Analysis of 23 Pediatric Patients with SARS-CoV-2 Infection in Anhui Province, China (preprint)

Background: The global spread of coronavirus disease 2019 (COVID-19) continues to threaten all human health worldwide. Although the symptoms, signs, responses, and outcomes associated with the disease varies for individuals, few studies have reported on pediatric patients with COVID-19.Methods: This study retrospectively reviewed the medical records from three tertiary hospitals in Anhui province, China, of 23 children with COVID-19. Here, epidemiologic characteristics, clinical features, laboratory test results, and treatment strategies for these pediatric patients are reported and analyzed.Results: In total, 23 children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were analyzed. All patients were given a nucleic acid detection test for SARS-CoV-2, and positive results confirmed the diagnosis of COVID-19. Ten patients (43.5%) were female, and 19 patients (82.6%) had defined exposure history and familial clustering. The youngest patient was 16 months of age, the oldest, 17 years. The clinical symptoms of all included pediatric patients with SARS-CoV-2 infection were mild, with cough (12, 52.2%) and fever (10, 43.5%) being the most frequent, making their symptoms indistinguishable from common respiratory infections. There was no difference in clinical manifestation between males and females (P > 0.05). Eight patients (34.8%) showed changes on chest computed tomography imaging. The median level of each laboratory test parameter was within the normal reference range. Treatments primarily included antiviral therapies, traditional Chinese medicine therapies, and symptomatic supportive treatment.Conclusions: The symptoms of all 23 pediatric patients with SARS-CoV-2 infection included in this study were mild. Because the primary presenting symptoms were indistinguishable from common respiratory infections and because most patients had an exposure history and familial clustering, we recommend supporting the diagnosis of mild or atypical COVID-19 in children with detailed epidemiologic information and chest computed tomography imaging as well as with nucleic acid detection tests. Obtaining a correct diagnosis in the early stage of the disease will contribute to controlling the spread of SARS-CoV-2 infection and to providing more immediate relevant treatment for infected children.

The Value of High-flow Nasal Cannula Oxygen Therapy in Treating Patients With Severe Novel Coronavirus Pneumonia (preprint)

Objective This study aimed to investigate the value of high-flow nasal cannula (HNFC) oxygen therapy in treating patients with severe novel coronavirus pneumonia (COVID-19).Methods The clinical data of 22 patients with severe COVID-19 were collected. The heart rate (HR), respiratory rate (RR) and oxygenation index (PO2/FiO2) at 0, 6, 24 and 72 hours after treatment were compared between the HFNC oxygen therapy group and the conventional oxygen therapy (COT) group. In addition, the white blood cell (WBC) count, lymphocyte (L) count, C-reactive protein (CRP) and procalcitonin (PCT) were compared before and at 72 hours after oxygen therapy treatment.Results Of the included patients, 12 were assigned to the HFNC oxygen therapy group and 10 were assigned to the COT group. The differences in HR, RR, PaO2/FiO2, WBC, L, CRP and PCT at 0 hours between the two groups were not statistically significant. At 6 hours after treatment with the two oxygen therapies, HR, RR and PaO2/FiO2 were better in the HFNC oxygen therapy group than in the COT group (p < 0.05), while at 24 and 72 hours after treatment with the two oxygen therapies, PaO2/FiO2 was better in the HFNC oxygen therapy group than in the COT group (p < 0.05), but the differences in HR and RR were not statistically significant. At 72 hours after treatment, L and CRP had significantly improved in the HFNC oxygen therapy group compared with the COT group, but the differences in WBC and PCT were not statistically significant. The length of stay in the intensive care unit (ICU) and the total length of hospitalization were shorter in the HFNC oxygen therapy group than in the COT group, and the differences between the two groups were statistically significant.Conclusion Compared with COT, early application of HFNC oxygen therapy in patients with severe COVID-19 can significantly improve oxygenation and RR, and HFNC oxygen therapy can improve the infection indexes of patients and reduce the length of stay in the ICU of patients. Therefore, it has high clinical application value.

Acute liver injury and its association with death risk of patients with COVID-19: a hospital-based prospective case-cohort study (preprint)

Background: Coronavirus disease 2019 (COVID-19) is a newly respiratory infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) with multiple organ injuries. The aim of this study was to analyze SARS-CoV-2-induced acute liver injury (ALI), its association with death risk and prognosis after discharge. Methods: Three-hundred and fifty-five COVID-19 patients were recruited. Clinical data were collected from electronic medical records. ALI was evaluated and its prognosis was tracked. The association between ALI and death risk was analyzed. Results: Of 355 COVID-19 patients, 211 were common, 88 severe, and 51 critical ill cases, respectively. On admission, 223 (62.8%) patients were with hypoproteinemia, 151(42.5%) with cholestasis, and 101 (28.5%) with hepatocellular injury. As expected, ALI was more common in critical ill patients. By multivariate logistic regression, male, older age and lymphocyte reduction were three important independent risk factors predicting ALI among COVID-19 patients. Death risk analysis shows that fatality rate was higher among patients with hypoproteinemia than those without hypoproteinemia (RR=9.471, P<0.001). Moreover, fatality rate was higher among patients with cholestasis than those without cholestasis (RR=2.182, P<0.05). Follow-up observation found that more than one hepatic functional indexes of two-third patients remained abnormal 14 days after discharge. Conclusions: ALI at early stage elevates death risk of COVID-19 patients. SARS-CoV-2-induced ALI has not recovered completely 14 days after discharge.

Acute kidney injury at early stage as a negative prognostic indicator of patients with COVID-19: a hospital-based retrospective analysis (preprint)

Coronavirus disease 2019 (COVID-19) is a newly emerged infection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and has been pandemic all over the world. This study described acute kidney injury (AKI) at early stage of COVID-19 and its clinical significance. Three-hundred and fifty-five COVID-19 patients with were recruited and clinical data were collected from electronic medical records. Patient's prognosis was tracked and risk factors of AKI was analyzed. Of 355 COVID-19 patients, common, severe and critical ill cases accounted for 63.1%, 16.9% and 20.0%, respectively. On admission, 56 (15.8%) patients were with AKI. Although AKI was more common in critical ill patients with COVID-19, there was no significant association between oxygenation index and renal functional indices among COVID-19 patients with AKI. By multivariate logistic regression, male, older age and comorbidity with diabetes were three important independent risk factors predicting AKI among COVID-19 patients. Among 56 COVID-19 patients with AKI, 33.9% were died on mean 10.9 day after hospitalization. Fatality rate was obviously higher among COVID-+19 patients with AKI than those without AKI (RR=7.08, P<0.001). In conclusion, male elderly COVID-19 patients with diabetes are more susceptible to AKI. AKI at early stage may be a negative prognostic indicator for COVID-19.