ABSTRACT
The coronavirus disease 2019 (COVID-19) has become a global pandemic, which is induced by infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with systemic lupus erythematosus (SLE) are susceptible to infections due to the chronic use of immunosuppressive drugs and the autoimmune disorders. Now we report a case of SLE infected with SARS-CoV-2, influenza A virus and Mycoplasma pneumoniae concurrently. The patient used hydroxychloroquine and prednisone chronically to control the SLE. After infection of SARS-CoV-2, she was given higher dose of prednisone than before and the same dosage of hydroxychloroquine. Besides, some empirical treatments such as antiviral, antibiotic and immunity regulating therapies were also given. The patient finally recovered from COVID-19. This case indicated that hydroxychloroquine may not be able to fully protect SLE patient form SARS-CoV-2. Intravenous immunoglobulin therapies and increased dose of corticosteroids might be adoptable for patient with both COVID-19 and SLE. Physicians should consider SARS-CoV-2 virus test when SLE patient presented with suspected infection or SLE flare under the epidemic of COVID-19.
ABSTRACT
BACKGROUND: The potential differences between a clinical diagnosis of coronavirus disease 2019 (COVID-19) (i.e., symptoms without positive virus test) and a microbiological diagnosis (i.e., positive virus test results) of COVID-19 are not known. AIMS: This study explored the differences between the two types of COVID-19 diagnosis among older patients in terms of clinical characteristics and outcomes. METHODS: A total of 244 inpatients aged ≥ 60 years with COVID-19 were included in this study, of whom 52 were clinically diagnosed and 192 were microbiologically diagnosed. Clinical and laboratory data on hospital admission and outcomes (discharged or died in hospital) of all patients were retrieved from medical records retrospectively. Patients who met the criteria for clinical diagnosis with negative virus test results were assigned to the clinical diagnosis group, whereas those with positive virus test results were assigned to the microbiological diagnosis group. After univariate analyses, two propensity score analyses [i.e., covariate adjustment using propensity score (CAPS) and propensity score matching (PSM)] were conducted to control bias. RESULTS: The clinical and microbiological diagnosis groups demonstrated significant differences in outcomes and in the majority of laboratory findings. After propensity score analyses, many differences between the two groups disappeared and the rate of mortality had no statistically significant difference (P = 0.318 and 0.828 for CAPS and PSM, respectively). CONCLUSIONS: Patients with similar signs, symptoms, and laboratory and imaging findings as confirmed COVID-19 cases may have a similar mortality risk, regardless of the virus test results, and require timely intervention to reduce their mortality.
Subject(s)
Betacoronavirus/isolation & purification , Clinical Laboratory Techniques , Coronavirus Infections , Diagnostic Imaging , Pandemics , Pneumonia, Viral , Symptom Assessment , Aged , COVID-19 , COVID-19 Testing , China/epidemiology , Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques/statistics & numerical data , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Correlation of Data , Diagnostic Imaging/methods , Diagnostic Imaging/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Mortality , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Retrospective Studies , Risk Assessment , SARS-CoV-2 , Symptom Assessment/methods , Symptom Assessment/statistics & numerical dataABSTRACT
BACKGROUND/OBJECTIVES: Previous studies have reported that older patients may experience worse outcome(s) after infection with severe acute respiratory syndrome coronavirus-2 than younger individuals. This study aimed to identify potential risk factors for mortality in older patients with coronavirus disease 2019 (COVID-19) on admission, which may help identify those with poor prognosis at an early stage. DESIGN: Retrospective case-control. SETTING: Fever ward of Sino-French New City Branch of Tongji Hospital, Wuhan, China. PARTICIPANTS: Patients aged 60 years or older with COVID-19 (n = 244) were included, of whom 123 were discharged and 121 died in hospital. MEASUREMENTS: Data retrieved from electronic medical records regarding symptoms, signs, and laboratory findings on admission, and final outcomes of all older patients with COVID-19, were retrospectively reviewed. Univariate and multivariate logistic regression analyses were used to explore risk factors for death. RESULTS: Univariate analysis revealed that several clinical characteristics and laboratory variables were significantly different (ie, P < .05) between discharged and deceased patients. Multivariable logistic regression analysis revealed that lymphocyte (LYM) count (odds ratio [OR] = 0.009; 95% confidence interval [CI] = 0.001-0.138; P = .001) and older age (OR = 1.122; 95% CI = 1.007-1.249; P = .037) were independently associated with hospital mortality. White blood cell count was also an important risk factor (P = .052). The area under the receiver operating characteristic curve in the logistic regression model was 0.913. Risk factors for in-hospital death were similar between older men and women. CONCLUSION: Older age and lower LYM count on admission were associated with death in hospitalized COVID-19 patients. Stringent monitoring and early intervention are needed to reduce mortality in these patients. J Am Geriatr Soc 68:E19-E23, 2020.