ABSTRACT
Epidemiological and clinical characteristics of patients with COVID-19 have been reported in the last two years. A few studies reported clinical course of illness of median 22 days, including viral shedding of median 20 days, but there are several cases with a longer time of viral shedding. In this study, we included four cases with a longer illness course of more than 40 days who had been discharged or still in hospital by March 15, 2020. Demographic, clinical treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records. We described the epidemiological and clinical characteristics and the course of viral shedding. Two patients had comorbidity, one with hypertension and the other with diabetes. We found smoking was not an independent risk factor. D-dimer maybe related to the severity of illness but not to the course of the illness. Nucleic acid detection suggested that maybe more sampling sites represented more virus replication sites and longer course of illness. In this study we found some non-critical severe relatively young patients whose character was different from former studies described to provide a basis for reference to assess the risk of transmission and the isolation duration of patients.
ABSTRACT
Background: Since December 2019, the outbreak of COVID-19 caused a large number of hospital admissions in China. Many patients with COVID-19 have symptoms of acute respiratory distress syndrome, even are in danger of death. This is the first study to evaluate dynamic changes of D-Dimer and Neutrophil-Lymphocyte Count Ratio (NLR) as a prognostic utility in patients with COVID-19 for clinical use. Methods In a retrospective study, we collected data from 349 hospitalized patients who diagnosed as the infection of the COVID-19 in Wuhan Pulmonary Hospital. We used ROC curves and Cox regression analysis to explore critical value (optimal cut-off point associated with Youden index) and prognostic role of dynamic changes of D-Dimer and NLR. Results 349 participants were enrolled in this study and the mortality rate of the patients with laboratory diagnosed COVID-19 was 14.9%. The initial and peak value of D-Dimer and NLR in deceased patients were higher statistically compared with survivors (P<0.001). There was a more significant upward trend of D-Dimer and NLR during hospitalization in the deceased patients, initial D-Dimer and NLR were lower than the peak tests (MD) -25.23, 95% CI: -31.81- -18.64, P <0.001; (MD) -43.73, 95% CI:-59.28- -31.17, P <0.001. The test showed a stronger correlation between hospitalization days, PCT and peak D-Dimer than initial D-Dimer. The areas under the ROC curves of peak D-Dimer and peak NLR tests were higher than the initial tests (0.94(95%CI: 0.90-0.98) vs. 0.80 (95% CI: 0.73-0.87); 0.93 (95%CI:0.90-0.96) vs. 0.86 (95%CI:0.82-0.91). The critical value of initial D-Dimer, peak D-Dimer, initial NLR and peak NLR was 0.73 mg/L, 3.78 mg/L,7.13 and 14.31 respectively. 35 (10.03%) patients were intubated. In the intubated patients, initial and peak D-Dimer and NLR were much higher than non-intubated patients (P<0.001). The critical value of initial D-Dimer, peak D-Dimer, initial NLR and peak NLR in prognosticate of intubation was 0.73 mg/L, 12.75 mg/L,7.28 and 27.55. The multivariable Cox regression analysis showed that age (HR 1.04, 95% CI 1.00-1.07, P=0.01), the peak D-Dimer (HR 1.03, 95% CI 1.01-1.04, P<0.001) were prognostic factors for COVID-19 patients’death. Conclusions To dynamically observe the ratio of D-Dimer and NLR was more valuable during the prognosis of COVID-19. The rising trend in D-Dimer and NLR, or the test results higher than the critical values may indicate a risk of death for participants with COVID-19.
Subject(s)
COVID-19 , Respiratory Distress SyndromeABSTRACT
Background Since December, 2019, the emerge of a Novel Coronavirus Disease 2019 (COVID-19) have caused global concern, the majority viewpoints are that the deaths are related to advanced ages, however, the emergence of younger deaths needs immediate attention.Methods Clinical characteristics, laboratory results, chest CT scans and treatment measures were retrospectively reviewed for six deceased patients under 60 years old with confirmed COVID-19 who were admitted to Wuhan Pulmonary Hospital in Wuhan, Hubei Province, China, from 6th January to 4th March, 2020.Results The age range of the patients was 50.17 ± 3.25 years (45–55 years), none of them had underlying diseases. All of patients presented with the symptoms of fever, respiratory system and digestive system. The level of albumin and lymphocyte counts decreased early in the stages of the disease, and then gradually increased. The neutrophil to lymphocyte ratio (NLR) increased (higher than normal range) in early stage and gradually decreased when the disease progressed. All the six patients showed ground-glass opacity (GGO) and bilateral patchy shadowing in early stage under the computed tomography (CT). All the patients died of severe pneumonia and multiple organ failure.Conclusions The decreased level of serum albumin occurred in the early stages of the disease, and delays in the first admission to hospital probably aggravate the disease development. The increase of the NLR in early stage of disease may be a risk of death for COVID-19. These findings may provide useful information for optimizing supportive care for COVID-19 pneumonia.
Subject(s)
COVID-19ABSTRACT
Background: Since December, 2019, Wuhan, China, has experienced an outbreak of 2019 novel coronavirus pneumonia (COVID-19). Epidemiological and clinical characteristics of patients with COVID-19 have been reported. A few studies reported clinical course of illness of median 22 days, including viral shedding of median 20 days, but there are several cases with a longer time of viral shedding.Methods: In this retrospective, single-centre cohort study, we included four cases with a longer course of illness of more than 40 days with laboratory-confirmed COVID-19 from Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or still in hospital by March 15, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records. We describe the epidemiological and clinical characteristics and the course of viral shedding.Results: Of the four patients, one was discharged and the other three were still in hospital. Two patients had comorbidity, one with hypertension and one with diabetes. We found smoking is not an independent risk factor . And D-Dimer maybe relates to severity of illness but not course of illness. Decreased lymphocyte count had a slow recovery process in three patients. elevated eosinophils count in all patients suggest maybe elevated eosinophils count was a reason of long course. Nucleic acid detection suggests maybe more sampling sites represent more virus replication sites and longer course illness.Conclusion: In this study we find some non-critical severe relatively young patients with sustained non-negative with nucleic acid detection whose character is different from former studies described. Of course, it needs much more cases to further study. It’s hoped to provide strategy of isolation of infected patients and optimal antiviral interventions in the future.