Age-dependent blood signatures of rehabilitated patients with mild COVID-19 (preprint)

Growing evidence suggests that pulmonary and neurological sequelae from critical novel coronavirus disease 2019 (COVID-19) can occur which are closely related to immune responses. However, data on the long-term systemic biochemical sequelae in mild COVID-19 are lacking. Here we investigated the blood biochemical indexes and cytokines of 25 mild cases from Wuhan nine months after infection with COVID-19. Compared with control, rehabilitated patients with mild COVID-19 showed significant reduction in the levels of RBC count and ALB in an age-dependent manner. Major symptoms such as fatigue and memory decline were found in elderly rehabilitators. Besides the overall reduction in the correlations among hematologic indicators in rehabilitated patients, the serum cytokine assay also confirmed the age-related alterations such as the level of CD40 Ligand in rehabilitators with mild COVID-19. Our current data indicated the age-dependent long-term consequences after mild COVID-19 infection and continuous follow-up is warranted.

Clinical Characteristics, Risk Factors and Cardiac Manifestations of Cancer Patients with COVID-19 (preprint)

Background: Coronavirus disease 2019 (COVID-19) has been associated with cardiovascular features, which may be deteriorated in cancer patients.Methods: We retrospectively assessed 1,244 COVID-19 patients from February 1st to August 31st (140 cancer and 1104 non-cancer patients). Clinical data and laboratory findings were obtained and compared between cancer and non-cancer groups. Risk factors for in-hospital mortality were identified by multivariable COX regression models.Findings: The median age of cancer group was older than that in non-cancer patients [61 (57-67) vs. 56 (40-68), p < 0.001]. For cancer group, 56% were in severe and critical status, while the proportion was 10% for non-cancer group. Cancer patients had increased levels of leukocyte, neutrophil count and BUN (all p < 0.01), while lymphocyte count was significantly lower (p < 0.001). The most common solid tumor types were gastrointestinal cancer (26%), lung cancer (21%), breast and reproductive cancer (both 19%). There is a rising for cardiac biomarkers, including Pro-BNP, cTnI, MYO, CK-MB, and D-Dimer in COVID-19 cancer population, especially in deceased cancer subjects. The 30-day in hospital mortality in cancer group was dramatically raised than that in non-cancer group (12.9% vs. 4.0%, p<0.01). In multivariable COX regression models, fever, disease severity status, underlying diseases were risk factors for mortality. The Pro-BNP and D-Dimer levels were significantly increased in cancer subjects with cardiovascular disease.Interpretation: COVID-19 cancer patients relate to deteriorating conditions, increased risk of admission to intensive care units and in-hospital mortality. They display severely impaired myocardium, damaged heart function and imbalanced homeostasis of coagulation, which warrants more aggressive treatment. Funding: The current work was supported by the National Natural Science Foundation Project of China (Grant No. 81670304) and the Fundamental Research Funds for the Central Universities of China (NO.2042019kf0058).Declaration of Interests: All authors report no relationship or conflict of interest to disclose.Ethics Approval Statement: This study was approved by the National Health Commission of China and the institutional review board at Renmin Hospital of Wuhan University (Wuhan, China).

Decreased Counts of T Lymphocyte Subsets Predict Prognosis in SARS-CoV-2-Infected Pneumonia in Wuhan, China: a Retrospective Study (preprint)

Background The outbreak and the rampant spread of SARS-CoV-2-infected pneumonia (COVID-19) first identified in Wuhan, China, has infected thousands of patients and killed more than two thousand. We aimed to find indicators that could predict the progression of SARS-CoV-2 pneumonia. Methods Medical history, clinical features, laboratory and radiological results were retrospectively reviewed from 112 patients with clinically diagnosed SARS-CoV-2 pneumonia in Renmin Hospital of Wuhan University from Jan 1 to Jan 31, 2020. Clinical outcomes were followed up to Feb 9, 2020. Results Based on their outcomes, we divided these patients into groups of remission, deterioration and death respectively, and analyzed the counts of lymphocyte and its subsets. A decreased combination of CD3+, CD4+ and CD8+ T lymphocyte counts was observed as the SARS-CoV-2 pneumonia progressed. Among them, the CD4+ T lymphocyte counts were reduced at the early stage, while CD8+ counts were decreased at advanced stage or end stage. Conclusions We identified in our study of 112 hospitalized patients that CD3+, CD4+ and CD8+ T lymphocyte counts were useful markers to predict the clinical progression of SARS-CoV-2 pneumonia at different stages. Considering the large number of patients with severe pneumonia, and the urgency of this ongoing global public health emergency, the counts of lymphocyte and its subsets from laboratory examinations could be easy and useful indicators for physicians to determine a timely and proper therapeutic strategy for patients and an early warning sign for predicting or reducing mortality in SARS-CoV-2-infected pneumonia.