Characteristics of patients with kidney injury associated with COVID-19.

To explore the characteristics of COVID-19 infection related kidney injury, we retrospectively collected cases of COVID-19 patients with definite clinical outcomes (discharge or death) and relevant laboratory results from Jan 3 to Mar 30, 2020 in Tongji hospital, Wuhan, China. 1509 patients were included, 1393 cases with normal baseline serum creatinine, and 116 cases with elevated baseline serum creatinine (EBSC). On admission, the prevalence of elevated serum creatinine, elevated blood urea nitrogen (BUN) and estimated glomerular filtration (eGFR) under 60 ml/min/1.73 m2 were 7.7%, 6.6% and 7.2%, respectively. The incidence of in-hospital death in the patients with EBSC was 7.8%, which was significantly higher than those with normal serum creatinine (1.2%). Inflammatory, immunological, and organ damage indices were relatively higher in the EBSC group, in which lymphocytes, albumin, and hemoglobin were significantly lower. Kaplan-Meier analysis revealed age above 65 years, males, comorbidities (especially for cardiovascular disease and tumor patients), lymphocyte count < 1.5 × 109/L, leukocyte count > 10 × 109/L, EBSC, eGFR < 60 ml/min/1.73 m2 were associated with in-hospital death. Multivariate Cox proportional hazard regression confirmed that EBSC (HR: 2.643, 95% CI: 1.111-6.285, P = 0.028), eGFR < 60 ml/min/1.73 m2 (HR: 3.889, 95% CI: 1.634-9.257, P = 0.002), were independent risk factors after adjusting for age, sex, any comorbidity, leukocyte and lymphocyte count. Therefore, the prevalence of kidney injury in patients with COVID-19 was high and associated with in-hospital mortality. Early detection and effective intervention of kidney injury may reduce COVID-19 deaths.

Clinical characteristics of confirmed and clinically diagnosed patients with 2019 novel coronavirus pneumonia: a single-center, retrospective, case-control study.

BACKGROUND: Novel coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by SARS-CoV-2. At the peak of the outbreak in Wuhan (January and February), there are two types of COVID-19 patients: laboratory confirmation and clinical diagnosis. This study aims to compare and analyze the clinical outcomes and characteristics of confirmed and clinically diagnosed COVID-19 patients to determine whether they are of the same type and require equal treatment. More importantly, the prognostic factors of COVID-19 patients are explored. METHODS: A total of 194 hospitalized patients with COVID-19 pneumonia were retrospectively studied. Demographic data, clinical characteristcs, laboratory results and prognostic information were collected by electronic medical record system and analyzed. RESULTS: Among 194 subjects included, 173 were confirmed and 21 were clinically diagnosed. There were no significant differences in clinical outcomes (mortality rate 39[22.54%] vs 7[33.33%], P = 0.272) and hospital stay (19.00 vs 16.90 days, P = 0.411) between the confirmed and clinically diagnosed group, and prognostic factors were similar between them. Older age, lower albumin levels, higher serum Lactate dehydrogenase (LDH) levels, higher D-D levels, longer prothrombin time (PT), higher IL-6 levels, lower T cells indicated poor prognosis in patients with COVID-19 pneumonia. NK cell has the highest AUC among all measured indicators (NK AUC = 0.926, P < 0.001). CONCLUSION: Laboratory-confirmed and clinically diagnosed COVID-19 patients are similar in clinical outcomes and most clinical characteristics. They are of the same type and require equal treatment. Age, AST, LDH, BUN, PT, D-D, IL6, white blood cell and neutrophil counts, T cell and T cell subset counts can efficiently predict clinical outcomes.

ANTECEDENTES: El nuevo coronavirus 2019 (COVID-19) es una nueva enfermedad infecciosa causada por el virus SARS-CoV-2. Durante el pico del brote en Wuhan (enero y febrero 2020), se detectaron dos tipos de pacientes portadores del COVID-19: pacientes confirmados a través de pruebas de laboratorio y pacientes confirmados por diagnóstico clínico. El objetivo de este estudio es comparar y analizar los resultados clínicos y las características de los pacientes con COVID-19 confirmados y clínicamente diagnosticados para determinar si son del mismo tipo y si necesitan el mismo tratamiento. El estudio es importante también para explorar los factores pronósticos de los pacientes con COVID-19. MÉTODOS: Un total de 194 pacientes hospitalizados con neumonía COVID-19 fueron estudiados retrospectivamente. Se utilizó un sistema de registro médico electrónico para recopilar los datos demográficos, las características clínicas, los resultados de laboratorio y la información pronóstica, para luego ser analizada. RESULTADOS: De los 194 pacientes incluidos, 173 dieron positivo y 21 fueron diagnosticados clínicamente. No se presentaron diferencias significativas en los resultados clínicos (tasa de mortalidad 39 [22,54%] vs. 7 [33,33%], p = 0,272) y la estancia hospitalaria (19,00 vs. 16,90 días, p = 0,411) entre el grupo de confirmados y el grupo diagnosticado clínicamente, y los factores pronósticos fueron similares entre ellos. Edad avanzada, niveles más bajos de albúmina, niveles más altos de lactato deshidrogenasa (LDH) en suero, niveles más altos de D-D, mayor tiempo de protrombina (PT), altos niveles de IL-6, células T más bajas indicaban mal pronóstico en pacientes con neumonía por COVID-19. La célula NK tiene el AUC más alto entre todos los indicadores medidos (NK AUC = 0,926, p < 0,001). CONCLUSIÓN: Los grupos de pacientes COVID-19 confirmados en laboratorio y diagnosticados clínicamente arrojan resultados clínicos similares y tienen la mayoría de las características clínicas. Son del mismo tipo y requieren el mismo tratamiento. La edad, AST, LDH, BUN, PT, D-D, IL6, los recuentos de glóbulos blancos y neutrófilos, recuentos de subgrupos de células T y células T pueden predecir los resultados clínicos de forma eficaz.

Effectiveness of Arbidol for COVID-19 Prevention in Health Professionals.

Background: Frontline health professionals are a COVID-19-susceptible population during the outbreak of COVID-19, but prophylactic drugs against SARS-CoV-2 infection are to be explored. Method: Frontline health professionals diagnosed with COVID-19 before February 9, 2020 in Tongji Hospital, Wuhan, China and the same amount of controls in the uninfected group were included in this study. Clinical and laboratory data were collected with standardized forms. Results: A total of 164 subjects were included in this study, 82 cases in the infected group and 82 controls in the uninfected group, with a median age of 37 years, including 63 males and 101 females. Nineteen (23.2%) patients in the infected group were administered oral arbidol, and 48 (58.5%) in the uninfected group (OR = 0.214, 95% CI 0.109-0.420). The cumulative uninfected rate of health professionals in the arbidol group was significantly higher than that of individuals in the non-arbidol group (log-rank test, χ2 = 98.74; P < 0.001). Forty-eight patients (58.5%) in the infection group were hospitalized, with a median age of 39 (31-49) years, of whom 7 (14.6%) were prophylactically administered arbidol. Thirty-four patients (41.5%) with mild symptoms were treated outside the hospital, among which the median age was 34 (30-39) years, and twelve patients (35.3%) took prophylactic oral arbidol. The hospitalization rate was significantly associated with age (P = 0.024) and oral arbidol administration (OR = 0.313, 95% CI 0.108-0.909). In the age-matched case-control study, the hospitalization rate was not significantly associated with arbidol administration (P = 0.091). Conclusion: Prophylactic oral arbidol was associated with a lower incidence of SARS-CoV-2 infection but not hospitalization rate in health professionals, providing a basis for the selection of prophylactic drugs for high-risk populations.

2019 Novel coronavirus disease (COVID-19) in hemodialysis patients: A report of two cases.

OBJECTIVE: To analyze the diagnosis and treatment of patients with chronic renal failure complicated with novel coronavirus pneumonia, and to evaluate the effect of blood purification technology on the treatment and prognosis of such patients. METHODS: Two COVID-19 cases undergoing hemodialysis with chronic renal failure were retrospectively analysed in our hospital. RESULTS: Two COVID-19 patients were admitted to hospital due to cough, with or without fever. Laboratory tests showed decreased lymphocyte count, elevated PCT, IL-10, IL-6, TNF-α, IL-2R, high-sensitivity cardiac troponin I, NT-proBNP, creatinine, and urea nitrogen. Chest CT scan showed multiple blurred plaques and patchy shadows in both patients. Two patients received continuous venovenous hemodiafiltration (CVVHDF) every other day for 4-6 h everytime, in addition to the standard treatment. After CVVHDF, not only cytokines were reduced, but also liver function and cardiac function significantly improved. Both patients did not develop severe pneumonia. They were discharged on March 1, 2020 when meeting the discharge criteria. CONCLUSION: Two COVID-19 patients on maintenance hemodialysis discharged after a month of hospitalization. The removal of cytokines through blood purification technology may be beneficial for the recovery of COVID-19 patients.