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      Effect of Colchicine vs Standard Care on Cardiac and Inflammatory Biomarkers and Clinical Outcomes in Patients Hospitalized With Coronavirus Disease 2019 : The GRECCO-19 Randomized Clinical Trial

      research-article
      , MD, PhD 1 , , , MD, PhD 2 , , MD, MSc, PhD 3 , , MD, MSc, PhD 4 , , MD 1 , , MD, PhD 5 , , MD, PhD 6 , , MD, PhD 7 , , MD, MSc 8 , , MD, PhD 9 , , MD, MSc 10 , , MD 11 , , MD, PhD 12 , , MD, PhD 13 , , MD, PhD 14 , , MD, PhD 15 , , MD, PhD 16 , , MD, PhD 17 , , MD, PhD 18 , , MD, PhD 19 , , MD, PhD 20 , , MD, PhD 21 , , MD 22 , , MD 1 , , MD, PhD 1 , , MD, PhD 23 , , MD, PhD 23 , , MD, PhD 24 , , MD, PhD 25 , , MD, PhD 26 , , MD, PhD 4 , , MD, PhD 26 , , MD, PhD 26 , , MD, PhD 2 , , MD, PhD 4 , , MD, PhD 27 , , MD, PhD 4 , , MD, PhD 28 , , MD, PhD 29 , , MD 3 , , MD, MSc, PhD 3 , , MD, PhD 30 , , MD, PhD 26 , , MD, PhD 31 , , MD, PhD 4 , , MD, PhD 1 , , MD, PhD 32 , , MD, PhD 32 , , MD, PhD 4 , 5 , on behalf of the GRECCO-19 investigators
      JAMA Network Open
      American Medical Association

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          Key Points

          Question

          Is the receipt of colchicine among patients hospitalized with symptomatic coronavirus disease 2019 associated with clinical benefit?

          Findings

          In this randomized clinical trial of 105 patients, the rate of the primary clinical end point (clinical deterioration) was higher in the control group than in the colchicine group, and the time to clinical deterioration was shorter in the control group than in the colchicine arm. No difference was observed in the primary biochemical end point (high-sensitivity troponin concentration), but patients in the colchicine group had a smaller increase in dimerized plasma fragment D compared with patients in the control group.

          Meaning

          The hypothesis-generating findings of this study suggest a role for colchicine in the treatment of patients with coronavirus disease 2019.

          Abstract

          This randomized clinical trial evaluates the effect of treatment with colchicine on cardiac and inflammatory biomarkers and clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19).

          Abstract

          Importance

          Severe acute respiratory syndrome coronavirus 2 infection has evolved into a global pandemic. Low-dose colchicine combines anti-inflammatory action with a favorable safety profile.

          Objective

          To evaluate the effect of treatment with colchicine on cardiac and inflammatory biomarkers and clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19).

          Design, Setting, and Participants

          In this prospective, open-label, randomized clinical trial (the Greek Study in the Effects of Colchicine in COVID-19 Complications Prevention), 105 patients hospitalized with COVID-19 were randomized in a 1:1 allocation from April 3 to April 27, 2020, to either standard medical treatment or colchicine with standard medical treatment. The study took place in 16 tertiary hospitals in Greece.

          Intervention

          Colchicine administration (1.5-mg loading dose followed by 0.5 mg after 60 min and maintenance doses of 0.5 mg twice daily) with standard medical treatment for as long as 3 weeks.

          Main Outcomes and Measures

          Primary end points were (1) maximum high-sensitivity cardiac troponin level; (2) time for C-reactive protein to reach more than 3 times the upper reference limit; and (3) time to deterioration by 2 points on a 7-grade clinical status scale, ranging from able to resume normal activities to death. Secondary end points were (1) the percentage of participants requiring mechanical ventilation, (2) all-cause mortality, and (3) number, type, severity, and seriousness of adverse events. The primary efficacy analysis was performed on an intention-to-treat basis.

          Results

          A total of 105 patients were evaluated (61 [58.1%] men; median [interquartile range] age, 64 [54-76] years) with 50 (47.6%) randomized to the control group and 55 (52.4%) to the colchicine group. Median (interquartile range) peak high-sensitivity cardiac troponin values were 0.0112 (0.0043-0.0093) ng/mL in the control group and 0.008 (0.004-0.0135) ng/mL in the colchicine group ( P = .34). Median (interquartile range) maximum C-reactive protein levels were 4.5 (1.4-8.9) mg/dL vs 3.1 (0.8-9.8) mg/dL ( P = .73), respectively. The clinical primary end point rate was 14.0% in the control group (7 of 50 patients) and 1.8% in the colchicine group (1 of 55 patients) (odds ratio, 0.11; 95% CI, 0.01-0.96; P = .02). Mean (SD) event-free survival time was 18.6 (0.83) days the in the control group vs 20.7 (0.31) in the colchicine group (log rank P = .03). Adverse events were similar in the 2 groups, except for diarrhea, which was more frequent with colchicine group than the control group (25 patients [45.5%] vs 9 patients [18.0%]; P = .003).

          Conclusions and Relevance

          In this randomized clinical trial, participants who received colchicine had statistically significantly improved time to clinical deterioration. There were no significant differences in high-sensitivity cardiac troponin or C-reactive protein levels. These findings should be interpreted with caution.

          Trial Registration

          ClinicalTrials.gov Identifier: NCT04326790

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          Most cited references22

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Structure, Function, and Antigenicity of the SARS-CoV-2 Spike Glycoprotein

            Summary The emergence of SARS-CoV-2 has resulted in >90,000 infections and >3,000 deaths. Coronavirus spike (S) glycoproteins promote entry into cells and are the main target of antibodies. We show that SARS-CoV-2 S uses ACE2 to enter cells and that the receptor-binding domains of SARS-CoV-2 S and SARS-CoV S bind with similar affinities to human ACE2, correlating with the efficient spread of SARS-CoV-2 among humans. We found that the SARS-CoV-2 S glycoprotein harbors a furin cleavage site at the boundary between the S1/S2 subunits, which is processed during biogenesis and sets this virus apart from SARS-CoV and SARS-related CoVs. We determined cryo-EM structures of the SARS-CoV-2 S ectodomain trimer, providing a blueprint for the design of vaccines and inhibitors of viral entry. Finally, we demonstrate that SARS-CoV S murine polyclonal antibodies potently inhibited SARS-CoV-2 S mediated entry into cells, indicating that cross-neutralizing antibodies targeting conserved S epitopes can be elicited upon vaccination.
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              • Article: not found

              Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

              Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Risk factors for the clinical outcomes of COVID-19 pneumonia have not yet been well delineated.
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                Author and article information

                Journal
                JAMA Netw Open
                JAMA Netw Open
                JAMA Netw Open
                JAMA Network Open
                American Medical Association
                2574-3805
                24 June 2020
                June 2020
                24 June 2020
                : 3
                : 6
                : e2013136
                Affiliations
                [1 ]Second Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
                [2 ]Department of Cardiology, G. Gennimatas General Hospital of Athens, Athens, Greece
                [3 ]Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milan, Italy
                [4 ]First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
                [5 ]Athens Medical Center, Athens, Greece
                [6 ]First Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
                [7 ]First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
                [8 ]Department of Internal Medicine, General Hospital of Kastoria, Kastoria, Greece
                [9 ]Second Department of Internal Medicine, General Hospital of Alexandroupoli, Democritus University of Thrace, Alexandroupoli, Greece
                [10 ]Department of Internal Medicine, Mpodosakio General Hospital of Ptolemaida, Ptolemaida, Greece
                [11 ]Department of Internal Medicine, General Hospital of Kozani, Kozani, Greece
                [12 ]Third Department of Internal Medicine, General Hospital Sotiria, National and Kapodistrian University of Athens, Athens, Greece
                [13 ]First Intensive Care Unit, General Hospital Evangelismos, National and Kapodistrian University of Athens, Athens, Greece
                [14 ]First Department of Pneumonology, General Hospital Sotiria, National and Kapodistrian University of Athens, Athens, Greece
                [15 ]First Department of Internal Medicine, Ioannina University Hospital, University of Ioannina, Ioannina, Greece
                [16 ]Infectious Diseases Unit, Laiko General Hospital, Athens, Greece
                [17 ]Internal Medicine Department, University Hospital of Patras, Patras, Greece
                [18 ]Fourth Department of Pneumonology, General Hospital Sotiria, Athens, Greece
                [19 ]Department of Cardiology, General Hospital of Elefsina Thriasio, Elefsina, Greece
                [20 ]Therapeutics Department, Alexandra Hospital, Athens, Greece
                [21 ]Second Medical Department, NIMTS Hospital, Athens, Greece
                [22 ]Department of Internal Medicine, General Hospital of West Attica Agia Varvara, Athens, Greece
                [23 ]Department of Cardiology, University of Patras Medical School, Patras, Greece
                [24 ]Second Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
                [25 ]Third Department of Cardiology, Hygeia Hospital, Athens, Greece
                [26 ]Department of Cardiology, Ioannina University Hospital, University of Ioannina, Ioannina, Greece
                [27 ]Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
                [28 ]Third Department of Cardiology, General Hospital Sotiria, National and Kapodistrian University of Athens, Athens, Greece
                [29 ]Hospital Universitario y Politécnico La Fe, Valencia, Spain
                [30 ]Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
                [31 ]Fourth Department of Internal Medicine, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
                [32 ]Icahn School of Medicine at Mount Sinai, New York, New York
                Author notes
                Article Information
                Accepted for Publication: May 29, 2020.
                Published: June 24, 2020. doi:10.1001/jamanetworkopen.2020.13136
                Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Deftereos SG et al. JAMA Network Open.
                Corresponding Author: Spyridon G. Deftereos, MD, PhD, Second Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Greece, 1 Rimini St, Chaidari, Attiki, Greece ( spdeftereos@ 123456gmail.com ).
                Author Contributions: Dr Deftereos had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
                Concept and design: Deftereos, Giannopoulos, Vrachatis, Siasos, Giotaki, Gargalianos, Sianos, Sipsas, Gogos, Olympios, Migdalis, Angelidis, Alexopoulos, Davlouros, Hahalis, Kanonidis, Kolettis, Pyrgakis, Toutouzas, Triposkiadis, Tsioufis, Vavouranakis, Reimers, Cleman, Goudevenos, Tsiodras, Tousoulis, Iliodromitis, Stefanadis.
                Acquisition, analysis, or interpretation of data: Deftereos, Giannopoulos, Vrachatis, Giotaki, Gargalianos, Metallidis, Baltagiannis, Panagopoulos, Dolianitis, Randou, Syrigos, Kotanidou, Koulouris, Milionis, Tsoukalas, Tsagalou, Migdalis, Gerakari, Davlouros, Kanonidis, Katritsis, Manolis, Michalis, Naka, Martinez-Dolz, Reimers, Stefanini, Mehran, Dangas, Stefanadis.
                Drafting of the manuscript: Deftereos, Giannopoulos, Vrachatis, Siasos, Giotaki, Gargalianos, Baltagiannis, Randou, Koulouris, Tsoukalas, Migdalis, Toutouzas, Vavouranakis, Reimers, Cleman.
                Critical revision of the manuscript for important intellectual content: Deftereos, Vrachatis, Giotaki, Gargalianos, Metallidis, Sianos, Panagopoulos, Dolianitis, Syrigos, Kotanidou, Milionis, Sipsas, Gogos, Olympios, Tsagalou, Migdalis, Gerakari, Angelidis, Alexopoulos, Davlouros, Hahalis, Kanonidis, Katritsis, Kolettis, Manolis, Michalis, Naka, Pyrgakis, Triposkiadis, Tsioufis, Martinez-Dolz, Reimers, Stefanini, Cleman, Goudevenos, Tsiodras, Tousoulis, Iliodromitis, Mehran, Dangas, Stefanadis.
                Statistical analysis: Deftereos, Giannopoulos, Vrachatis, Baltagiannis, Vavouranakis.
                Obtained funding: Deftereos, Migdalis.
                Administrative, technical, or material support: Deftereos, Vrachatis, Gargalianos, Sianos, Baltagiannis, Syrigos, Kotanidou, Koulouris, Sipsas, Migdalis, Gerakari, Kolettis, Michalis, Iliodromitis.
                Supervision: Deftereos, Giannopoulos, Siasos, Gargalianos, Syrigos, Gogos, Tsoukalas, Olympios, Alexopoulos, Hahalis, Kanonidis, Katritsis, Kolettis, Pyrgakis, Toutouzas, Reimers, Tsiodras, Iliodromitis, Mehran, Stefanadis.
                Conflict of Interest Disclosures: Dr Vrachatis reported receiving a scholarship from Hellenic Society of Cardiology. Dr Michalis reported receiving grants and nonfinancial support from ELPEN Pharmaceuticals outside the submitted work. Dr Naka reported receiving grants and nonfinancial support from ELPEN Pharmaceuticals outside the submitted work. Dr Stefanini reported receiving a research grant to his institution and speaker fees from Boston Scientific and speaker fees from B. Braun Medical, Biosensors, and GADA outside the submitted work. Dr Mehran reported receiving grants and personal fees from Abbott Laboratories; grants from Applied Therapeutics, Bayer, Beth Israel Deaconess, CERC, Chiesi, Concept Medical, CSL Behring, DSI, Medtronic, Novartis Pharmaceuticals, and OrbusNeich; receiving grants from and serving on the advisory board of Bristol-Myers Squibb; receiving grants from and having a spouse who is a consultant for Abiomed; having a spouse who is a consultant for The Medicines Company; serving as a consultant for Boston Scientific, Janssen Scientific Affairs, Medscape/WebMD, Roivant Services, Sanofi, Siemens Medical Solutions, and Spectranetics/Philips/Volcano; receiving nonfinancial support from Idorsia Pharmaceuticals and Regeneron Pharmaceuticals; receiving advisory and speaking fees from Medtelligence (Janssen Scientific Affairs); serving on the data safety monitoring board for Watermark Research Partners; owning equity in Claret Medical and Elixir Medical; and serving as associate editor for ACC and JAMA Cardiology outside the submitted work. Dr Dangas reported receiving grants and personal fees from AstraZeneca, Janssen Pharmaceuticals, Sanofi, and Abbott Laboratories and receiving grants from Bayer, Daiichi-Sankyo, Bristol-Myers Squibb, and Novartis outside the submitted work. No other disclosures were reported.
                Funding/Support: The study was funded by ELPEN Pharmaceuticals, Acarpia Pharmaceuticals, and Karian Pharmaceuticals.
                Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
                Group Information: The GRECCO-19 investigators comprises George Adamis, MD (First Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece); Alexandra Agorogianni, MD (Second Medical Department, NIMTS Hospital, Athens, Greece); Evangelos Balis, MD (First Intensive Care Unit, General Hospital Evangelismos, National and Kapodistrian University of Athens, Athens, Greece); Ioannis Baraboutis, MD (Department of Internal Medicine, Pammakaristos Hospital, Athens, Greece); Zafeiria Barmparessou, MD (First Department of Pneumonology, General Hospital Sotiria, National and Kapodistrian University of Athens, Athens, Greece); Georgios Bobotis, MD (Department of Cardiology, Papagerogiou Hospital); George Bouras, MD (Cardiology Department, NIMTS Hospital); Alexandra Chronaiou, MD (Fourth Department of Pneumonology, General Hospital Sotiria); Theofilos Chrysanthidis, MD (First Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece), Ioanna Davoni, RN (Department of Cardiology, G. Gennimatas General Hospital of Athens); Gerasimos Deftereos, BSc (Department of Cardiology, G. Gennimatas General Hospital of Athens); Evangelos Oikonomou, MD (First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Greece); Nadia El Fellah, MD (Department of Internal Medicine, General Hospital of West Attica Agia Varvara, Athens, Greece); Dimitrios Filippou, MD (Department of Anatomy, National and Kapodistrian University of Athens); Katerina Fountoulaki, MD (Department of Cardiology, General Hospital of Elefsina Thriasio, Elefsina, Greece); Paraskevi C. Fragkou, MD (Fourth Department of Internal Medicine, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece); Maria Giaka, MD (Department of Internal Medicine, General Hospital of Kozani, Kozani, Greece); Sotirios Giotakis, MD (Second Department of Cardiology, Attikon Hospital), Konstantina Goula, RN (Department of Cardiology, G. Gennimatas General Hospital of Athens); Sotiria Grigoropoulou, MD (Fourth Department of Internal Medicine, Attikon Hospital); Konstantinos Iliodromitis, MD (Second Department of Cardiology, Attikon Hospital); Edison Jahaj, MD (First Intensive Care Unit, General Hospital Evangelismos); George Kalambokis, MD (First Department of Internal Medicine, Ioannina University Hospital, University of Ioannina, Ioannina, Greece); Andreas Kaoukis, MD (Department of Cardiology, G. Gennimatas General Hospital of Athens); Drosos E. Karageorgopoulos, MD (Fourth Department of Internal Medicine, Attikon Hospital); Nikolaos Karamvakalis, MD (Second Medical Department, NIMTS Hospital); Stratis Katsianos, MD (Third Department of Cardiology, General Hospital Sotiria); Vasilios Kekeris, MD (Airport Services of Emergency Medical Care/EKAB); George Kochiadakis, MD (Cardiology Department, University of Crete, Heraclion, Greece); Anastasios Kollias, MD (Third Department of Internal Medicine, General Hospital Sotiria); Fotios Kolokathis, MD (Second Department of Cardiology, Attikon Hospital); Michalis Komis, MD (Department of Cardiology, General Hospital of Elefsina Thriasio); Athanasios Koromilias, MD (First Department of Pneumonology, General Hospital Sotiria); Charalampos Kossyvakis, MD (Department of Cardiology, G. Gennimatas General Hospital of Athens); Ioanna Kotsamidi, MD (Department of Internal Medicine, General Hospital of Kozani); Eleanna Kotsia, MD (Second Department of Cardiology, Attikon Hospital); Artemis Kyriakidou, MD (Department of Internal Medicine, General Hospital of Kastoria, Kastoria, Greece); Konstantinos G. Kyriakoulis, MD (Third Department of Internal Medicine, General Hospital Sotiria); Sotiria Laparidou, MD (Department of Internal Medicine, General Hospital of Kozani); Fotios Lezgidis, MD (Department of Internal Medicine, Mpodosakio General Hospital of Ptolemaida, Ptolemaida, Greece); Georgia Loli, MD (First Department of Internal Medicine, AHEPA Hospital); Spyridon P. Louvros, MD (Department of Cardiology, G. Gennimatas General Hospital of Athens); Theodora Maniatopoulou, MD (First Department of Internal Medicine, Ioannina University Hospital); Anastasia Mavrogiannaki, MD (Second Medical Department, NIMTS Hospital); Eirini Melidou, MD (Department of Internal Medicine, General Hospital of Kozani); Nikolaos Moussas, MD (Athens Medical Center, Athens, Greece); Danai Mparlampa, MD (Department of Internal Medicine, Pammakaristos Hospital); George Neroutsos, MD (Department of Cardiology, Chalkida General Hospital, Chalkida, Greece); Anastasia Nikolaidou, MD (First Department of Internal Medicine, AHEPA Hospital); Sebastien-Filippas Ntekouan, MD (First Department of Internal Medicine, Ioannina University Hospital); Dimitrios Ntemos, MD (Department of Internal Medicine, General Hospital of Kozani); Dimitrios Palaiologos, MD (Second Department of Cardiology, Attikon Hospital); Aikaterini Panteli, MD (First Department of Internal Medicine, Ioannina University Hospital); Konstantinos Papathanasiou, MD (Second Department of Cardiology, Attikon Hospital); Fragkiskos Parthenakis, MD (Cardiology Department, University of Crete); Sofia Pavlidou, MD (Department of Internal Medicine, Mpodosakio General Hospital of Ptolemaida); Vasilis Petrakis, MD (Second Department of Internal Medicine, General Hospital of Alexandroupoli, Democritus University of Thrace, Alexandroupoli, Greece); Garyphallia Poulakou, MD (Third Department of Internal Medicine, General Hospital Sotiria); Stefanos Poulios, MD (Department of Internal Medicine, General Hospital of Kozani), Konstantinos Raisakis, MD (Department of Cardiology, G. Gennimatas General Hospital of Athens); Grigorios Salvaras, MD (Department of Internal Medicine, Mpodosakio General Hospital of Ptolemaida), John Skoularigis, MD (Department of Cardiology, University of Thessaly, Larissa, Greece); Nikoleta Stanitsa, MD (Second Department of Cardiology, Attikon Hospital); Jorge Sanz-Sánchez, MD (Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milan, Italy); Eleni Sarri, MD (Second Department of Cardiology, Attikon Hospital); Anastasios Semertzidis, MD (Department of Internal Medicine, General Hospital of Kastoria); Ioannis Styliadis, MD (Department of Cardiology, Papagerogiou Hospital); Prodromos Temberikidis, MD (First Intensive Care Unit, General Hospital Evangelismos); Charalampos Thanos, MD (Department of Internal Medicine, Pammakaristos Hospital); Andreas Theodorakis, MD (Department of Cardiology, Missolonghi General Hospital, Missolonghi, Greece), Christos Tolis, MD (Department of Cardiology, G. Gennimatas General Hospital of Athens); Dimitrios Touloumenidis, MD (Department of Internal Medicine, Mpodosakio General Hospital of Ptolemaida); Athanasios Trikas, MD (Cardiology Department, Elpis General Hospital, Athens, Greece); Olga Tsachouridou, MD (First Department of Internal Medicine, AHEPA Hospital); Dimitrios Tsiachris, MD (Athens Medical Center); Ilias Tsiakas, MD (First Department of Internal Medicine, Ioannina University Hospital); Panagiotis-Anastasios Tsioufis, MD (Department of Internal Medicine, General Hospital of Kozani); George Tsitsinakis, MD (Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy); Stamatios D. Tsouroulas, MD (Department of Cardiology, G. Gennimatas General Hospital of Athens); Argyris Tzouvelekis, MD (First Department of Pneumonology, General Hospital Sotiria); Ioannis Vagias, MD (Department of Internal Medicine, General Hospital of Kozani); Panagiotis Xarras, MD (Department of Internal Medicine, General Hospital of Kozani); Alexandra Yannou, MD (Department of Internal Medicine, Pammakaristos Hospital); Dimitrios Yiagoulis, MD (Department of Internal Medicine, Mpodosakio General Hospital of Ptolemaida).
                Data Sharing Statement: See Supplement 3.
                Article
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                10.1001/jamanetworkopen.2020.13136
                7315286
                32579195
                53d9c932-b62e-4b90-ae66-960a659d67f9
                Copyright 2020 Deftereos SG et al. JAMA Network Open.

                This is an open access article distributed under the terms of the CC-BY License.

                History
                : 15 May 2020
                : 29 May 2020
                Categories
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                Original Investigation
                Online Only
                Infectious Diseases

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