Clinical value of admission blood glucose level on prognosis of COVID-19 patients

Objective: To explore the clinical value of admission blood glucose level on prognosis of COVID- 19 patients. Methods A total of 420 novel coronavirus pneumonia (COVID-19) patients admitted to Tongji Hospital of Tongji MedicalCollege from January 18, 2020 to February 26, 2020 were selected as the subjects of study. The data of diabetes or not, admissionblood glucose level(GLU), clinical severity grade were collected through the electronic medical record system, and the outcome, which defined as in-hospital motality, was also monitored. The patients were divided into diabetes group and non-diabetes groupin terms of the complication of diabetes, and then, firstly, stratified these two groups into survival subgroup and non-survivalsubgroup in according to the event of in-hospital motality, GLU between these two subgroups were compared. Secondly, according to the clinical severity grade, these two groups were stratified into moderate subgroup, severe subgroup and criticalsubgroup, and GLU among these subgroups were also compared. Thirdly, according to the admission blood glucose level, stratified these two groups into GLU 3.9~7.8 mmol /L subgroup, GLU 7.8~10.0 mmol/L subgroup and GLU>10.0 mmol/Lsubgroup, the in-hospital motality rates among these subgroups were compared. Finally, the multivariate logistic regression wasused to explore whether increased GLU were independent risk factor for in-hospital motality in diabetes group and non-diabetesgroup when adjusted for sex, age and underlying disease. Results In non-diabetes group, compared with Survival subgroup, GLUwas significantly elevated in non-Survival subgroup[6.96(5.95, 8.23)mmol/L vs 5.96 (5.32, 6.92) mmol/L], the difference wasstatistically significant(U=6047.0, P < 0.001), but in diabetes group, there was no significant difference between non-survivalsubgroup and Survival subgroup [12.42(8.41, 18.17) mmol/L vs 9.88 (7.79, 14.02) mmol/L], the difference was statisticallysignificant(U=1 200.5, P=0.059).In Non-diabetes group, GLU elevated remarkably along with the clinical severity gradeincreased, moderate subgroup, severe subgroup, critical subgroup GLU were 5.87(5.24, 6.69) mmol/L, 6.94(5.95, 7.90) mmol/L,9.73 (6.22, 11.64) mmol/L, the difference were statistically significant, respectively(U=723.0~4978.0, all P < 0.01). However indiabetes group, there was no significant difference on GLU when the clinical severity grade increased, moderate subgroup, severesubgroup, critical subgroup GLU were 9.88(7.81, 11.93)mmol/L, 12.42(8.43, 16.94)mmol/L, 11.43(7.89, 18.76)mmol/L, the difference were statistically significant, respectively (U=262.0~946.5, all P>0.05).In non-diabetes group, GLU> 10.0 mmol/L subgroup had the hightest in-hospital motality rate (72.0%) among all three subgroups, the differences were statisticallysignificant(X2=24.607, 9.625, all P < 0.01), when compared between GLU 3.9~7.8 mmol/L subgroup (in-hospital motality rate24.8%) and GLU 7.8~10.0 mmol/L subgroup (in-hospital motality rate 30.0%), there was no significant difference on in-hospitalmotality rate (X2=0.383, P > 0.05). However, in diabetes group, along with GLU increased, it had no significant difference on inhospitalmotality rate, GLU 3.9~7.8 mmol/L subgroup, GLU 7.8~10.0 mmol/L subgroup, GLU> 10.0 mmol/L subgroup, the inhospitalmotality rate were 34.8%, 41.4%, 49.2%, respectively(X2=0.236~1.380, all P> 0.05). Multivariate logistic regressionshowed, in non-diabets group, GLU>10.0 mmol/L was the independent risk factor when adjusted for sex, age and underlyingdisease, odds ratio was 7.969, and 95% confidence interval was 3.022~21.013, but in diabets group.It seemed that GLU>10.0 mmol/L was not the independent risk factor. Conclusion Admission blood glucose is a good predictor for disease severity andoutcome in non-diabetes patients with COVID-19. When admission hyperglycemia occurs, it tends to predict a poor prognosis.

Analysis of the characteristics of hematological parameters in the early stages of COVID-19

The aim of the article was to analyze the characteristics of early peripheral blood laboratory examination results of patients with new coronavirus pneumonia (coronavirus disease 2019, COVID-19), and provide references for early clinical identification. From January 11, 2020 to February 18, 2020, all 626 patients who attended the fever clinic of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology and tested positive for the new coronavirus (SARS-CoV-2) nucleic acid were selected as the research group In addition, 254 suspected patients who visited the fever clinic during the same period and the SARS-CoV-2 nucleic acid test was negative for two or more consecutive times were selected as the control group, and analyzed the blood cell test, biochemical routine, and inflammation markers of the two groups of patients at the fever clinic for the first time. The characteristics of 31 hematological indicators. Compared with the control group, the white blood cell (WBC), lymphocyte (LYMPH), platelet (PLT), serum calcium (serum calcium, Ca) of the study group were significantly reduced, and the hypersensitive C-reactive protein (hypersensitive C-reactive protein, hsCRP) significantly increased, the difference was statistically significant, and there was a difference in the distribution of results. In the study group, WBC was mostly normal or decreased. WBC was normal in 85.3%, decreased in 9.4%, LYMPH decreased in 43.1%, PLT decreased in 12.8%, Ca decreased in 61.8%, hsCRP was higher than 10mg/L accounted for 66.2%. The remaining 26 hematological indicators (Cl, Na, K, HCO3, Urea, UA, Cr, TBA, CHE, ALB, ALT, ALP, LDH, TP, PCT, DBIL, GLB, IBIL, TBIL, P-GGT, TCHOL, AST, Hb, RBC, NEUT, MON) There was no statistically significant difference between the two groups. WBC, LYMPH, PLT, Ca and hsCRP have significant changes in the early stage of COVID-19 patients. Joint detection and observation of the above indicators can provide important references for early clinical identification.

Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy.

BACKGROUND: A relatively high mortality of severe coronavirus disease 2019 (COVID-19) is worrying, and the application of heparin in COVID-19 has been recommended by some expert consensus because of the risk of disseminated intravascular coagulation and venous thromboembolism. However, its efficacy remains to be validated. METHODS: Coagulation results, medications, and outcomes of consecutive patients being classified as having severe COVID-19 in Tongji hospital were retrospectively analyzed. The 28-day mortality between heparin users and nonusers were compared, as was a different risk of coagulopathy, which was stratified by the sepsis-induced coagulopathy (SIC) score or D-dimer result. RESULTS: There were 449 patients with severe COVID-19 enrolled into the study, 99 of them received heparin (mainly with low molecular weight heparin) for 7 days or longer. D-dimer, prothrombin time, and age were positively, and platelet count was negatively, correlated with 28-day mortality in multivariate analysis. No difference in 28-day mortality was found between heparin users and nonusers (30.3% vs 29.7%, P = .910). But the 28-day mortality of heparin users was lower than nonusers in patients with SIC score ≥4 (40.0% vs 64.2%, P = .029), or D-dimer >6-fold of upper limit of normal (32.8% vs 52.4%, P = .017). CONCLUSIONS: Anticoagulant therapy mainly with low molecular weight heparin appears to be associated with better prognosis in severe COVID-19 patients meeting SIC criteria or with markedly elevated D-dimer.