ABSTRACT
Background: Coronavirus Disease 2019 (COVID-19) is currently a global pandemic. Information about the death predicting of severe COVID-19 is not clear. Methods: 151 in-patients from January 23th to March 8th 2020 were divided into severe and critically severe group, as well as survival and death group. The analysis of differences of clinical and imaging data were performed between groups. The logistic regression analysis of factors associated with death in COVID-19 were conducted, and the prediction model of death risk was developed.Results: Many clinical and imaging indices were significantly different between groups, including the age, the epidemic history, the past medical history, the duration of symptoms prior to admission, blood routine, inflammatory related factors, Na+, myocardial zymogram, liver and renal function, coagulation function, fraction of inspired oxygen and complications. The proportion of patients in imaging stage III and comprehensive CT scores was increased significantly in death group. The area under receiver operating characteristic curve of the prediction model was 0.9593.Conclusions: The clinical and imaging data reflect the severity of COVID-19 pneumonia. The prediction model of death risk might be a promising method to help clinicians to quickly identify and screen potential individuals who had a high-risk of death.
Subject(s)
COVID-19 , Pneumonia , DeathABSTRACT
Background: Coronavirus disease 2019 (COVID-19) is a current global pandemic. However, impact of recent influenza A virus infection on the clinical course and outcomes of severe COVID-19 adult inpatients needs to be further explored.Methods: In this retrospective cohort study, severe, laboratory confirmed COVID-19 adult patients from Wuhan Tongji Hospital were included. Data were obtained from electronic medical records and compared between patients with and without recent influenza A virus infection.Results: 200 patients were included, 51.5% with recent influenza A virus infection. Recent influenza A virus infection group presented with longer persistence of cough and sputum from illness onset (35.0 vs. 27.0 days, P = 0.018) and (33.0 vs. 26.0 days, P = 0.015), respectively. Median time of progression to critical illness from illness onset was shorter (day 11.5 vs. day 16.0, P = 0.034). Time to clinical improvement and length of hospital stay were longer in recent infection group (23.0 vs. 19.0 days, P = 0.044) and (22.0 vs. 18.0 days, P = 0.030), respectively.Conclusions: Patients with recent influenza A virus infection showed a delay in time to clinical improvement and increased length of hospital stay. There is a high clinical need to improve the detection of common respiratory pathogens to identify co-infection during the epidemic of COVID-19.
Subject(s)
COVID-19 , Coinfection , Tumor Virus InfectionsABSTRACT
Objectives: Although the respiratory and immune systems are the major targets of SARS-CoV-2, increasing evidence revealed that kidney injury was not rare in coronavirus disease 2019 (COVID-19). However, the incidences of kidney abnormalities were significantly different, from 0.5 to 75.4% in several reports. The association of kidney injury with prognosis remain controversial.Methods:In this retrospective single center cohort study, laboratory confirmedCOVID-19inpatients with severe type were enrolled. Demographic, clinicaland laboratory data were collected. Association ofserum creatinine (SCr)with 28-days mortality in severe COVID-19 patients was analyzed.Results:18.79% (48/304) patients died during the first 28-days of hospitalization.Non-survivors had a significantly higher SCr levels than survivors (109.27μmol/L vs. 69.99μmol/L, P <0.001). The 28-days mortality in high SCr group (>76μmol/L) was significantly higher than that in low SCr group (31.7% vs. 7.5%, P <0.001). Multivariate logistic regression revealed that the independent risk factors of 28-days outcome included age(OR: 2.95, 95%CI: 1.08-8.05), WBC (OR: 6.09, 95%CI: 2.27-6.39), lymphopenia (OR: 3.49, 95%CI: 1.55-7.92), IL-6 (OR: 4.44, 95%CI: 1.64-11.99) and SCr (OR: 2.69, 95%CI: 1.18-6.11). Kaplan-Meier analysis demonstrated the survival disadvantage in patients with high SCr levels (>76μmol/L). ROC curve showed the SCr cut-off value for predicting 28-days death was 77.5 μmol/L, with the sensitivity of 68.8% and speciality of 74.1%.Conclusion: SCr was associated with poor prognosis and might be an independent risk factor for in-hospital death. The cut-off value of SCr for prognosis prediction was 77.5 μmol/L, with the sensitivity of 68.8% and speciality of 74.1%.
Subject(s)
COVID-19 , Kidney Diseases , LymphopeniaABSTRACT
Background:The 2019 novel coronavirus disease (COVID-19) spread in many countries.Data about viral shedding duration, particularly the prolonged ones of the pathogen SARS-Coronavirus-2 (SARS-CoV-2) is scarce. The longest viral RNA sheddingduration reported previously was 37 days. Herein, we report the clinical and immunologic features ofrecovered COVID-19cases with a medium viral RNA shedding duration of 44 days. Cases presentation: Nine laboratory-confirmed COVID-19 cases from Wuhan with viral RNA shedding duration more than 30 days were included in our study,5 of them were moderate.Althoughinflammatory markers were significantlyhigher, the medium duration in severepatients was similar to that in moderate patients (44.5days vs. 43.6days). Severepatients showed higher NK cells levels, although the T cells and B cells were lower as compared with moderate patients. Contrary to previous reports in influenza, prolonged viralshedding time did not cause poor prognosis in this study.Conclusions: There could be characteristic immunological dysfunction in COVID-19 patients with prolonged viral shedding durationand interestingly, prolonged viral shedding duration seemed not to be related with poor prognosis.