Epidemiological, Clinical Characteristics and Risk Factors for Severe Condition and ICU Admission of COVID-19 Patients of Early Stage in China: A review (preprint)

Objective: Some retrospective studies reporting epidemiological, clinical characteristics of COVID-19 patients of early stage were published. We aim to provide an overview of epidemiological and clinical characteristics of the COVID-19 patients, and identification, treatment of early stage, especially for the patients with poor prognosis. Data Sources: PubMed, CNKI and Google Scholar. Study Selection: We searched for published retrospective studies that described epidemiological and clinical characteristics of confirmed COVID-19 patients in China by April 14th, 2020 with search terms. Some studies were excluded according to criteria. Finally, 53 studies were included. Data Extraction: Characteristics of the COVID-19 patients available from included articles were extracted, reorganized and recorded into electronic data forms. Data Synthesis: Characteristics of patients in the included studies were summarized and analyzed for median-interquartile ranges and univariable odds ratio. Conclusion: This study summarized, analyzed and compared epidemiological, clinical characteristics and estimated univariable risk factors among confirmed COVID-19 patients either in former epicenter, in severe condition, with ICU admission or not of early stage. Higher proportions of patients were found to have older age and more comorbidities, typical characteristics on admission and complications either in former epicenter, with severe condition or ICU admission. No evidence showed that patients who were male or had smoking history had higher susceptibility, but they were significant risk factors for severe condition. Some self-implementable traditional Chinese medicine therapies conducted for immunity improvement, control of comorbidities and reduction of some medicine intake. Limited evidence revealed that some characteristics of the disease might be changing with human-to-human transmission, and more research, especially international collaboration, is needed.

Risk Factors Associated with Disease Severity and Clinical Outcomes for COVID-19 in Wuhan, China (preprint)

Background: A new type of pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared in Wuhan, China. However, the risk factors and characteristics related to the severity of the disease and its outcomes need to be further explored.Methods: In this retrospective study, we evaluated COVID-19 patients with severe disease and those who were critically ill, as diagnosed at Jinyintan Hospital (Wuhan, China). The demographic information, clinical characteristics, complications, and laboratory results for the patients were evaluated. Multivariate logistic regression methods were used to analyze risk factors related to hospital deaths.Results: The 235 COVID-19 patients included were divided into a severe group of 183 (78%) and a critical group of 52 (22%). Of these patients, 185 (79%) were discharged, and 50 (21%) died during hospitalization. In multivariate logistic analyses, age (OR=1.07, 95% CI 1.02-1.14, P=0.009), critical disease (OR=48.23, 95% CI 10.91-323.13, P<0.001), low lymphocyte counts (OR=15.48, 95% CI 1.98-176.49, P=0.015), elevated interleukin 6 (IL-6) (OR=9.11, 95% CI 1.69-67.75, P=0.017), and elevated aspartate aminotransferase (AST) (OR=8.46, 95% CI 2.16-42.60, P=0.004) were independent risk factors for adverse outcomes.Conclusions: The results show that advanced age (> 64 years), critical illness, low lymphocyte levels, and elevated IL-6 and AST were factors for the risk of death for COVID-19 patients who had severe disease and those who were critically ill.

Secondary Infection in Severe and Critical COVID-19 Patients in China: A Multicenter Retrospective Study (preprint)

Background. Since 2020 COVID-19 pandemic became an emergent public sanitary incident. The epidemiology data and the impact on prognosis of secondary infection in severe and critical COVID-19 patients in China remained largely unclear.Methods. We retrospectively reviewed medical records of all adult patients with laboratory-confirmed COVID-19 who were admitted to ICUs from January 18th 2020 to April 26th 2020 at two hospitals in Wuhan, China and one hospital in Guangzhou, China. We measured the frequency of bacteria and fungi cultured from respiratory tract, blood and other body fluid specimens. The risk factors for and impact of secondary infection on clinical outcomes were also assessed. Results. Secondary infections were very common (86.6%) when patients were admitted to ICU for >72 hours. The majority of infections were respiratory, with the most common organisms being Klebsiella pneumoniae (24.5%), Acinetobacter baumannii (21.8%), Stenotrophomonas maltophilia (9.9%), Candida albicans (6.8%), and Pseudomonas spp. (4.8%). Furthermore, the proportions of multidrug resistant (MDR) bacteria and carbapenem resistant Enterobacteriaceae (CRE) were high. We also found that age ≥60 years and mechanical ventilation ≥13days independently increased the likelihood of secondary infection. Finally, patients with positive cultures had reduced ventilator free days in 28 days and patients with CRE and/or MDR bacteria positivity showed lower 28 day survival rate.Conclusions. In a retrospective cohort of severe and critical COVID-19 patients admitted to ICUs in China, the prevalence of secondary infection was high, especially with CRE and MDR bacteria, resulting in poor clinical outcomes.

Nosocomial infection control strategy in cabin hospital during the outbreak of COVID-19 / 中华医院管理杂志

The construction of mobile Cabin hospitals is a pioneering effort for the prevention and controlling of the patients with mild symptoms during the outbreak epidemic of Novel Coronavirus Pneumonia. It is a prerequisite and important guarantee for the hospital to manage the hospital infection and prevent the spreading of the epidemic. Our team is located in Dongxihu mobile Cabin hospital, which is one of the first three Cabin hospitals in Wuhan. This article takes the operation process of this hospital as a clue, and discusses aspects of personal protection, environmental sanitation management, item management, occupational exposure disposal, and discharged patient management. It also analyzed common and critical problems in operation. With a view to provide reference for other Cabin hospitals or temporary treatment agencies.

The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study (preprint)

Background: Since the clinical correlates, prognosis and determinants of AKI in patients with Covid-19 remain largely unclear, we perform a retrospective study to evaluate the incidence, risk factors and prognosis of AKI in severe and critically ill patients with Covid-19.Methods: We reviewed medical records of all adult patients (>18 years) with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University. The clinical data, including patient demographics, clinical symptoms and signs, laboratory findings, treatment [including respiratory supports, use of medications and continuous renal replacement therapy (CRRT)] and clinical outcomes, were extracted from the electronic records, and we access the incidence of AKI and the use of CRRT, risk factors for AKI, the outcomes of renal diseases, and the impact of AKI on the clinical outcomes.Results: Among 210 subjects, 131 were males (62.4%). The median age was 64 years (IQR: 56-71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) patients were classified as stage 1, 2 and 3, respectively. 54 cases (58.7%) received CRRT. Age, sepsis, Nephrotoxic drug, IMV and elevated baseline Scr were associated with AKI occurrence. The renal recover during hospitalization among 16 AKI patients (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure and higher P/F ratio. Of 210 patients, 93 patients deceased within 28 days of ICU admission. AKI stage 3, critical disease, greater age and minimum P/F <150mmHg independently associated with it.Conclusions: Among patients with Covid-19, the incidence of AKI was high. age , sepsis, nephrotoxic drug, IMV and baseline Scr were strongly associated with the development of AKI. Time from admission to AKI diagnosis, right heart failure and P/F ratio were independently associated with the potential of renal recovery. Finally, AKI KIDGO stage 3 independently predicted the risk of death within 28 days of ICU admission.

A Simple Nomogram for Predicting Failure of Non-Invasive Respiratory Therapies in Adults with COVID-19: A Retrospective Multicenter Study (preprint)

Background: Non-invasive respiratory therapies (NIRTs) (high flow nasal cannula and non-invasive ventilation) are widely used in COVID-19 patients who developed acute respiratory failure. However, use of these therapies may delay initiation of invasive mechanical ventilation in some patients and hence worsen their outcome. This study set out to identify early predictors of NIRT failure and to develop a simple-to-use nomogram and an online calculator identifying patients at high risk of NIRT failure. Methods: A retrospective cohort of 652 COVID-19 patients with ARF who received NIRTs, was used to develop early predictors of NIRT failure, defined as subsequent need for invasive mechanical ventilation or death within 28 days after ICU admission. Multivariate logistic analysis was used to develop the nomogram and ten-fold cross-validation was applied to internally validate the stability of the model. Findings: The failure rate of NITRs was 63% (415/652). The ROX index (ratio of pulse oximetry oxygen saturation/fraction of inspired oxygen to respiratory rate), age, GCS score, and use of vasoprEssors on the first day of NIRTs were independent risk factors for NIRT failure (RAGE factors). Based on the multivariate analysis, the RAGE nomogram for NIRTs failure had a C-statistics of 0 . 83 (95% CI:0 . 80–0 . 87). An internal validation demonstrated that the mean C-statistic remained stable (C-statistics=0 . 84±0 . 03). Internal calibration was excellent (calibration slope=1). Interpretation: The nomogram and online calculator are relatively simple-to-use and able to predict the risk of NIRT failure in COVID-19 patients with acute respiratory failure. Funding Statement: This work was supported by Key Research and Development Plan of Jiangsu Province (BE2018743 and BE2019749) and Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (CIFMS) from Chinese Academy of Medical Sciences (2016-I2M-1-014).Declaration of Interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.Ethics Approval Statement: The study was approved by the ethics committee of Jin Yintan Hospital (KY-2020-10.02). Informed consent was waived due to the retrospective and observational nature of the study.

A CRISPR-Cas12a-based specific enhancer for more sensitive detection of SARS-CoV-2 infection (preprint)

High Ct-values falling in the grey zone are frequently encountered in SARS-CoV-2 detection by real-time reverse transcription PCR (rRT-PCR) and have brought urgent challenges in diagnosis of samples with low viral load. Based on the single-stranded DNA reporter trans-cleavage activity by Cas12a upon target DNA recognition, we create a Specific Enhancer for detection of PCR-amplified Nucleic Acids (SENA) to confirm SARS-CoV-2 detection through specifically targeting its rRT-PCR amplicons. SENA is highly sensitive, with its limit of detection being at least 2 copies/reaction lower than that of the corresponding rRT-PCR, and highly specific, which identifies both false-negative and false-positive cases in clinic applications. SENA provides effective confirmation for nucleic acid amplification-based molecular diagnosis, and may immediately eliminate the uncertainty problems of rRT-PCR in SARS-CoV-2 clinic detection. One Sentence SummaryCRISPR-Cas12a-based COVID-19 diagnosis.

Highly ACE2 Expression in Pancreas May Cause Pancreas Damage After SARS-CoV-2 Infection (preprint)

The ongoing outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started in the end of 2019 in China has triggered a global public health crisis. Previous studies have shown that SARS-CoV-2 infects cells by binding angiotensin-converting enzyme 2 (ACE2), which is the same as SARS-CoV. The expression and distribution of ACE2 in the pancreas are unknown. At the same time, the injury of pancreas after SARS-CoV-2 infection has not been concerned. Here, we collected public datasets (bulk RNA-seq and single-cell RNA-seq) to indicate the expression and the distribution of ACE2 in pancreas (in both exocrine glands and islets). And further, clinical data including mild and severe patients with COVID-19 demonstrated there existed mild pancreatitis. In the 67 severe cases, 11 patients (16.41%) showed elevated levels of both amylase and lipase, and 5 patients (7.46%) showed imaging alterations. Only one patient (1.85%) showed elevated levels of both amylase and lipase in 54 mild cases, without imaging changes. Our study revealed the phenomenon and possible cause of mild pancreatic injury in patients with COVID-19. This suggests that pancreatitis after SARS-CoV-2 infection should also be paid attention in clinical work.