSPSS). A mediation model was applied with social support mediating the association between attachment style and depression and anxiety. Results: Significant correlations were found between attachment style and psychological distress, and between social support and psychological distress. Social support partially mediated the associations between attachment style and psychological distress (Depression: p < 0.001, confidence interval [CI] = 0.4018, 1.7468; Anxiety: p < 0.001, confidence interval [CI] = 0.0493, 0.9822). These results remained the same while controlling for age. Conclusion: Our findings suggest that the secure attachment style serves as a protective factor against psychological distress and vice versa; insecure attachment style serves as a risk factor for developing psychological distress during a peak period of COVID-19. Nevertheless, social support played a central role in the association between attachment style and psychological distress, thus, individuals with an insecure attachment may thus be helped by offering them social support during a crisis, which in turn may increase their well-being. Full article

(This article belongs to the Special Issue Risk Factors for COVID-19 Infection)

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24 pages, 3899 KiB

Open AccessArticle

Sex-Dependent Differences in Predictive Value of the C₂HEST Score in Subjects with COVID-19—A Secondary Analysis of the COLOS Study

by Piotr Rola, Adrian Doroszko, Małgorzata Trocha, Katarzyna Giniewicz, Krzysztof Kujawa, Marek Skarupski, Damian Gajecki, Jakub Gawryś, Tomasz Matys, Ewa Szahidewicz-Krupska, Barbara Adamik, Krzysztof Kaliszewski, Katarzyna Kiliś-Pstrusińska, Agnieszka Matera-Witkiewicz, Michał Pomorski, Marcin Protasiewicz, Marcin Madziarski, Urszula Chrostek, Joanna Radzik-Zając, Anna Radlińska, Anna Zaleska, Krzysztof Letachowicz, Wojciech Pisarek, Mateusz Barycki, Janusz Sokołowski, Ewa Anita Jankowska and Katarzyna Madziarska Show full author list Hide full author list

Viruses 2022, 14(3), 628; https://0-doi-org.brum.beds.ac.uk/10.3390/v14030628 - 17 Mar 2022

Cited by 3 | Viewed by 1922

Abstract

Background: Since the outbreak of the COVID-19 pandemic, a growing number of evidence suggests that COVID-19 presents sex-dependent differences in clinical course and outcomes. Nevertheless, there is still an unmet need to stratify the risk for poor outcome at the beginning of hospitalization. Since individual C₂HEST components are similar COVID-19 mortality risk factors, we evaluated sex-related predictive value of the score. Material and Methods: A total of 2183 medical records of consecutive patients hospitalized due to confirmed SARS-CoV-2 infections were analyzed. Subjects were assigned to one of two of the study arms (male vs. female) and afterward allocated to different stratum based on the C₂HEST score result. The measured outcomes included: in-hospital-mortality, three-month- and six-month-all-cause-mortality and in-hospital non-fatal adverse clinical events. Results: The C₂HEST score predicted the mortality with better sensitivity in female population regarding the short- and mid-term. Among secondary outcomes, C₂HEST-score revealed predictive value in both genders for pneumonia, myocardial injury, myocardial infarction, acute heart failure, cardiogenic shock, and acute kidney injury. Additionally in the male cohort, the C₂HEST value predicted acute liver dysfunction and all-cause bleeding, whereas in the female arm-stroke/TIA and SIRS. Conclusion: In the present study, we demonstrated the better C₂HEST-score predictive value for mortality in women and illustrated sex-dependent differences predicting non-fatal secondary outcomes. Full article

(This article belongs to the Special Issue Risk Factors for COVID-19 Infection)

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13 pages, 677 KiB

Open AccessArticle

Angiotensin Converting Enzyme Inhibitors May Increase While Active Vitamin D May Decrease the Risk of Severe Pneumonia in SARS-CoV-2 Infected Patients with Chronic Kidney Disease on Maintenance Hemodialysis

by Piotr Tylicki, Karolina Polewska, Aleksander Och, Anna Susmarska, Ewelina Puchalska-Reglińska, Aleksandra Parczewska, Bogdan Biedunkiewicz, Krzysztof Szabat, Marcin Renke, Leszek Tylicki and Alicja Dębska-Ślizień

Viruses 2022, 14(3), 451; https://0-doi-org.brum.beds.ac.uk/10.3390/v14030451 - 22 Feb 2022

Cited by 6 | Viewed by 2105

Abstract

The group most at risk of death due to COVID-19 are patients on maintenance hemodialysis (HD). The study aims to describe the clinical course of the early phase of SARS-CoV-2 infection and find predictors of the development of COVID-19 severe pneumonia in this population. This is a case series of HD nonvaccinated patients with COVID-19 stratified into mild pneumonia and severe pneumonia group according to the chest computed tomography (CT) pneumonia total severity score (TSS) on admission. Epidemiological, demographic, clinical, and laboratory data were obtained from hospital records. 85 HD patients with a mean age of 69.74 (13.19) years and dialysis vintage of 38 (14–84) months were included. On admission, 29.14% of patients had no symptoms, 70.59% reported fatigue followed by fever—44.71%, shortness of breath—40.0%, and cough—30.59%. 20% of the patients had finger oxygen saturation less than 90%. In 28.81% of patients, pulmonary parenchyma was involved in at least 25%. The factors associated with severe pneumonia include fever, low oxygen saturation and arterial partial pressure of oxygen, increased C-reactive protein and ferritin serum levels, low blood count of lymphocytes as well as chronic treatment with angiotensin converting enzyme inhibitors; while the chronic active vitamin D treatment was associated with mild pneumonia. In conclusion, even though nearly one-third of the patients were completely asymptomatic, while the remaining usually reported only single symptoms, a large percentage of them had extensive inflammatory changes at diagnosis with SARS-CoV-2 infection. We identified potential predictors of severe pneumonia, which might help individualize pharmacological treatment and improve clinical outcomes. Full article

(This article belongs to the Special Issue Risk Factors for COVID-19 Infection)

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24 pages, 1233 KiB

Open AccessReview

How Infection and Vaccination Are Linked to Acute and Chronic Urticaria: A Special Focus on COVID-19

by Emek Kocatürk, Melba Muñoz, Daniel Elieh-Ali-Komi, Paulo Ricardo Criado, Jonny Peter, Pavel Kolkhir, Pelin Can, Bettina Wedi, Michael Rudenko, Maia Gotua, Luis Felipe Ensina, Clive Grattan and Marcus Maurer

Viruses 2023, 15(7), 1585; https://0-doi-org.brum.beds.ac.uk/10.3390/v15071585 - 20 Jul 2023

Cited by 2 | Viewed by 3175

Abstract

Since more than a century ago, there has been awareness of the connection between viral infections and the onset and exacerbation of urticaria. Our knowledge about the role of viral infection and vaccination in acute and chronic urticaria improved as a result of the COVID-19 pandemic but it has also highlighted knowledge gaps. Viral infections, especially respiratory tract infections like COVID-19, can trigger the onset of acute urticaria (AU) and the exacerbation of chronic urticaria (CU). Less frequently, vaccination against viruses including SARS-CoV-2 can also lead to new onset urticaria as well as worsening of CU in minority. Here, with a particular focus on COVID-19, we review what is known about the role of viral infections and vaccinations as triggers and causes of acute and chronic urticaria. We also discuss possible mechanistic pathways and outline the unmet needs in our knowledge. Although the underlying mechanisms are not clearly understood, it is believed that viral signals, medications, and stress can activate skin mast cells (MCs). Further studies are needed to fully understand the relevance of viral infections and vaccinations in acute and chronic urticaria and to better clarify causal pathways. Full article

(This article belongs to the Special Issue Risk Factors for COVID-19 Infection)

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79 pages, 1721 KiB

Open AccessReview

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

by Levente Zsichla and Viktor Müller

Viruses 2023, 15(1), 175; https://0-doi-org.brum.beds.ac.uk/10.3390/v15010175 - 07 Jan 2023

Cited by 33 | Viewed by 8953

Abstract

The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors. Full article

(This article belongs to the Special Issue Risk Factors for COVID-19 Infection)

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