Factor Structure and Psychometric Properties for the PTSD Checklist of Chinese Adolescents in the Closed Period after the COVID-19 Outbreak.

After COVID-19 appeared in China in December 2019, the mental health of adolescents, as a vulnerable group in public health emergencies, was negatively affected by the epidemic and the unprecedented prevention and control measures. The purpose of this study was to investigate the factor structure and psychometric properties of the Posttraumatic Stress Disorder (PTSD) Checklist (PCL) among Chinese adolescents. A total of 915 participants completed the PTSD. Confirmatory factor analyses (CFAs) and multi-group CFAs were used to test the factor structure and psychometric properties of PTSD. The CFA results showed that five-factor PCL was the optimal fitting model with satisfactory reliability and validity; moreover, it was suggested that the properties of PCL were invariant across gender, PTSD and asymptomatic groups, early and late adolescents, as well as over time. In summary, PCL is applicable among Chinese adolescents and can be used for effective measurement of PTSD caused by epidemics and to conduct cross-group studies.

The Factor Structure and Rasch Analysis of the Fear of COVID-19 Scale (FCV-19S) Among Chinese Students.

The Fear of COVID-19 Scale (FCV-19S) is a new one-dimensional scale used to measure fear of an individual about the COVID-19. Given the seriousness of the COVID-19 situation in China when our study was taking place, our aim was to translate and examine the applicability of the FCV-19S in Chinese students. The sample used for validation comprised 2,445 Chinese students. The psychometrical characteristics of the Chinese FCV-19S (FCV-19S-C) were tested using Rasch analysis. Principal component analysis (PCA) proved the unidimensional structure of the model. Both infit and outfit mean square (MNSQ) values (0.69-1.31) and point-measure correlations (0.82-0.86) indicated a good model fit. Person-item separation and reliability values indicated good reliability of the scale. The person-item map revealed an acceptable level of match between the persons and the items. Differential item functioning of the FCV-19S-C showed no differences with respect to age or gender. FCV-19S-C scores were significantly associated with anxiety, stress, depression, ego-resilience, and general health. The FCV-19S-C was proven to be effective in measuring fear of Chinese students about the COVID-19.

Elevated α-hydroxybutyrate dehydrogenase as an independent prognostic factor for mortality in hospitalized patients with COVID-19.

AIMS: Many studies have explored the clinical characteristics of patients with coronavirus disease (COVID-19), especially patients with cardiovascular disease. However, associated mechanisms and markers remain to be further investigated. This study aimed to investigate the effect of α-hydroxybutyrate dehydrogenase (α-HBDH) levels on disease progression and prognosis of patients with COVID-19. METHODS AND RESULTS: One thousand seven hundred and fifty-one patients from the Leishenshan hospital in Wuhan were divided into elevated and normal groups by α-HBDH level, and the clinical information between the two groups was compared retrospectively. The main outcome evaluation criteria included in-hospital death and disease severity. Univariate and multivariate regression analyses, survival curves, logistic regression, and receiver operating characteristic curve models were performed to explore the relationship between elevated α-HBDH and the two outcomes. Besides, curve fitting analyses were conducted to analyse the relationship between computed tomography score and survival. Among 1751 patients with confirmed COVID-19, 15 patients (0.87%) died. The mean (SD) age of patients was 58 years in normal α-HBDH group and 66 years in elevated α-HBDH group (P < 0.001). The mortality during hospitalization was 0.26% (4 of 1559) for patients with normal α-HBDH levels and 5.73% (11 of 192) for those with elevated α-HBDH levels (P < 0.001). Multivariate Cox analysis confirmed an association between elevated α-HBDH levels and higher risk of in-hospital mortality [hazard ratio: 4.411, 95% confidence interval (95% CI), 1.127-17.260; P = 0.033]. Multivariate logistic regression for disease severity and α-HBDH levels showed significant difference between both groups (odds ratio = 3.759; 95% CI, 1.895-7.455; P < 0.001). Kaplan-Meier curves also illustrated the survival difference between normal and elevated α-HBDH patients (P < 0.001). CONCLUSIONS: Our study found that serum α-HBDH is an independent risk factor for in-hospital mortality and disease severity among COVID-19 patients. α-HBDH assessment may aid clinicians in identifying high-risk individuals among COVID-19 patients.

Decreased CO2 Levels as Indicators of Possible Mechanical Ventilation-Induced Hyperventilation in COVID-19 Patients: A Retrospective Analysis.

Background: Six months since the outbreak of coronavirus disease (COVID-19), the pandemic continues to grow worldwide, although the outbreak in Wuhan, the worst-hit area, has been controlled. Thus, based on the clinical experience in Wuhan, we hypothesized that there is a relationship between the patient's CO2 levels and prognosis. Methods: COVID-19 patients' information was retrospectively collected from medical records at the Leishenshan Hospital, Wuhan. Logistic and Cox regression analyses were conducted to determine the correlation between decreased CO2 levels and disease severity or mortality risk. The Kaplan-Meier curve analysis was coupled with the log-rank test to understand COVID-19 progression in patients with decreased CO2 levels. Curve fitting was used to confirm the correlation between computed tomography scores and CO2 levels. Results: Cox regression analysis showed that the mortality risk of COVID-19 patients correlated with decreased CO2 levels. The adjusted hazard ratios for decreased CO2 levels in COVID-19 patients were 8.710 [95% confidence interval (CI): 2.773-27.365, P < 0.001], and 4.754 (95% CI: 1.380-16.370, P = 0.013). The adjusted odds ratio was 0.950 (95% CI: 0.431-2.094, P = 0.900). The Kaplan-Meier survival curves demonstrated that patients with decreased CO2 levels had a higher risk of mortality. Conclusions: Decreased CO2 levels increased the mortality risk of COVID-19 patients, which might be caused by hyperventilation during mechanical ventilation. This finding provides important insights for clinical treatment recommendations.

Bilirubin Levels as Potential Indicators of Disease Severity in Coronavirus Disease Patients: A Retrospective Cohort Study.

Objectives: The coronavirus disease (COVID-19) pandemic has caused a large number of deaths. Some patients with severe or critical COVID-19 have been observed to have elevated bilirubin levels. Studies on the association of bilirubin level and mortality in patients with COVID-19 are limited. This study aimed to examine the role of bilirubin levels in COVID-19 severity and mortality. Methods: A retrospective cohort study was conducted in patients hospitalized with COVID-19 in Leishenshan Hospital in Wuhan, China. Cox regression analyses and logistic regression analyses were conducted to investigate the risks for mortality and disease severity, respectively. Kaplan-Meier analyses with log-rank tests were performed to assess the association between bilirubin level and survival. Results: In total, 1,788 patients with COVID-19 were included in the analysis. 5.8% (4/69) of patients in the elevated serum total bilirubin (STB) group died, compared to 0.6% (11/1,719) of patients in the non-elevated STB group. The median alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities in the elevated STB group were 29 U/L [interquartile range (IQR): 16-45 U/L] and 22 U/L (IQR: 13-37 U /L), respectively, which were significantly higher than the median ALT (median: 23, IQR: 15-37) and AST (median: 20, IQR: 16-26) activities in the non-elevated STB group (both p < 0.05). Patients with an elevated STB level showed increased mortality [hazard ratio (HR): 9.45, P = 0.002], elevated conjugated bilirubin (CB) levels (HR: 4.38, P = 0.03), and an elevated ratio of CB to unconjugated bilirubin (UCB, CB/UCB) (HR: 2.49, P = 0.01). CB/UCB was positively correlated with disease severity (odds ratio: 2.21, P = 0.01). Conclusions: COVID-19 patients with elevated STB and CB levels had a higher mortality, and CB/UCB was predictive of disease severity and mortality. Thus, it is necessary to pay special attention to COVID-19 patients with elevated bilirubin levels in clinical management.

Association of procalcitonin levels with the progression and prognosis of hospitalized patients with COVID-19.

Rationale: Coronavirus disease 2019 (COVID-19) was first announced in Wuhan, and has rapidly evolved into a pandemic. However, the risk factors associated with the severity and mortality of COVID-19 are yet to be described in detail. Methods: We retrospectively reviewed the information of 1525 cases from the Leishenshan Hospital in Wuhan. Univariate and multivariate Cox regression analyses were generated to explore the relationship between procalcitonin (PCT) level and the progression and prognosis of COVID-19. Univariate and multivariate logistic regression analyses were performed to explore the relationship between disease severity in hospitalized patients and their PCT levels. Survival curves and the cumulative hazard function for COVID-19 progression were conducted in the two groups. To further detect the relationship between the computed tomography score and survival days, curve-fitting analyses were performed. Results: Patients in the elevated PCT group had a higher incidence of severe and critical severity conditions (P < 0.001), death, and higher computed tomography (CT) scores. There was an association between elevated PCT levels and mortality in the univariate ((hazard ratio [1], 3.377; 95% confidence interval [2], 1.012-10.344; P = 0.033) and multivariate Cox regression analysis (HR, 4.933; 95% CI, 1.170-20.788; P = 0.030). Similarly, patients with elevated PCT were more likely to have critically severe disease conditions in the univariate (odds ratio [2], 7.247; 95% CI, 3.559-14.757; P < 0.001) and multivariate logistic regression analysis (OR, 10.679; 95% CI, 4.562-25.000; P < 0.001). Kaplan-Meier curves showed poorer prognosis for patients with elevated PCT (P = 0.024). The CT score 1 for patients with elevated PCT peaked at day 40 following the onset of symptoms then decreased gradually, while their total CT score was relatively stable. Conclusion: PCT level was shown as an independent risk factor of in-hospital mortality among COVID-19 patients. Compared with inpatients with normal PCT levels, inpatients with elevated PCT levels had a higher risk for overall mortality and critically severe disease. These findings may provide guidance for improving the prognosis of patients with critically severe COVID-19.

Dynamic Interleukin-6 Level Changes as a Prognostic Indicator in Patients With COVID-19.

BACKGROUND: Interleukin-6 (IL-6), a proinflammatory cytokine, has been reported to be associated with disease severity and mortality in patients with coronavirus disease 2019 (COVID-19). Yet, dynamic changes in IL-6 levels and their prognostic value as an indicator of lung injury in COVID-19 patients have not been fully elucidated. OBJECTIVE: To validate whether IL-6 levels are associated with disease severity and mortality and to investigate whether dynamic changes in IL-6 levels might be a predictive factor for lung injury in COVID-19 patients. METHODS: This retrospective, single-center study included 728 adult COVID-19 patients and used data extracted from electronic medical records for analyses. RESULTS: The mortality rate was higher in the elevated IL-6 group than in the normal IL-6 group (0.16 vs 5%). Cox proportional hazards and logistic regression analyses for survival (adjusted hazard ratio, 10.39; 95% confidence interval [CI], 1.09-99.23; p = 0.042) and disease severity (adjusted odds ratio, 3.56; 95% CI, 2.06-6.19; p < 0.001) revealed similar trends. Curve-fitting analyses indicated that patient computed tomography (CT) scores peaked on days 22 and 24. An initial decline in IL-6 levels on day 16 was followed by resurgence to a peak, nearly in tandem with the CT scores. CONCLUSION: Increased IL-6 level may be an independent risk factor for disease severity and in-hospital mortality and dynamic IL-6 changes may serve as a potential predictor for lung injury in Chinese COVID-19 patients. These findings may guide future treatment of COVID-19 patients.

Association Between Diabetes and COVID-19: A Retrospective Observational Study With a Large Sample of 1,880 Cases in Leishenshan Hospital, Wuhan.

Aims: This study aimed to investigate the clinical courses and outcomes of diabetes mellitus patients with coronavirus disease 2019 (COVID-19) in Wuhan. Methods: This study enrolled 1,880 consecutive patients with confirmed COVID-19 in Leishenshan Hospital. We collected and analyzed their data, including demographic data, history of comorbidity, clinical symptoms, laboratory tests, chest computed tomography (CT) images, treatment options, and survival. Results: The percentages of patients with diabetes among the severe and critical COVID-19 cases were higher than those among the mild or general cases (89.2%, 10.8 vs. 0%, p = 0.001). However, patients with and without diabetes showed no difference in the follow-up period (p = 0.993). The mortality rate in patients with or without diabetes was 2.9% (n = 4) and 1.1% (n = 9), respectively (p = 0.114). Univariate and multivariate Cox regression analyses and the Kaplan-Meier curves did not show any statistically significant differences between patients with and without diabetes (all p > 0.05). Conclusions: Our study results suggested that diabetes had no effect on the prognosis of COVID-19 patients but had a negative association with their clinical courses. These results may be useful for clinicians in the management of diabetic patients with COVID-19.

Clinical characteristics of emergency surgery patients infected with coronavirus disease 2019 (COVID-19) pneumonia in Wuhan, China.

BACKGROUND: We aimed to investigate clinical symptoms and epidemiologic features of emergency surgery patients infected with the 2019 novel coronavirus disease (COVID-19). More than 5 million people worldwide have been diagnosed with COVID-19 since December 2019 to the time of this publication. Thousands of emergency operations have been carried out since December 2019. To date, however, no literature has focused on the clinical symptoms of emergency surgery patients with COVID-19 pneumonia. METHODS: We conducted a retrospective cohort study of 164 emergency surgery patients with or without COVID-19 pneumonia in Zhongnan Hospital of Wuhan University in Wuhan, China, from January 1, 2020, to January 20, 2020. For this report, the final date of follow-up was February 5, 2020. The associated clinical, laboratory, epidemiologic, demographic, radiologic, and outcome data were collected and analyzed. RESULTS: Of the 164 emergency surgery patients, the median age was 41 years (interquartile range, 29-89), and 136 (82.9%) were women. The associated main clinical symptom included fever (93 [56.7%])，dry cough (56 [34.2%]), fatigue (86 [52.4%]), nausea (78 [47.6%]), and dizziness (77 [47%]). Of 54 emergency surgery patients infected with COVID-19, the median age was 46 years (interquartile range: 25-89), and 45 (83.3%) were women. The pathologic clinical symptoms investigated included fever (54 [100%]), fatigue (48 [88.9%]), nausea (52 [96.3%]), dizziness (46 [85.2%]), and dry cough (44 [81.5%]). The lymphopenia (0.37 × 109/L [interquartile range: 0.23-0.65]) and increased C-reactive protein (24.7 × 109/L [interquartile range: 13.57-38]) were observed. The preoperative fever and postoperative fever in emergency surgery patients with or without COVID-19 pneumonia were analyzed in this study. Of 54 emergency surgery patients with COVID-19, 15 (27.8%) showed preoperative fever, 54 (100%) had postoperative fever. Of 110 emergency surgery patients without COVID-19, 5 (4.5%) had preoperative fever, 31 (28.2%) patients had postoperative fever. In emergency surgery patients with COVID-19, the fever lasted more than 7 days, markedly exceeded the length of time non-COVID-19 patients experienced fever (approximately 3 days). Furthermore, 43 health care workers were exposed to emergency surgery patients with COVID-19 pneumonia and were infected with COVID-19 pneumonia. CONCLUSION: In our study, the clinical symptoms of emergency surgery patients infected with COVID-19 displayed marked differences from those reporting common COVID-19 pneumonia. In addition, the health care workers were suspected to have been exposed to a great risk when caring for emergency surgery patients with COVID-19 pneumonia. Management guidelines of emergency surgery patients are described in in this report.