The Effect of Work Engagement and Perceived Organizational Support on Turnover Intention among Nurses: A Meta-Analysis Based on the Price–Mueller Model

Aim. To elaborate on the relationship between work engagement, perceived organizational support, and the turnover intention of nurses by analysing some potential moderators. Background. Nurses' turnover intention is negatively impacted by their level of work engagement and perceptions of organizational support. However, it is challenging to reach a consistent conclusion. Methods. Data were acquired from six electronic databases. Each study was evaluated using the quality assessment tool for cross-sectional studies of the Agency for Healthcare Research and Quality (AHRQ). STATA 15.0 was used to analyse the data, and a random effects model was used. The groups that included two or more studies were added to the moderator analysis. Results. A total of 40 study articles involving 23,451 participants were included. The turnover intention of nurses was inversely associated with work engagement (coefficient: −0.42) and perceived organizational support (coefficient: −0.32). A substantial moderating role was played by cultural background, economic status, working years, and investigation time (P<0.05). Conclusion. Work engagement and organizational support significantly reduced turnover intention among nurses. Considering the acute shortage of nurses worldwide, nurses with lower wages, fewer working years, and lower levels of work engagement should be given more attention and support from their organizations. Implications for Nursing Management. The meta-analysis suggested that managers should give their employees a more organizational support and promote their work engagement to motivate nurses' retention intention and maintain a stable workforce with little employee turnover.

Individual bat viromes reveal the co-infection, spillover and emergence risk of potential zoonotic viruses (preprint)

Bats are reservoir hosts for many zoonotic viruses. Despite this, relatively little is known about the diversity and abundance of viruses within bats at the level of individual animals, and hence the frequency of virus co-infection and inter-species transmission. Using an unbiased meta-transcriptomics approach we characterised the mammalian associated viruses present in 149 individual bats sampled from Yunnan province, China. This revealed a high frequency of virus co-infection and species spillover among the animals studied, with 12 viruses shared among different bat species, which in turn facilitates virus recombination and reassortment. Of note, we identified five viral species that are likely to be pathogenic to humans or livestock, including a novel recombinant SARS-like coronavirus that is closely related to both SARS-CoV-2 and SARS-CoV, with only five amino acid differences between its receptor-binding domain sequence and that of the earliest sequences of SARS-CoV-2. Functional analysis predicts that this recombinant coronavirus can utilize the human ACE2 receptor such that it is likely to be of high zoonotic risk. Our study highlights the common occurrence of inter-species transmission and co-infection of bat viruses, as well as their implications for virus emergence.

Comparison of Global and Regional Compliance-Guided Positive End-Expiratory Pressure Titration on Regional Lung Ventilation in Moderate-to-Severe Pediatric Acute Respiratory Distress Syndrome

Purpose To investigate the difference in the positive end-expiratory pressure (PEEP) selected with chest electrical impedance tomography (EIT) and with global dynamic respiratory system compliance (Crs) in moderate-to-severe pediatric acute respiratory distress syndrome (pARDS). Methods Patients with moderate-to-severe pARDS (PaO2/FiO2 < 200 mmHg) were retrospectively included. On the day of pARDS diagnosis, two PEEP levels were determined during the decremental PEEP titration for each individual using the best compliance (PEEPC) and EIT-based regional compliance (PEEPEIT) methods. The differences of global and regional compliance (for both gravity-dependent and non-dependent regions) under the two PEEP conditions were compared. In addition, the EIT-based global inhomogeneity index (GI), the center of ventilation (CoV), and standard deviation of regional delayed ventilation (RVDSD) were also calculated and compared. Results A total of 12 children with pARDS (5 with severe and 7 with moderate pARDS) were included. PEEPC and PEEPEIT were identical in 6 patients. In others, the differences were only ± 2 cm H2O (one PEEP step). There were no statistical differences in global compliance at PEEPC and PEEPEIT [28.7 (2.84–33.15) vs. 29.74 (2.84–33.47) ml/cm H2O median (IQR), p = 0.028 (the significant level after adjusted for multiple comparison was 0.017)]. Furthermore, no differences were found in regional compliances and other EIT-based parameters measuring spatial and temporal ventilation distributions. Conclusion Although EIT provided information on ventilation distribution, PEEP selected with the best Crs might be non-inferior to EIT-guided regional ventilation in moderate-to-severe pARDS. Further study with a large sample size is required to confirm the finding.

Artificial Intelligence-Empowered Chatbot for Effective COVID-19 Information Delivery to Older Adults

The coronavirus disease 2019 (COVID-19) epidemic poses a threat to the everyday life of people worldwide and brings challenges to the global health system. During this outbreak, it is critical to find creative ways to extend the reach of informatics into every person in society. Although there are many websites and mobile applications for this purpose, they are insufficient in reaching vulnerable populations like older adults who are not familiar with using new technologies to access information. In this paper, we propose an AI-enabled chatbot assistant that delivers real-time, useful, context-aware, and personalized information about COVID-19 to users, especially older adults. To use the assistant, a user simply speaks to it through a mobile phone or a smart speaker. This natural and interactive interface does not require the user to have any technical background. The virtual assistant was evaluated in the lab environment through various types of use cases. Preliminary qualitative test results demonstrate a reasonable precision and recall rate.

COVID-19, Urban Transportation, and Air Pollution (preprint)

Urban air pollution has severe negative effects on health and the economy, especially in developing and industrializing countries, such as China and India. Although the transportation sector is widely acknowledged as among the largest contributors to urban air pollution, quantifying its causal effects on air pollution is challenging, as decisions to travel are endogenous with air quality. The spread of COVID-19 offers a unique opportunity for causal identification, as the pandemic directly affects decisions to travel but has little direct effect on air pollution. Leveraging the number of COVID-19 infections and COVID-19-related queries to online search engines as instruments for decisions to travel, controlling for two-way fixed effects, we quantify the effects of three public transportation subsectors (buses, railways, and taxis) and private vehicles on six primary air pollutants (CO, NO2, O3, PM2.5, PM10, and SO2) of 36 central cities of China, using two-stage ridge regression and double/debiased machine-learning models. Our work demonstrates that the negative effects of urban transportation on air quality are likely to be significantly underestimated without addressing endogeneity in the observational data. Further, our estimates after addressing endogeneity indicate that the effects of public transportation and private vehicles on different air pollutants are heterogeneous. Notably, our work shows that air pollution shifts the demand from mass transportation (buses and railways) to taxis. These findings have implications for sustainable transportation planning, operation, and policy evaluation.

Quantatitive Analysis of Conserved Sites on the SARS-CoV-2 Receptor-Binding Domain to Promote Development of Universal SARS-Like Coronavirus Vaccines (preprint)

Although vaccines have been successfully developed and approved against SARS-CoV-2, it is still valuable to perform studies on conserved antigenic sites for preventing possible pandemic-risk of other SARS-like coronavirus in the future and prevalent SARS-CoV-2 variants. By antibodies obtained from convalescent COVID-19 individuals, receptor binding domain (RBD) were identified as immunodominant neutralizing domain that efficiently elicits neutralizing antibody response with on-going affinity mature. Moreover, we succeeded to define a quantitative antigenic map of neutralizing sites within SARS-CoV-2 RBD, and found that sites S2, S3 and S4 (new-found site) are conserved sites and determined as subimmunodominant sites, putatively due to their less accessibility than SARS-CoV-2 unique sites. P10-6G3, P07-4D10 and P05-6H7, respectively targeting S2, S3 and S4, are relatively rare antibodies that also potently neutralizes SARS-CoV, and the last mAbs performing neutralization without blocking S protein binding to receptor. Further, we have tried to design some RBDs to improve the immunogenicity of conserved sites. Our studies, focusing on conserved antigenic sites of SARS-CoV-2 and SARS-CoV, provide insights for promoting development of universal SARS-like coronavirus vaccines therefore enhancing our pandemic preparedness.

Production of SARS-CoV-2 virus-like particles in insect cells (preprint)

Coronavirus disease (COVID-19) causes a serious threat to human health. To production of SARS-COV-2 virus-like particles (VLPs) in insect cells for vaccine development and scientific research. The E, M and S genes were cloned into multiple cloning sites of the new triple expression plasmid with one p10 promoter, two pPH promoters and three multiple cloning sites. The plasmid was transformed into DH10 BacTM Escherichia coli competent cells to obtain recombinant bacmid. Then the recombinant bacmid was transfected in ExpiSf9 insect cells to generate recombinant baculovirus. After ExpiSf9 infected with the recombinant baculovirus, the E, M, and S protein co-expressed in insect cells. Finally, SARS-CoV-2 VLPs were self-assembled in insect cells after infection. The morphology and the size of SARS-CoV-2 VLPs are similar to the native virions.

Short-term effects of COVID-19 on risk of traumatic fractures in China: a multi-city study (preprint)

Introduction: Traumatic injury is a leading cause of death and disability worldwide, and fifth most common of in China. Along with the outbreak of COVID-19, strict control measures to restrict people’s movement have been conducted in China. Subsequently, the injury mechanisms and pattern of traumatic fractures changed significantly. This study aimed to investigate the associations between COVID-19 and fracture risk, and provide a targeted reference for the world through China’s experience.Methods: This was a retrospective study of a nationally representative sample of COVID-19 prevalence areas using stratified random sampling. The data of traumatic fracture sustaining patients, including age and sex, fractured sites, mechanism of injury, and concurrent fractures in selected hospitals, were collected from 10 January and 10 July, 2020. The epidemiologic characteristics of traumatic fractures and the associations between COVID-19 and fracture risk were explored using the descriptive epidemiological methods and distribution lag nonlinear model.Results: A total of 67,249 (52.3% males) patients (average age 49.4±19.4 years) with 68,989 fractures were included. The highest proportion of fractures were sustained to the tibia and fibula (14.9%), followed by the femur (13.6%), and ulna and radius (12.5%). Low-energy fractures accounted for 23.3%. With the increase of newly confirmed COVID-19 cases, fracture risk decreased for children, young and middle-aged adults, elderly men, high-energy fracture, and for residents in low and middle-prevalence areas.Conclusion: Fracture risk decreased sharply in all residents except elderly women, low-energy fractures, and in high-prevalence areas when newly confirmed COVID-19 cases increased in China. Primary (home) prevention measures are emphasized to prevent traumatic fractures during the COVID-19 pandemic.

Association of Serum Uric Acid Levels with COVID-19 Severity (preprint)

Aims: Hyperuricemia has attracted increasing attention, however, limited attention has been paid to the potential dangers of lowering serum uric acid (SUA). We observed lower levels of SUA in COVID-19 patients. Therefore, we aim to explore the SUA levels in COVID-19 patients and the relationship between SUA and the severity of COVID-19. Methods: A case-control study based on 91 cases with COVID-19 and 1:3 age- and sex-matched healthy control subjects (N=273) were included. We firstly compared the SUA levels and the uric acid/creatinine (UA/Cr) ratio between COVID-19 patients and the healthy controls. Then, we examined the association of the SUA levels and UA/Cr ratios with COVID-19 severity defined according to the fifth edition of China’s Diagnosis and Treatment Guidelines of COVID-19. Results: SUA levels at admission were 2.59% lower, UA/Cr ratios 6.06% lower in COVID-19 patients compared to controls. In sex stratified analysis, SUA and UA/Cr were lower in male COVID-19 patients while only SUA was lower in female COVID-19 patient. Moreover, SUA and UA/Cr values were 4.27% and 8.23% lower in the severe group than in the moderate group among male COVID patients. A multiple linear regression analysis showed that SARS-CoV-2 infection and male sex were independent factors associated with lower SUA levels. COVID-19 male patients with low SUA levels at had higher risk of developing severe symptoms than those with high SUA levels (incidence rate ratio: 4.05; 95% CI:1.11，14.72) at admission. After completion of the first follow-up of the COVID-19 patients within 1-3 weeks after discharge, we found that male patients experienced severe symptoms had significantly lower SUA and UA/Cr ratio levels comparing to moderate patients but no significant difference between different time points. In females, female patients have both SUA and UA/Cr ratio levels lower at discharge than that at admission, however these differences disappear at follow-up exam.Conclusion: COVID-19 patients had SUA and UA/Cr values lower than normal at admission. Male COVID-19 patients with low SUA levels had a significantly higher risk of developing severe symptoms than those with high SUA levels. During the aggravation course of the disease, the level of SUA gradually decreased until discharge. At follow-up exam, the level of SUA is similar to the levels at admission.

Association of serum uric acid levels with COVID-19 severity (preprint)

Aims: Hyperuricemia has attracted increasing attention, however, limited attention has been paid to the potential dangers of lowering serum uric acid (SUA). We observed lower levels of SUA in COVID-19 patients. Therefore, we aim to explore the SUA levels in COVID-19 patients and the relationship between SUA and the severity of COVID-19.Methods: A case-control study based on 91 cases with COVID-19 and 1:3 age- and sex-matched healthy control subjects (N = 273) were included. We firstly compared the SUA levels and the uric acid/creatinine (UA/Cr) ratio between COVID-19 patients and the healthy controls. Then, we examined the association of the SUA levels and UA/Cr ratios with COVID-19 severity defined according to the fifth edition of China’s Diagnosis and Treatment Guidelines of COVID-19.Results: SUA levels at admission were 2.59% lower, UA/Cr ratios 6.06% lower in COVID-19 patients compared to controls. In sex stratified analysis, SUA and UA/Cr were lower in male COVID-19 patients while only SUA was lower in female COVID-19 patient. Moreover, SUA and UA/Cr values were 4.27% and 8.23% lower in the severe group than in the moderate group among male COVID patients. A multiple linear regression analysis showed that SARS-CoV-2 infection and male sex were independent factors associated with lower SUA levels. COVID-19 male patients with low SUA levels at had higher risk of developing severe symptoms than those with high SUA levels (incidence rate ratio: 4.05; 95% CI:1.11,14.72) at admission. After completion of the first follow-up of the COVID-19 patients within 1–3 weeks after discharge, we found that male patients experienced severe symptoms had significantly lower SUA and UA/Cr ratio levels comparing to moderate patients but no significant difference between different time points. In females, female patients have both SUA and UA/Cr ratio levels lower at discharge than that at admission, however these differences disappear at follow-up exam.Conclusion: COVID-19 patients had SUA and UA/Cr values lower than normal at admission. Male COVID-19 patients with low SUA levels had a significantly higher risk of developing severe symptoms than those with high SUA levels. During the aggravation course of the disease, the level of SUA gradually decreased until discharge. At follow-up exam, the level of SUA is similar to the levels at admission.

THE EFFECT OF ACUTE STRESS RESPONSE ON PROFESSIONAL IDENTITY AND SELF-EFFICACY OF NURSING STUDENTS IN CHINA DURING COVID-19 OUTBREAK：A CROSS-SECTIONAL STUDY

Background: During the rapidly evolving situation of COVID-19, the external environment and job stress may influence the professional identity and self-efficacy of nursing students. An assessment of professional identity, self-efficacy, and acute stress reponse of nursing students during the coronavirus outbreak, as well as the effect of acute stress response on them is necessary and badly needed. Objective: To evaluate the nursing students’ professional identity, self-efficacy, and acute stress response during the COVID-19 outbreak, and to investigate the effect of acute stress response on nursing students’ professional identity and self-efficacy. Design, settings, and participants: Assessment of professional identity, self-efficacy and acute stress response were designed for this cross-sectional study. A total of 2024 nursing students from Shanxi Medical University completed the questionnaire used in this study. Methods: The online questionnaire, including personal characteristics, professional identity questionnaire of nursing students (PIQNS), generalized self-efficacy scale (GSES) and Stanford acute stress response scale questionnaire (SASRQ), was utilized for the measurement. Results: The total score of and sub-scales’ score of professional identity of nursing students significantly increased after the COVID-19 outbreak (p<0.001). Additionally, self-efficacy had a positive effect on professional identity (p<0.001) while acute stress response had a negative effect on professional identity and self-efficacy, respectively (p<0.001). Conclusion: The results of this study provide insights into the effect of acute stress response on professional identity and self-efficacy of nursing students during COVID-19 outbreak in China. Nursing education must be oriented to help strength the professional identity of nursing students from this emergence

A Cross-Sectional Survey of Knowledge, Attitude and Practice Associated with COVID-19 among Undergraduate Students in China (preprint)

Background: The COVID-19 pandemic has become a great threat to public health, which has greatly impacted the study and life of undergraduate students in China. Objective: This study aims to perform a survey of their knowledge, attitude and practice (KAP) associated with COVID-19. Methods: A cross-sectional survey was designed to gather information regarding the COVID-19 related KAP among undergraduates during the home isolation in the outbreak. Subjects were recruited from 10 universities in Shaanxi Province, China. Enrollees voluntarily submitted their answers to a pre-designed questionnaire online. Results: A total of 872 subjects (female, 534; male, 338) were enrolled with ages from 17 to 25 years old. This cohort included 430 medical and 442 non-medical students, 580 freshmen and 292 higher school year students. There were 453 from public schools and 442 from private school, residing in 28 regions and provinces at the time of study. Results showed that appropriate knowledge was acquired by 82.34% subjects; the levels were significantly higher in undergraduates from public universities and medical majors than those from private schools and non-medical majors (p＜0.05). 73.81% subjects reported positive attitudes; females showed significantly higher levels of positive attitudes than males (p＜0.05). Proactive practice was found in 87.94% subjects. Using a common scoring method, the overall scores for Knowledge, Attitude and Practice were 4.12±0.749 (range: 0~5), 8.54±1.201 (range: 0~10), and 8.91±1.431 (range: 0~10), respectively. There was a positive correlation between attitude and practice (r=0.319, p<0.05) in the whole study group. Total KAP score was 21.57±2.291 (range: 0~25), which was significantly different among gender groups and major groups. Conclusions: Most undergraduates acquired necessary knowledge, positive attitude and proactive practice in response to COVID-19 outbreak; but their KAP scores significantly varied by gender, major and school types.

Virus-free and live-cell visualizing SARS-CoV-2 cell entry for studies of neutralizing antibodies and compound inhibitors (preprint)

The ongoing COVID-19 pandemic, caused by SARS-CoV-2 infection, has resulted in hundreds of thousands of deaths. Cellular entry of SARS-CoV-2, which is mediated by the viral spike protein and host ACE2 receptor, is an essential target for the development of vaccines, therapeutic antibodies, and drugs. Using a mammalian cell expression system, we generated a recombinant fluorescent protein (Gamillus)-fused SARS-CoV-2 spike trimer (STG) to probe the viral entry process. In ACE2-expressing cells, we found that the STG probe has excellent performance in the live-cell visualization of receptor binding, cellular uptake, and intracellular trafficking of SARS-CoV-2 under virus-free conditions. The new system allows quantitative analyses of the inhibition potentials and detailed influence of COVID-19-convalescent human plasmas, neutralizing antibodies and compounds, providing a versatile tool for high-throughput screening and phenotypic characterization of SARS-CoV-2 entry inhibitors. This approach may also be adapted to develop a viral entry visualization system for other viruses.

The prevalence of antibodies to SARS-CoV-2 among blood donors in China (preprint)

Objectives The prevalence of antibodies to SARS-CoV-2 among blood donors in China remains unknown. To reveal the missing information, we investigated the seroprevalence of SARS-CoV-2 antibodies among blood donors in the cities of Wuhan, Shenzhen, and Shijiazhuang of China. Design Cross-sectional study Setting Three blood centers, located in the central, south and north China, respectively, recruiting from January to April 2020. Participants 38,144 healthy blood donors donated in Wuhan, Shenzhen and Shijiazhuang were enrolled, who were all met the criteria for blood donation during the COVID-19 pandemic in China. Main outcome measures Specific antibodies against SARS-CoV-2 including total antibody (TAb), IgG antibody against receptor-binding domain of spike protein (IgG-RBD) and nucleoprotein (IgG-N), and IgM. Pseudotype lentivirus-based neutralization test was performed on all TAb-positive samples. In addition, anonymous personal demographic information, including gender, age, ethnicity, occupation and educational level, and blood type were collected. Results A total of 519 samples from 410 donors were confirmed by neutralization tests. The SARS-CoV-2 seroprevalence among blood donors was 2.29% (407/17,794, 95%CI: 2.08% to 2.52%) in Wuhan, 0.029% (2/6,810, 95%CI: 0.0081% to 0.11%) in Shenzhen, and 0.0074% (1/13,540, 95%CI: 0.0013% to 0.042%) in Shijiazhuang, respectively. The earliest emergence of SARS-CoV-2 seropositivity in blood donors was identified on January 20, 2020 in Wuhan. The weekly prevalence of SARS-CoV-2 antibodies in Wuhan's blood donors changed dynamically and were 0.08% (95%CI: 0.02% to 0.28%) during January 15 to 22 (before city lockdown), 3.08% (95%CI: 2.67% to 3.55%) during January 23 to April 7 (city quarantine period) and 2.33% (95%CI: 2.06% to 2.63%) during April 8 to 30 (after lockdown easing). Female and older-age were identified to be independent risk factors for SARS-CoV-2 seropositivity among donors in Wuhan. Conclusions The prevalence of antibodies to SARS-CoV-2 among blood donors in China was low, even in Wuhan city. According to our data, the earliest emergence of SARS-CoV-2 in Wuhan's donors should not earlier than January, 2020. As most of the population of China remained uninfected during the early wave of COVID-19 pandemic, effective public health measures are still certainly required to block viral spread before a vaccine is widely available.

Safety, Tolerability and Immunogenicity of a Recombinant Adenovirus Type 5 Vectored COVID-19 Vaccine in Healthy Adults in China: Preliminary Report of a First-In Human Single-Center, Open-Label, Dose-Escalating Clinical Trial (preprint)

Background: We aimed to assess the safety, tolerability and immunogenicity of a recombinant adenovirus type 5 (Ad5) vectored COVID-19 vaccine expressing the spike glycoprotein of a SARS-Cov-2 strain. This is the first-in-human study of a candidate vaccine against COVID-19.Methods: We conducted a single-center, open-label, dose-escalating clinical trial of Ad5 vectored COVID-19 vaccine. Healthy adults aged between 18-60 years were sequentially enrolled and allocated to receive a single intramuscular injection in one of three dose groups: 5 × 10^10, 1×10^11, and 1·5×10^11 viral particles. Safety was assessed over the next 28 days. Specific antibodies were measured on enzyme-linked immunosorbent assay (ELISA), and the neutralizing antibody responses induced by vaccination were detected by using SARS-CoV-2 virus neutralization and pseudovirus neutralization tests. T-cell responses were accessed by enzyme-linked immunospot (ELISpot) and flow-cytometry assays. Results: A total of 108 participants were recruited and received low dose, middle dose, or high dose vaccine, with 36 in each dose group. 30(83·3%), 30(83·3%), and 27(75·0%) recipients in the low dose, middle dose, and high dose groups reported at least one adverse reaction within the first 7 days after the vaccination. The most common injection-site adverse reaction was pain, the most commonly reported systematic adverse reactions were fever, fatigue, headache, and muscle pain. A majority of the adverse reactions that were reported in all dose groups were mild or moderate in severity. No serious adverse event was noted within 28 days post-vaccination. Both ELISA antibodies and neutralizing antibodies increased significantly at day 14, and peaked 28 days post-vaccination. Specific T cell response peaked at day 14 post-vaccination.Conclusions: The Ad5 vectored COVID-19 vaccine is tolerable and immunogenic. Humoral responses against SARS-CoV-2 peaked at day 28 post-vaccination in health adults, and rapid specific T cell responses were noted since day 14.Trial Registration: The study is registered with ClinicalTrials.gov, number NCT04313127. Funding Statement: National Key R&D Program of China (2020YFC10841400), National Science and Technology Major Project (2016ZX10004001, 2018ZX09201005), and CanSino Biotechnology Inc.Declaration of Interests: Mr. Gou report being employees of Tianjin CanSino Biotechnology Inc, No other potential conflict of interest relevant to this article was reported.Ethics Approval Statement: The protocol and informed consent were approved by the Institutional Review Board of the Jiangsu Provincial Center of Disease Control and Prevention. Written informed consents from all participants were obtained before screening. This study was undertaken by Jiangsu Provincial Center of Disease Control and Prevention, Hubei Provincial Center for Disease Control and Prevention and Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology in accordance with the Declaration of Helsinki and Good Clinical Practice.

No Clear Benefit to the Use of Corticosteroid as Treatment in Adult Patients with Coronavirus Disease 2019 : A Retrospective Cohort Study (preprint)

Background Coronavirus disease 2019 (COVID-19) is becoming an increasing global health issue which has spread across the globe. We aimed to study the effect of corticosteroids in the treatment of adult inpatients with COVID-19. Methods A retrospective cohort of 115 consecutive adult COVID-19 patients admitted to The Third Peoples Hospital of Hubei Province between Jan 18, 2020, and Feb 28, 2020 was analysed to study the effectiveness of corticosteroid. They were categorized according to whether or not corticosteroid therapy was given, and compared in terms of demographic characteristics, clinical features, laboratory indicators and clinical outcomes. The primary endpoint was defined as either mortality or intensive care unit (ICU) admission. Known adverse prognostic factors were used as covariates in multiple logistic regressions to adjust for their confounding effects on outcomes. Results Among 115 patients, 73 patients (63.5%) received corticosteroid. The levels of age, C-reactive protein, D-dimer and albumin were similar in both groups. The corticosteroid group had more adverse outcomes (32.9% vs. 11.9%) and statistically significant differences were observed (p=0.013). In multivariate analysis, corticosteroid treatment was associated with a 2.155-fold increase in risk of either mortality or ICU admission, although not statistically significant. Conclusion No evidence suggests that adult patients with COVID-19 will benefit from corticosteroids, and they might be more likely to be harmed with such treatment.

Clinical features in mild type and severe type of COVID-19 patients (preprint)

Background Coronavirus Disease 2019 (COVID-19) outbroke in Wuhan and spread to the world quickly. We aim to describe the clinical features and compare them between mild type and severe type of COVID-19 patients.Methods Laboratory confirmed COVID-19 patients were included in this study. Patients’ demographic data and clinical data were recorded and compared between mild type and severe type.Results Fifteen patients were confirmed COVID-19 and enrolled in this study. Six patients were of mild type, while 9 patients were of severe type. Statistical differences were found between mild type and severe type patients in retirement, epidemiological history, baseline blood level of lactate dehydrogenase and Oxygenation Index (All p < 0.05). All patients had ground-glass opacities without consolidation in initial chest computed tomography images, 2 (16.7%) patients had pulmonary nodules. There were no statistical differences between mild type and severe type patients in initial chest CT findings (All p > 0.05).Conclusions Differences can be found in baseline clinical features between mild type and severe type of COVID-19 patients to help health care providers making early judgement to the severity and proper treatment.Trial registration: The study was registered in ClinicalTrials.gov, NCT04279782. Registered 20 February 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04279782?term=NCT04279782&draw=2&rank=1

Analysis of factors associated early diagnosis in coronavirus disease 2019 (COVID-19) (preprint)

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.