ABSTRACT
Background: Coronavirus disease-2019 (COVID-19) has spread all over the world and brought extremely huge losses. At present, there is no study to systematically analyse the features of hydroxybutyrate dehydrogenase (alpha-HBDH) in COVID-19 patients with different ages, clinical types and outcomes. Methods: Electronic medical records including demographics, clinical manifestation, alpha-HBDH test results and outcomes of 131 hospitalized COVID-19 patients, with confirmed result of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection, were extracted and analyzed. Results: The alpha-HBDH value in greater than or equal to 61 years old group, severe group and critical group, death group all increased at first and then decreased, while no obvious changes were observed in other groups. And there were significant differences of the alpha-HBDH value among different age groups, clinical type groups and outcome groups. The optimal scale regression model showed that alpha-HBDH value and age were related to clinical type. Conclusions: alpha-HBDH value increases in some COVID-19 patients, obviously in greater than or equal to 61 years old, death and critical group, indicating that patients in these three groups suffer from more serious tissues and organs damage, higher alpha-HBDH value and risk of death. The obvious difference between death and survival group in early stage may provide a approach to judge the prognosis. The accuracy of the model to distinguish severe/critical type and other types is 85.84%, suggesting that alpha-HBDH could judge the clinical type of COVID-19 patients accurately. In brief, alpha-HBDH is an important indicator to judge the severity and prognosis of COVID-19.
Subject(s)
COVID-19 , Coronavirus Infections , DeathABSTRACT
Background: Coronavirus disease 2019 (COVID-19) has been declared as a threat to the global. Due to the lack of efficient treatments, indicators were urgently needed during the evolvement of disease to analyze the illness and prognosis, and prevent the aggravation of COVID-19. Methods: Patients' general information, clinical type, all CK values and outcome were collected. CK value of all cases during disease course started from different initial time were analyzed. Results: All cases underwent 504 tests of CK since symptom onset and the median value was 51.7 (35.0-91.5) U/L. The first median value on the day 8 from exposure onset was 78.1 (69.1-85.8) U/L then showed an upward trend from the day 8 to the day 12 (reaching a peak of 279.3 U/L), finally showed a fluctuation decline after the day 12. The CK median value in critical cases reached the peak (625.5 U/L) on the transforming date, and then decreased rapidly to the normal range. Before death, the CK median value in dead cases firstly increased until the day -14 with a peak as 470.0 U/L, then decreased with fluctuation until day -2, and finally increased again on the day 0. Conclusions: CK reached its peak on the day when it became critical type, dynamic detection of CK can guide clinical judgment of prognosis. The increase of CK is a high risk factor of death. Severe cell damage 2 weeks before death might determines the outcome of the disease even if CK drops to the normal range afterward.
Subject(s)
COVID-19 , DeathABSTRACT
Background: Coronavirus disease-2019 (COVID-19) has spread all over the world and brought extremely huge losses. There is no study to systematically analyse the features of hydroxybutyrate dehydrogenase (-HBDH) in COVID-19 patients during the periods before and after illness progression, before death and course from exposure onset. Methods: We collected all included patients' general information, clinical type, -HBDH value and outcome, and analyzed -HBDH values within different initial time and different periods. Results: In the first 30 days after symptom onset, the -HBDH median value was 156.33 U/L. The first test of -HBDH since exposure onset appeared on the 8th day, it increased from the 8th day to 18th day and decreased after the 18th day. -HBDH median value showed a slight change until it started to increase 1 day before transforming to severe type, while it continued to increase during 4 days before and after transforming to critical type. The -HBDH median value ranged from 191.11 U/L to 455.11U/L before death. Conclusions: -HBDH value increases in some COVID-19 patients, obviously in severe type, critical type and death patients, and mainly in 18 days after exposure onset and 10 days after symptom onset. -HBDH increases 1 day before transforming to severe type, continues to increase in critical type and death patients, increases rapidly 5 days before death. The increase of -HBDH suggests that COVID-19 patients have tissues and organs damage, mainly in heart. In brief, -HBDH is an important indicator to judge the severity and prognosis of COVID-19.
Subject(s)
COVID-19 , DeathABSTRACT
Objectives: To study the features of creatine-kinase (CK) in COVID-19 patients with different ages, clinical types and outcomes and quantify the relationship between CK value and clinical type. Methods: All laboratory confirmed COVID-19 patients hospitalized in Xiangyang No.1 People's Hospital were included. Patients' general information, clinical type, all CK values and outcome were collected. Results: The peak median value of CK in cases aged greater than or equal to 71 years old (appeared at T2) was higher than that in cases aged less than or equal to 70 years old. There was statistical difference between the two groups. Similarly, the peak in critical cases (appeared at T2) was higher than moderate and severe types, and significant difference were existed among moderate, severe, and critical types. Moreover, the peak value in death group (appeared at T2) was higher than those in survival group. Significant difference was also found between them. According to the optimal scale regression model, the CK value and age were associated with the clinical type. Conclusions: Difference of the CK in different ages, clinical types, and outcomes were significant. The results of the optimal scale regression model are helpful to judge the clinical type of COVID-19 patients.
Subject(s)
COVID-19ABSTRACT
Background: To characterize C-reactive protein (CRP) changes features from patients with coronavirus disease 2019 (COVID-19) and to quantify the correlation between CRP value and clinical classification. Methods: This was a bidirectional observational cohort study. All laboratory confirmed COVID-19 patients hospitalized in Xiangyang No.1 People's Hospital were included. Patients' general information, clinical type, CRP value and outcome were collected. Patients were grouped according to the age, clinical type and outcome, and their CRP were compared. The CRP value, age gender, and clinical type were used to build a categorical regression model to investigate the association between CRP and clinical type. Results: The 131 patients aged 50.13 plus-or-minus 17.13 years old. There were 4 mild, 88 moderate, 21 severe and 18 critical cases. Statistical significance of CRP median exists between different clinical types and ages. There were 10 deaths and 121 cases have been discharged. The CRP in death group dramatically increased continuously until died, while increased firstly and decreased later in the survivor and survivor in critical type. The categorical regression model also showed that CRP and age had significant coefficient. During the first 15 days from symptom onset, the maximum of CRP ranged between 0.47-53.37 mg/L were related to mild combined with moderate type, ranged 53.84-107.08 mg/L were related to severe type, and 107.42-150.00 mg/L were related to the critical type. Conclusions: CRP showed different distribution feature and existed differences in various ages, clinical types and outcomes of COVID-19 patients. The features corresponded with disease progression.
Subject(s)
COVID-19 , DeathABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) has been declared as a threat to the global. Due to the lack of efficient treatments, indicators were urgently needed during the evolvement of disease to analyze the illness and prognosis and prevent the aggravation of COVID-19. METHODS: All laboratory confirmed COVID-19 patients hospitalized in Xiangyang No.1 People's Hospital were included. Patients' general information, clinical type, CRP value and outcome were collected. CRP values of all patients during disease course from different initial time were analyzed. RESULTS: The 131 enrolled patients were 50.13 plus-or-minus 17.13 years old. All cases underwent 724 tests of CRP since symptom onset, 53.18% of the test results were abnormal and the median value was 9.52 (2.63-34.10) mg/L. The first median value on the day 8 from exposure onset was 39.08 (11.92-47.89) mg/L then fluctuated around it until the day 28. The CRP median increased from 15.93 mg/L to 41.44 mg/L and then decreased to 18.26 mg/L before transformation of severe type, and then increased to 62.25 mg/L on the transforming date. Conversely, the CRP median increased from 56.17 mg/L 102.75 mg/L before transformation of critical type but decreased to 68.68 mg/L on the transforming date. The changes of CRP median over time before death ranged from 77.77 mg/L to 133.52 mg/L. CONCLUSIONS: CRP increased before symptom onset and substantially increased during the early-to-mid stage (especially early stage), which was different from other virus-infected diseases. The changes of CRP before the transformation of clinical type was inconsistent with the aggravating of illness. And the CRP maintained over 100.00 mg/L prompted poor prognosis.
Subject(s)
COVID-19 , Virus DiseasesABSTRACT
Background: The stage of CT images was rarely studied and the relationship between the severity of Coronavirus Disease 2019 (COVID-19) and CT images has not been studied based on systematic quantitative analysis currently. Purpose: To investigate the staging duration and classification of CT images of patients with COVID-19 based on quantitative analysis. Materials and Methods: This is an ambispective observational cohort study based on 125 patients with COVID-19 from Jan 23 to Feb 28, 2020. The stage of CT and pulmonary lesion size were quantitatively analyzed. The categorical regression analysis based on optimal scale (CATREG) was performed to evaluate the association of CT score, age, and gender with the clinical type. Results: The CT images of 125 patients with COVID-19 (50.13 plus-or-minus 16.91 years, 66 women) were analyzed in this study. Except for pre-early stage, the duration of early, progression-consolidation, and dissipation stage of CT images was 3.40 plus-or-minus 2.31, 10.07 plus-or-minus 4.91, and 20.60 plus-or-minus 7.64 days, respectively. The median CT score was 5.00 (2.00-8.50) during the first 30 days, which reached a peak on the 11th day. Significant differences were found between the median CT scores of different clinical types (P less than 0.05). Besides, the age was correlated with the clinical type (P less than 0.001), the CT scores of 0.00-11.50, 11.50-16.00, and 16.00-20.00 were separately correlated with the moderate, severe, and critical type with the output accuracy 69.60%. Conclusion: The four-stage staging method based on quantitative analysis is consistent with the change rules of staging features and COVID-19. Quantitative study by scoring pulmonary lesion sizes accurately revealed the evolvement of pulmonary lesions and differences between different clinical types.
Subject(s)
COVID-19 , Lung DiseasesABSTRACT
BackgroundAs the spreading of the COVID-19 around the global, we investigated the characteristics and changes of symptoms in COVID-19 patients. MethodsThis was an ambispective observational cohort study, and 133 confirmed COVID-19 patients were included and all symptoms over the course were analyzed qualitatively. The symptoms, their changes over the course in the cohort and in the different clinical types, etc. were illustrated. Differences in different periods and severities were analyzed through Chi square test, association with severity was analyzed through LASSO binomial logistic regression analysis. Inter-correlation and classification of symptoms were completed. Major symptoms were screened and their changes were illustrated. ResultsA total of 43 symptoms with frequencies as 6067 in this cohort. Differences of symptoms in different stages and clinical types were significant. Expectoration, shortness of breath, dyspnea, diarrhea, poor appetite were positively but vomiting, waist discomfort, pharyngeal discomfort, acid reflux were negatively correlated with the combined-severe and critical type; dyspnea was correlated with the critical type. The 17 major symptoms were identified. The average daily frequency of symptoms per case was decreased continuously before the transition into the severe type and increased immediately one day before the transition and then decreased. It was decreased continuously before the transition date of the critical type and increased from the transition into the critical type to the next day and decreased thereafter. Dyspnea (P<0.001), shortness of breath (P<0.01) and chest distress (P<0.05) were correlated with death and their corresponding coefficient was 0.393, 0.258, 0.214, respectively. ConclusionThe symptoms of COVID-19 patients mainly related to upper respiratory tract infection, cardiopulmonary function, and digestive system. The mild type and the early stage in other types mainly related to upper respiratory tract infection. The cardiopulmonary function and digestive system associated symptoms were found in all other types and stages. Dyspnea was correlated with critical type and dyspnea, shortness of breath, and chest distress were correlated with death. Respiratory dysfunction (or incompleteness) associated symptoms were the characteristic symptoms. The changes of symptoms did not synchronously with the changes of severity before the transition into the severe or critical type.
Subject(s)
COVID-19ABSTRACT
Background The pandemic of coronavirus disease 2019 (COVID-19) has become the first concern in international affairs as the novel coronavirus (SARS-CoV-2) is spreading all over the world at a terrific speed. The accuracy of early diagnosis is critical in the control of the spread of the virus. Although the real-time RT-PCR detection of the virus nucleic acid is the current golden diagnostic standard, it has high false negative rate when only apply single test. Objective Summarize the baseline characteristics and laboratory examination results of hospitalized COVID-19 patients. Analyze the factors that could interfere with the early diagnosis quantitatively to support the timely confirmation of the disease. Methods All suspected patients with COVID-19 were included in our study until Feb 9th, 2020. The last day of follow-up was Mar 20th, 2020. Throat swab real-time RT-PCR test was used to confirm SARS-CoV-2 infection. The difference between the epidemiological profile and first laboratory examination results of COVID-19 patients and non-COVID-19 patients were compared and analyzed by multiple logistic regression. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to assess the potential diagnostic value in factors, which had statistical differences in regression analysis. Results In total, 315 hospitalized patients were included. Among them, 108 were confirmed as COVID-19 patients and 207 were non-COVID-19 patients. Two groups of patients have significance in comparing age, contact history, leukocyte count, lymphocyte count, C-reactive protein, erythrocyte sedimentation rate (p<0.10). Multiple logistic regression analysis showed age, contact history and decreasing lymphocyte count could be used as individual factor that has diagnostic value (p<0.05). The AUC of first RT-PCR test was 0.84 (95% CI 0.73-0.89), AUC of cumulative two times of RT-PCR tests was 0.92 (95% CI 0.88-0.96) and 0.96 (95% CI 0.93-0.99) for cumulative three times of RT-PCR tests. Ninety-six patients showed typical pneumonia radiological features in first CT scan, AUC was 0.74 (95% CI 0.60-0.73). The AUC of patients age, contact history with confirmed people and the decreased lymphocytes were 0.66 (95% CI 0.60-0.73), 0.67 (95% CI 0.61-0.73), 0.62 (95% CI 0.56-0.69), respectively. Taking chest CT scan diagnosis together with patients age and decreasing lymphocytes, AUC would be 0.86 (95% CI 0.82-0.90). The age threshold to predict COVID-19 was 41.5 years, with a diagnostic sensitivity of 0.70 (95% CI 0.61-0.79) and a specificity of 0.59 (95% CI 0.52-0.66). Positive and negative likelihood ratios were 1.71 and 0.50, respectively. Threshold of lymphocyte count to diagnose COVID-19 was 1.53x109/L, with a diagnostic sensitivity of 0.82 (95% CI 0.73-0.88) and a specificity of 0.50 (95% CI 0.43-0.57). Positive and negative likelihood ratios were 1.64 and 0.37, respectively. Conclusion Single RT-PCR test has relatively high false negative rate. When first RT-PCR test show negative result in suspected patients, the chest CT scan, contact history, age and lymphocyte count should be used combinedly to assess the possibility of SARS-CoV-2 infection.
Subject(s)
COVID-19 , PneumoniaABSTRACT
Backgroud: To describe the frequency and distribution characteristics of gastrointestinal symptoms of coronavirus disease 2019 (COVID-19) patients.Methods: As a cohort study, all confirmed COVID-19 patients with gastrointestinal symptoms at Xiangyang No.1 people’s hospital were included until February 21st, 2020. Course of disease no less than 21 days.Gastrointestinal symptoms relevant data were extracted and analyzed. The frequency histograms of the symptoms were plotted. Main symptom characteristics were summarized.Results: Of 50 included patients with gastrointestinal symptoms, 21 were male, 29were female. The mean age was 53 (SD 16) years. Course of disease ranged from 21 to 34 days with a median of 26 days. Among all patients, 16 were critically ill and five died, 12 discharged. Thirty-one clinical symptoms occurred 3168 times in total, 6 gastrointestinal symptoms occurred 439 (13.86%) times and 25 non-gastrointestinal symptoms occurred 2 729(86.14%) times. All symptoms and non-gastrointestinal symptoms distributed in 1 to 34 days, reached peak on 6th day of follow up, first seven days were the fastigium and decreasing in the rest days. Gastrointestinal symptoms mainly distributed in 1 to 34 days, reached a peak of 36 times per day on 6th of follow-up with a fastigium during 6 to 12 day, showed a trend of rise first and then fall. Nausea, vomit and abdominal discomfort occurred 133, 70 and 62 times, respectively.Conclusions: A symptom frequency to time distribution model could describe the disease process quantitatively, indicating the change law of gastrointestinal symptoms and the organ damages in gastrointestinal system, could help us to better understand and treat the new disease. Females showed higher incidence of gastrointestinal symptoms, whether there is a sex difference in susceptibility needs to be further confirmed.Trial regitration: retrospectively registeredAuthors Guoxin Huang and Shengduo Pei contributed equally to this work.
Subject(s)
Coronavirus Infections , Signs and Symptoms, Digestive , Nausea , Vomiting , COVID-19ABSTRACT
Summary Objective To describe the epidemiological and clinical characteristics of the Coronavirus Disease 2019 (COVID-19) hospitalized patients and to offer suggestions to the urgent needs of COVID-19 prevention, diagnosis and treatment. Methods We included 102 confirmed COVID-19 cases hospitalized in Xiangyang No.1 peoples hospital, Hubei, China until Feb 9th, 2020. Demographic data, laboratory findings and chest computed tomographic (CT) images were obtained and analyzed. Findings All cases were confirmed by real-time RT-PCR, including 52 males and 50 females with a mean age of 50.38 years (SD 16.86). Incubation time ranged from one to twenty days with a mean period of 8.09 days (SD 4.99). Fever (86[84.3%] of 102 patients), cough (58[57%]), fatigue (28[27%]), shortness of breath (24[23%]), diarrhea (15[15%]), expectoration (13[12%]), inappetence (11[10%]) were common clinical manifestations. We observed a decreased blood leukocyte count and lymphopenia in 21 (20.6%) and 56 (54.9%) patients, respectively. There were 66 (68%) of 97 patients with elevated C-reactive protein levels and 49 (57.6%) of 85 with increased erythrocytes sedimentation rate. Higher levels of procalcitonin and ferritin were observed in 19 (25.3%) of 75 and 12 (92.3%) of 13 patients, respectively. Eight patients were admitted to intensive care unit (ICU), six developed respiratory failure, three had multiple organ failure and three died. The cumulative positivity rate over three rounds of real-time RT-PCR was 96%. One-hundred patients were found with typical radiological abnormalities in two rounds of chest CT scans, indicating a 98% consistency with real-time RT-PCR results. Interpretation Most COVID-19 patients in Xiangyang were secondary cases without sex difference, and the rate of severe cases and death was low. Middle-to-old-age individuals were more susceptible to the virus infection and the subsequent development of severe/fatal consequences. The average incubation period was longer among our patients. We recommend prolonging the quarantine period to three weeks. Three times real-time RT-PCR plus two times CT scans is a practical clinical diagnosis strategy at present and should be used to increase the accuracy of diagnosis, thereby controlling the source of infection more effectively. Key Words SARS-CoV-2; COVID-19; epidemiological and clinical features; diagnosis