Association between the overall burden of comorbidity and Ct values among the older patients with Omicron infection: Mediated by inflammation.

Objectives: To investigate the associations between the overall burden of comorbidity, inflammatory indicators in plasma and Ct values among the elderly with COVID-19. Methods: We conducted a retrospective observational study. The results of each nucleic acid test of during hospitalization were obtained. Linear regression models assessed the associations between the overall burden of comorbidity, inflammatory indicators in plasma and Ct values among the elderly. A causal mediation analysis was performed to assess the mediation effects of inflammatory indicators on the association between the overall burden of comorbidity and Ct values. Results: A total of 767 COVID-19 patients aged ≥ 60 years were included between April 2022 and May 2022. Patients with a high burden of comorbidity had significantly lower Ct values of the ORF gene than subjects with a low burden of comorbidity (median, 24.81 VS 26.58, P < 0.05). Linear regression models showed that a high burden of comorbidity was significantly associated with higher inflammatory responses, including white blood cell count, neutrophil count and C-reactive protein. Also, white blood cell count, neutrophil count, C-reactive protein and the overall burden of comorbidity assessed by age-adjusted Charlson comorbidity index were independent risk factors for the Ct values. A mediation analysis detected the mediation effect of white blood cells on the association between the burden of comorbidity and Ct values, with the indirect effect estimates of 0.381 (95% CI: 0.166, 0.632, P < 0.001). Similarly, the indirect effect of C-reactive protein was -0.307 (95% CI: -0.645, -0.064, P = 0.034). White blood cells and C-reactive protein significantly mediated the relationship between the burden of comorbidity and Ct values by 29.56% and 18.13% of the total effect size, respectively. Conclusions: Inflammation mediated the association between the overall burden of comorbidity and Ct values among elderly with COVID-19, which suggests that combined immunomodulatory therapies could reduce the Ct values for such patients with a high burden of comorbidity.

Research progress on characteristics, epidemiology and control measure of SARS-CoV-2 Delta VOC

COVID-2019 has become a global pandemic, and a variety of SARS-CoV-2 variants have emerged with the continuous evolution and variation. SARS-CoV-2 Delta VOC (B.1.617.2) has the characteristics of strong transmission, short incubation period of infection, high pathogenicity and rapid disease progression, which has gradually become the main epidemic strain in India and even in the world, leading to countries and regions of the epidemic rebound. In this paper, the current epidemic characteristics and core control measures of SARS-CoV-2 Delta VOC was reviewed.

Use of antibacterial drugs in 616 COVID-19 patients in Shanghai

OBJECTIVE: To analyze the use of antibiotics in patients with coronavirus disease 2019(COVID-19) in Shanghai and to provide evidence for the treatment of COVID-19 and the management of antibacterial drugs. METHODS: The clinical data of 616 patients with COVID-19 in Shanghai Public Health Clinical Center from 20 th, Jan. 2020 to 30 th Apr., 2020 were collected retrospectively, including demographic data, time of admission, time of discharge, and use of antibacterial drugs. All patients were followed up until they were discharged. The frequency of antibacterial drug usage, AUD and the situation of antibacterial using were analyzed. RESULTS: Among 616 patients, 137 were mild, 382 were common, 79 were severe and 18 were critical severe. There were 343 males with an average age of 41.1 years and a median length of stay of 16 days, 273 female cases with an average age of 42.8 years and a median length of stay of 14 days. A total of 165 patients(26.8%) received antibiotics therapy. The usage rates of antibiotics in the mild, common, severe and critical severe subgroups were 4.3%, 21.7%, 73.4% and 100.0%, respectively, which was closely related to clinical classification. The overall usage rates of antibacterial drugs in hospitalized patients gradually decreased with the increase of months. In common patients, the usage rates of antibacterial drugs in March and April were significantly lower than that in January and February. The AUD in all patients was 25.3. As the clinical classification worsened, the AUD in each subgroup gradually increased(0.9, 11.9, 46.2, and 143.8). In total, mild and common patients, the AUD showed a downward trend in January, February, March and April. The total frequency of antibacterial drugs was 286 times, and the top 5 most frequently used drugs were fluoroquinolones, beta-lactamase/beta-lactamase inhibitors, carbapenems, cephalosporins, and linezolid. In severe patients, the antibacterial drugs were mainly restricted use grade antibiotics, and in critical severe patients were mainly special use grade antibiotics. CONCLUSION: In the treatment of COVID-19 patients, the usage rates of antibacterial drugs and AUD were related to clinical classification. As our knowledge and understanding of COVID-19 deepen, our usage rates and strategies of antibacterial drugs are being adjusted, in order to avoid inappropriate use of antibacterial drugs as much as possible.

Efficacy of early hydroxychloroquine treatment in preventing COVID-19 pneumonia aggravation, the experience from Shanghai, China.

The aim of this study is to assess the efficacy of multiple treatments, especially hydroxychloroquine, used in different disease stages of coronavirus disease 2019 (COVID-19). All consecutive patients with COVID-19 admitted to Shanghai Public Health Clinical Center (Shanghai, China) between January 20, 2020, and April 30, 2020, were enrolled, and their clinical data were retrospectively collected. Binary logistic regression was used to screen the factors associated with disease aggravation, and multivariable analyses with the Cox proportional hazards model were used to estimate the effects of prognostic factors on the improvement time and PCR conversion days in throat swabs and stool swabs. A total of 616 patients, including 50 (8.11%) severe and 18 (2.92%) critical patients, were enrolled in our retrospective cohort study. The early use of hydroxychloroquine was a protective factor associated with disease aggravation (95% CI: 0.040-0.575, p = 0.006). Clinical improvement by 20 days was significantly different between patients with hydroxychloroquine used early and those with hydroxychloroquine not used (p = 0.016, 95% CI: 1.052-1.647). The median time to clinical improvement was 6 days in the hydroxychloroquine used early group, compared with 9 days in the without hydroxychloroquine used group and 8 days in the with hydroxychloroquine not used early group (p < 0.001). Hydroxychloroquine used early was associated with earlier PCR conversion in both throat swabs (HR = 1.558, p = 0.001) and stool swabs (HR = 1.400, p = 0.028). The use of hydroxychloroquine at an early stage is a potential therapeutic strategy for treating patients before irreversible severe respiratory complications occur. The early use of hydroxychloroquine decreased the improvement time and the duration of COVID-19 detection in throat and stool swabs.

D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study.

BACKGROUND: Over 5,488,000 cases of coronavirus disease-19 (COVID-19) have been reported since December 2019. We aim to explore risk factors associated with mortality in COVID-19 patients and assess the use of D-dimer as a biomarker for disease severity and clinical outcome. METHODS: We retrospectively analyzed the clinical, laboratory, and radiological characteristics of 248 consecutive cases of COVID-19 in Renmin Hospital of Wuhan University, Wuhan, China from January 28 to March 08, 2020. Univariable and multivariable logistic regression methods were used to explore risk factors associated with in-hospital mortality. Correlations of D-dimer upon admission with disease severity and in-hospital mortality were analyzed. Receiver operating characteristic curve was used to determine the optimal cutoff level for D-dimer that discriminated those survivors versus non-survivors during hospitalization. RESULTS: Multivariable regression that showed D-dimer > 2.0 mg/L at admission was the only variable associated with increased odds of mortality [OR 10.17 (95% CI 1.10-94.38), P = 0.041]. D-dimer elevation (≥ 0.50 mg/L) was seen in 74.6% (185/248) of the patients. Pulmonary embolism and deep vein thrombosis were ruled out in patients with high probability of thrombosis. D-dimer levels significantly increased with increasing severity of COVID-19 as determined by clinical staging (Kendall's tau-b = 0.374, P = 0.000) and chest CT staging (Kendall's tau-b = 0.378, P = 0.000). In-hospital mortality rate was 6.9%. Median D-dimer level in non-survivors (n = 17) was significantly higher than in survivors (n = 231) [6.21 (3.79-16.01) mg/L versus 1.02 (0.47-2.66) mg/L, P = 0.000]. D-dimer level of > 2.14 mg/L predicted in-hospital mortality with a sensitivity of 88.2% and specificity of 71.3% (AUC 0.85; 95% CI = 0.77-0.92). CONCLUSIONS: D-dimer is commonly elevated in patients with COVID-19. D-dimer levels correlate with disease severity and are a reliable prognostic marker for in-hospital mortality in patients admitted for COVID-19.