Severe versus common COVID-19: an early warning nomogram model.

The wide spread of coronavirus disease 2019 is currently the most rigorous health threat, and the clinical outcomes of severe patients are extremely poor. In this study, we establish an early warning nomogram model related to severe versus common COVID-19. A total of 1059 COVID-19 patients were analyzed in the primary cohort and divided into common and severe according to the guidelines on the Diagnosis and Treatment of COVID-19 by the National Health Commission of China (7th version). The clinical data were collected for logistic regression analysis to assess the risk factors for severe versus common type. Furthermore, 123 COVID-19 patients were reviewed as the validation cohort to assess the performance of this model. Multivariate logistic analysis revealed that age, dyspnea, lymphocyte count, C-reactive protein and interleukin-6 were independent factors for prewarning the severe type occurrence. Then, the early warning nomogram model including these risk factors for inferring the severe disease occurrence out of common type of COVID-19 was constructed. The C-index of this nomogram in the primary cohort was 0.863, 95% confidence interval (CI) (0.836-0.889). Meanwhile, in the validation cohort, the C-index of this nomogram was 0.889, 95% CI (0.828-0.950). In both the primary cohort and validation cohorts, the calibration curve showed good agreement between prediction and actual probability. The early warning model shows that data at the very beginning including age, dyspnea, lymphocyte count, CRP, and IL-6 may prewarn the severe disease occurrence to some extent, which could help clinicians early and timely treatment.

Clinical effect of Guanggu jisheng decoction in treatment of recovery stage coronavirus disease 2019

Objective: To observe the clinical effect of Guanggu Jisheng decoction on the treatment of coronavirus disease 2019 (COVID-19) during recovery stage.

Analysis on traditional Chinese medicine syndromes of 756 cases with Coronavirus disease 2019

Objective To explore the rule of traditional Chinese medicine (TCM) syndromes of coronavirus disease 2019 (COVID-19) patients, providing guidance for clinical practice. Methods The information and syndrome of 756 cases with COVID-19 in Guanggu Branch of Maternity and Child Healthcare Hospital of Hubei Province were collected by cross sectional survey, the TCM syndrome differentiation was given by TCM experts, the syndrome characteristics were analyzed, and the relationships between syndromes and gender, age, course and severity of disease were analyzed. Results Among the 756 cases, 101 cases (13.4%) were diagnosed as cold-dampness accumulating lung syndrome, 239 cases (31.6%) were diagnosed as dampness-heat obstructing lung syndrome, 18 cases (2.4%) were diagnosed as epidemic toxin blocking lung syndrome, 195 cases (25.8%) were diagnosed as deficiency of lung and spleen Qi, 203 cases (26.9%) were diagnosed as deficiency of both Qi and Yin. The order of the median course of the TCM syndromes was: cold-dampness accumulating lung syndrome (21 d)dampness-heat obstructing lung syndrome (22 d)epidemic toxin blocking lung syndrome (27 d)both lung and spleen Qi deficiency syndrome (33 d)both Qi and Yin deficiency syndrome (36 d). There was no significant difference in syndrome distribution among different genders (P 0.05). The distribution of dampness-heat obstructing lung syndrome in patients over 65 years old was significantly lower than that in patients aged 65 and under (22.4% [69/308] vs 37.9%[170/448]), while the syndrome of deficiency of lung and spleen Qi (30.2%[93/308] vs 22.8%[102/448]) and the syndrome of both Qi and Yin deficiency (34.1%[105/308] vs 21.9%[98/448]) were just the opposite. The distribution of the syndromes was correlated with the severity and the course of COVID-19 (P=0.01, P 0.01). The syndrome of colddampness accumulating lung was relatively common in the general cases (14.1%[86/612]), while the syndrome of epidemic toxin blocking lung was more common in the severe and critical cases (6.2%[9/144]). The syndrome of cold-dampness accumulating lung was most common in the early stage (26.2%[28/107]) of COVID-19. Dampness-heat obstructing lung syndrome was common in both the early (43.9%[47/107]) and the middle stages (42.0%[116/276]). The syndrome of both lung and spleen Qi deficiency and the syndrome of both Qi and Yin deficiency were more common in the middle (21.7% [60/276], 18.1%[50/276]) and late stages (31.1%[116/373], 38.1%[142/373]). Conclusion The syndromes of COVID-19 are mostly hot and excessive in its early stage and getting into deficiency with the progress of the disease. And the syndromes are closely related to the age, severity and course of COVID-19 patients.

Traditional Chinese medicine syndrome differentiation of coronavirus disease 2019 patients

Objective To explore the rule of traditional Chinese medicine (TCM) syndrome differentiation of coronavirus disease 2019 (COVID-19) patients. Methods The symptoms of 756 cases with COVID-19 in Guanggu Branch of Maternity and Child Healthcare Hospital of Hubei Province were collected by cross sectional survey. The incidence rates of the symptoms were recorded by frequency method at different courses of the disease: prodromal stage (onset), middle stage (7-30 days), and later stage (>30 days). The common symptoms (incidence rate>5.0%) were analyzed by systematic clustering. With expert experience, the rule of TCM syndrome differentiation of COVID-19 patients was summarized. Results Fever (52.25%, 395 cases), cough (43.25%, 327 cases), asthenia (27.25%, 206 cases), chest distress (26.72%, 202 cases), asthma (17.59%, 133 cases) and expectoration (5.03%, 38 cases) were the most common symptoms in the prodromal stage (756 cases) of the disease, which were clustered into one category except expectoration, indicating the pathogenesis of both lung and body surface suppressed by dampness. In the middle stage (383 cases), the 19 common symptoms including greasy fur (64.49%, 247 cases), yellow fur (43.86%, 168 cases), thick fur (40.21%, 154 cases), cough (34.73%, 133 cases), red tongue (32.38%, 124 cases), poor stool (25.85%, 99 cases), asthma (25.33%, 97 cases), asthenia (25.07%, 96 cases), poor appetite (23.76%, 91 cases), bitterness of mouth (14.36%, 55 cases), dry fur (12.01%, 46 cases), purple tongue (12.01%, 46 cases), perspiration (11.49%, 44 cases), constipation (10.18%, 39 cases), white phlegm (8.62%, 33 cases), insomnia (7.31%, 28 cases), nausea (7.05%, 27 cases), diarrhea (6.79%, 26 cases) and yellow phlegm (6.27%, 24 cases), were clustered into three groups, indicating the pathogenesis of damp-heat accumulation, obstruction of lung and spleen by dampness, and dryness due to dampness-heat. In the later stage (373 cases), the 13 common symptoms including greasy fur (50.94%, 190 cases), asthenia (39.41%, 147 cases), cough (37.80%, 141 cases), red tongue (33.78%, 126 cases), asthma (32.17%, 120 cases), perspiration (23.86%, 89 cases), dry mouth (22.79%, 85 cases), poor appetite (20.11%, 75 cases), poor stool (19.30%, 72 cases), bitterness of mouth (15.01%, 56 cases), white phlegm (10.72%, 40 cases), palpitation (8.31%, 31 cases) and little fur (8.04%, 30 cases), were clustered into two groups, indicating the pathogenesis of deficiency of Qi and Yin with residual dampness, and deficiency of lung Qi and spleen Qi with residual dampness. Conclusion The TCM syndromes of COVID-19 patients in different stages have its own typical characteristics, with a regular change from exterior to interior, from dampness to dampness-heat and from excess to deficiency..