Risk stratification of patients with acute respiratory distress syndrome complicated with sepsis using lactate trajectories.

BACKGROUND: No consensus has been reached on an optimal blood lactate evaluation system although several approaches have been reported in the literature in recent years. A group-based trajectory modeling (GBTM) method could better stratify patients with acute respiratory distress syndrome (ARDS) complicated with sepsis in the intensive care unit (ICU). PATIENTS AND METHODS: 760 patients from the comprehensive ICU of Tianjin Medical University General Hospital with ARDS complicated with sepsis were eligible for analysis. Serial serum lactate levels were measured within 48 h of admission. In addition to the GBTM lactate groups, the initial lactate, peak lactate level, the area under the curve of serial lactate (lactate AUC), and lactate clearance were also considered for comparison. The short- and long-term outcomes were the 30- and 90-day mortality, respectively. RESULTS: Three lactate groups were identified based on GBTM, with group 3 exhibiting the worse short- [hazard ratio (HR) for 30-day mortality: 2.96, 95% confidence interval (CI) 1.79-4.87, P < 0.001] and long term (HR for 90-day mortality: 3.49, 95% CI 2.06-5.89, P < 0.001) outcomes followed by group 2 (HR for 30-day mortality: 2.05, 95% CI 1.48-2.84, P < 0.001 and HR for 90-day mortality: 1.99, 95% CI 1.48-2.67, P < 0.001). GBTM lactate groups exhibited significantly improved diagnostic performance of initial lactate + SOFA scores/APACHE II scores models. Based on the multivariable fractional polynomial interaction (MFPI) approach, GBTM lactate groups could better differentiate high-risk patients than the initial lactate groups in short- and long-term outcomes. CONCLUSIONS: To the best of our knowledge, this is the first report that GBTM-based serial blood lactate evaluations significantly improve the diagnostic capacity of traditional critical care evaluation systems and bring many advantages over previously documented lactate evaluation systems.

WITHDRAWN: Clinical and CT imaging features of 2019 novel coronavirus disease (COVID-19).

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Impact of chemotherapy on lymphocytes and serological memory in recovered COVID-19 patients with acute leukemia.

Chemotherapy is the major method of treatment for acute leukemia to date, while intensive chemotherapy may impair immunity. We previously reported that leukemia patients were more susceptible to COVID-19 than the overall population. However, for COVID-19 recovered patients with leukemia, the impacts of intensive chemotherapy on the immune memory of COVID-19 are unknown. This study characterized the changes in immune cells and SARS-CoV-2 antibodies in acute leukemia patients, who underwent chemotherapy after recovering from COVID-19. The study enrolled three groups of individuals. One group was a total of three acute leukemia patients, who recovered well from COVID-19 before the last cycle of chemotherapy. The other two groups were six COVID-19 recovered healthy people, and six normal uninfected healthy people, respectively. Levels of B cells, T cells, and NK cells in peripheral blood were analyzed by multiparameter flow cytometry. Besides, the SARS-CoV-2 antibodies were monitored. The results showed that B cells were severely decreased after chemotherapy, especially memory B cells. Most of the T cells and NK cells showed only minor changes after chemotherapy, except for γδ T cells. The serum levels of SARS-CoV-2 antibodies were not significantly affected after chemotherapy in two leukemia patients. However, interestingly, one leukemia patient's SARS-CoV-2 IgM showed dramatically increase, suggesting possible loss of serological memory after chemotherapy. These findings raised the concern for the stability of immune memory against SARS-CoV-2 during chemotherapy and the choice of anti-leukemia treatment in the COVID-19 pandemic.

Successful recovery of a patient with multiple myeloma from severe coronavirus disease 2019 (COVID-19) pneumonia during the first chemotherapy cycle: A case report.

A continuing outbreak of pneumonia associated with the 2019 novel coronavirus (2019-nCoV) was initially described in Wuhan, China in December 2019. Weak and elderly individuals, and those with chronic diseases such as hematological malignancies are prone to develop severe pneumonia. The humoral immunity of patients with multiple myeloma is prevalently low, and their inferior immunity further deteriorates during chemotherapy. For patients with onco-hematological malignancies infected with 2019-nCoV during the first chemotherapy cycle, the clinical treatment experience is lacking. The present study is a report of a 61-year-old patient newly diagnosed with multiple myeloma in the key 2019-nCoV outbreak area, who suffered severe 2019-nCoV pneumonia during the first chemotherapy cycle. The present case report demonstrated that a rapidly progressive and severe form of pneumonia was a specific clinical feature of COVID-19, especially in immunocompromised patients with cancer. The treatment strategy combining timely suspending chemotherapy, early intervention using intravenous immunoglobulin, interferon α inhalation and oral antiviral drugs was effective. Therefore, in the pandemic environment, it is strongly recommend that the risk of 2019-nCoV infection is assessed prior to chemotherapy.

Analysis of Chinese Herbal Formulae Recommended for COVID-19 in Different Schemes in China: A Data Mining Approach.

BACKGROUND: Novel coronavirus pneumonia (NCP), or coronavirus disease 2019 (COVID-19), is a worldwide health threat that has affected millions of people globally. Traditional Chinese medicine (TCM) has been introduced for the treatment of COVID-19. However, efficacy differs among herbal medicines, and the ideal prescription pattern for TCM herbal formulae for COVID-19 treatment needs to be explored. Therefore, the data mining method has been used in this study to analyze the TCM prescription pattern for COVID-19. OBJECTIVE: The aim of this study was to analyze the TCM prescription pattern in Regional Schemes in China for COVID-19 in order to provide a new reference for the use of TCM in COVID-19 treatment. METHODS: By searching the TCM treatment protocols of COVID-19 in 23 Regional Schemes, TCM syndromes and herbal medicines were analyzed by data mining. The Ancient and Modern Medical Case Cloud Platform (V2.1 personal Edition) was used to perform frequency statistics, correlation analysis, and cluster analysis. A total of 82 TCM syndromes and 171 Chinese herbal medicines were found. The course of the disease can be divided into the early stage, middle stage, severe stage, and recovery stage. RESULTS: In the early stage, the focus is primarily on resolving dampness, dispelling cold, and diffusing the lungs. In the middle stage, the treatment priority is clearing heat and resolving toxins, promoting lung function, and relieving asthma. In the severe stage, the focus is on tonifying Qi, restoring Yang, and relieving the depletion of Yin and Yang. In the recovery stage, the main treatment is to invigorate the spleen and regulate Qi, tonify Qi, nourish Yin, and clear residual disease. There are certain differences between the Regional Schemes and the Nation Schemes, but the core prescription pattern of the former is consistent with the latter. The effectiveness of these 171 Chinese herbs include but are not limited to inhibiting COVID-19, strengthening immune system function, preventing heart failure, acting as antioxidants, oxidative stress inhibitory effects, maintaining organ function, and improving leukocyte survival. CONCLUSION: This study may help to improve understanding of TCM herbal prescription pattern, practices, reveal the efficacy of combinations of Chinese herbs, and provide new ideas for TCM treatment for COVID-19.

Delayed-phase thrombocytopenia in patients with coronavirus disease 2019 (COVID-19).

Coronavirus disease 2019 (COVID-19) can affect the haematopoietic system. Thrombocytopenia at admission was prevalent, while late-phase or delayed-phase thrombocytopenia (occurred 14 days after symptom onset) is rare. This retrospective, single-centre study screened 450 COVID-19 patients and enrolled 271 patients at the Union Hospital, Wuhan, China, from January 25 to March 9, 2020. COVID-19-associated delayed-phase thrombocytopenia occurred in 11·8% of enrolling patients. The delayed-phase thrombocytopenia in COVID-19 is prone to develop in elderly patients or patients with low lymphocyte count on admission. The delayed-phase thrombocytopenia is significantly associated with increased length of hospital stay and higher mortality rate. Delayed-phase nadir platelet counts demonstrated a significantly negative correlation with B cell percentages. We also provided and described bone marrow aspiration pathology of three patients with delayed-phase thrombocytopenia, showing impaired maturation of megakaryocytes. We speculated that immune-mediated platelet destruction might account for the delayed-phase thrombocytopenia in a group of patients. In addition, clinicians need to pay attention to the delayed-phase thrombocytopenia especially at 3-4 weeks after symptom onset.