Comparison of Deep Vein Thrombosis Risks in Acute Respiratory Distress Syndrome Caused by COVID-19 and Bacterial Pneumonia: A Retrospective Cohort Study (preprint)

Background: High incidence of deep vein thrombosis (DVT) has been observed in patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 and those by bacterial pneumonia. However, it is also important to differentiate between these two groups of patients. Study Design and Methods: We performed a retrospective cohort study to investigate the difference of DVT between the two independent cohorts of ARDS and eventually enrolled 240 patients, 105 of whom with ARDS caused by COVID-19 and 135 by bacterial pneumonia. We analyzed demographics and clinical characteristics for patients with and without DVT in these two cohorts and explored the main differences and similarities between them. Results: The 28-days incidence of DVT in COVID-19 cohort was higher than that in bacterial pneumonia cohort (57.1% vs 41.5%, P=0.016). Taking death as competitive risk, Fine-Gray test showed no significant difference in 28-day cumulative incidence of DVT between these two groups (P=0.220). Fine-Gray competing risk analysis showed an association between CK (creatine kinase isoenzyme)-MB levels, PaO2 (partial pressure of arterial oxygen)/FiO2 (fraction of inspired oxygen) ratios, D-dimer levels and DVT in COVID-19 cohort and an association between serum creatinine levels, IMV, and DVT in bacterial pneumonia cohort. The sensitivity and specificity of corresponding receiver operating characteristic curve originating from the combination of CK-MB levels, PaO2/FiO2 ratios and D-dimer levels ≥ 0.5 µg/mL was not inferior to those of the Padua prediction score and the Wells score for screening for DVT in COVID-19 cohort. Conclusions: Compared with patients with ARDS caused by bacterial pneumonia, the incidence of DVT is higher by logistic model in patients with ARDS caused by COVID-19, and the risk factors for DVT are completely different. Our novel prediction model can aid early identifying patients with high risk for DVT. Keywords: Acute Respiratory Distress Syndrome; Pneumonia, Bacterial; COVID-19; Deep Vein Thrombosis

Scores based on neutrophil percentage and lactate dehydrogenase with or without oxygen saturation predict the risk of hospital mortality in severe COVID-19 patients (preprint)

Background. Risk scores are urgently needed to assist clinicians in predicting the risk of death in severe patients with SARS-CoV-2 infection in the context of millions of people infected, rapid disease progression, and shortage of medical resources.Method. A total of 139 severe patients with SARS-CoV-2 from China and Iran were included. Using data from China (training dataset, n = 96), prediction models were developed based on logistic regression models, nomogram and risk scoring system for simplification. Leave-one-out cross validation was used for internal validation and data from Iran (test dataset, n = 43) for external validation. Results. The NSL model (Area under the curve (AUC) 0.932) and NL model (AUC 0.903) were developed based on neutrophil percentage (NE), lactate dehydrogenase (LDH) with or without oxygen saturation (SaO2) using the training dataset. Compared with the training dataset, the predictability of NSL model (AUC 0.910) and NL model (AUC 0.871) were similar in the test dataset. The risk scoring systems corresponding to these two models were established for clinical application. The AUCs of the NSL and NL scores were 0.928 and 0.901 in the training dataset, respectively. At the optimal cut-off value of NSL score, the sensitivity was 94% and specificity was 82%. In addition, for NL score, the sensitivity and specificity were 94% and 75%, respectively.Conclusion. NSL and NL score are straightforward means for clinicians to predict the risk of death in severe patients. NL score could be used in selected regions where patients’ SaO2 cannot be tested.

Correlation between White Blood Cell Count at Admission and Mortality in COVID-19 Patients: A Retrospective Study (preprint)

Background: Coronavirus disease-19 (COVID-19) has spread rapidly and has become a world health threaten. Its risk factors with death were still unknow. White blood cells (WBC) as a reflection of inflammation had play a vital role in COVID-19, however its level with death were still not know. Methods: In this retrospective, single-center study, all confirmed patients with COVID-19 on admission at West Branch of Union Hospital from Jan 29 to Feb 28, were collected and analyzed. Demographic and clinical data including laboratory examinations were analyzed and compared between recovery and death patients.Results: A total of 163 patients including 33 death cases were included in this study. Significant associations were found between WBC level and death (HR = 1.14, 95%CI: 1.09-1.20, p<0.001). The regression analysis results showed there was a significant association between WBC level and death (HR = 5.72, 95%CI: 2.21-14.82, p < 0.001) when use the second quartile as a cutoff value (> 6.16×10^9/L). The difference was still existing after we adjusting for confounding factors (HR = 6.26, 95%CI: 1.72-22.77, p = 0.005). In addition, Kaplan-meier survival analysis showed that there was a significant decline of the cumulative survival rate (p < 0.001) in those with WBC level ≥ 6.16×10^9/L.Conclusion: WBC at admission is significantly corelated with death in COVID-19 patients. Higher level of WBC should be given more attention in the treatment of COVID-19.

Correlation between Fasting Blood Glucose Level at Admission and Mortality in COVID-19 Patients: A Retrospective Study (preprint)

Background Coronavirus disease-19 (COVID-19) has spread rapidly, with a growing number of cases confirmed around the world. This study explores the relationship of fasting blood glucose (FBG) at admission with mortality. Methods In this retrospective, single-center study, we analyzed the clinical characteristics of confirmed cases of COVID-19 in Wu Han from 29 January 2020 to 23 February 2020. Cox proportional hazard regression analysis was performed to evaluate the relationship between FBG and mortality. Results A total of 107 patients were enrolled in our study. The average age was 59.49 ± 13.33 and the FBG at admission was 7.35 ± 3.13 mmol/L. There were 16 people died of COVID-19 with an average age 68.1 ± 9.5 and the FBG was 8.94 ± 4.76 mmol/L. Regression analysis showed that there were significant association between FBG and death (HR = 1.13, 95%CI: 1.02-1.24). After adjusting for covariables, the significance still exists. In addition, our result showed that FBG > 7.0 mmol/L or diabetic mellitus can significantly increase mortality after adjusting for the age and gender. Conclusions This study suggests that FBG at admission is an effective and reliable indicator for disease prognosis in COVID-19 patients.