A nomogramic model based on clinical and laboratory parameters at admission for predicting the survival of COVID-19 patients (preprint)

Background: COVID-19 has become a major global threat. The present study aimed to develop a nomogram model to predict the survival of COVID-19 patients based on their clinical and laboratory data at admission. Methods: COVID-19 patients who were admitted at Hankou Hospital and Huoshenshan Hospital in Wuhan, China from January 12, 2020 to March 20, 2020, whose outcome during the hospitalization was known, were retrospectively reviewed. The categorical variables were compared using Pearson’s χ 2 -test or Fisher’s exact test, and continuous variables were analyzed using Student’s t -test or Mann Whitney U -test, as appropriate. Then, variables with a P- value of ≤0.1 were included in the log-binomial model, and merely these independent risk factors were used to establish the nomogram model. The discrimination of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), and internally verified using the Bootstrap method. Results: A total of 262 patients (134 surviving and 128 non-surviving patients) were included in the analysis. Seven variables, which included age (relative risk [RR]: 0.905, 95% confidence interval [CI]: 0.868-0.944; P <0.001), chronic heart disease (CHD, RR: 0.045, 95% CI: 0.0097-0.205; P <0.001, the percentage of lymphocytes (Lym%, RR: 1.125, 95% CI: 1.041-1.216; P =0.0029), platelets (RR: 1.008, 95% CI: 1.003-1.012; P =0.001), C-reaction protein (RR: 0.982, 95% CI: 0.973-0.991; P <0.001), lactate dehydrogenase (LDH, RR: 0.993, 95% CI: 0.990-0.997; P <0.001) and D-dimer (RR: 0.734, 95% CI: 0.617-0.879; P <0.001), were identified as the independent risk factors. The nomogram model based on these factors exhibited a good discrimination, with an AUC of 0.948 (95% CI: 0.923-0.973). Conclusions: A nomogram based on age, CHD, Lym%, platelets, C-reaction protein, LDH and D-dimer was established to accurately predict the prognosis of COVID-19 patients. This can be used as an alerting tool for clinicians to take early intervention measures, when necessary

The Psychological impact on the front-line medical staff during the recuperation after fighting against COVID-19 in China (preprint)

Background At the beginning of 2020, the novel corona virus disease (COVID-19) broke out in Wuhan (China) on a large scale. Medical staff from all over the country quickly supported Wuhan and put into combat. In May 2020, the epidemic has been effectively controlled, and medical staff withdrew from Wuhan and entered into recuperation. Methods During the recuperation in March and June, 2020, 441 medical staff were participated to investigate the psychological symptoms on SCL-90. Student's t-test and one-way analysis of variance were chosen to analyze the data. Results Of the 441 participants, the positive ratio (i ≥ 2) of the ten dimensions and the average score of SCL-90 was from 3.17% to 13.61%. Compared respectively with the medical staff in front-line and the Chinese norms, the scores obviously decreased during the recuperation. Gender, occupation, professional ranks and titles, working position in Wuhan and the patient’s condition affected the scores of SCL-90, age and educational attainment had little effect. Conclusions These results showed that the recuperation had the positive impact on the psychological status of the medical staff after fighting against COVID-19, which is worthy of further promotion. Our findings also showed that a small number of medical staff still had the risk on the mental problem, which need continuous attention and intervention.

Rhabdomyolysis is Associated with Hospital Mortality in Patients with COVID-19 (preprint)

Purpose: To evaluate the clinical features and outcomes of rhabdomyolysis (RM) in patients with COVID-19. Method: A single center retrospective cohort study of 1,014 consecutive hospitalized patients with confirmed COVID-19 at the Huoshenshan hospital in Wuhan, China, between February 17 and April 12, 2020. Results: : The overall incidence of RM was 2.2%. Comparing with patients without RM, patients with RM tended to have a higher risk of deterioration, representing by higher ratio to be admitted to the intensive care unit (ICU) (90.9 % vs 5.3%, P <0.001), and to undergo mechanical ventilation (86.4 % vs 2.7% P <0.001). Compared with patients without RM, patients with RM had laboratory test abnormalities, including indicators of inflammation, coagulation activation and kidney injury. Patients with RM had a higher risk of hospital death ( P < 0.001). Cox proportional hazard regression model confirmed that RM indicators, including peak creatine kinase (CK) >1000 IU/L (HR=6.46, 95% CI: 3.02-13.86), peak serum myoglobin (MYO) >1000 ng/mL (HR=9.85, 95% CI: 5.04-19.28) were independent risk factors for in-hospital death. Additionally, patients with COVID-19 that developed RM tended to have a delayed virus clearance. Conclusion: RM might be an important factor contributing to adverse outcomes of patients with COVID-19. Early detection and effective intervention of RM may help reduce deaths of patients with COVID-19.

Psychological symptoms of the front-line medical staff during the recuperation after fighting against COVID-19 in China (preprint)

BackgroundAt the beginning of 2020, COVID-19 broke out in Wuhan, China. Medical staff from all over the country quickly supported Wuhan and put into combat. In May 2020, the epidemic has been effectively controlled, and medical staff withdrew from Wuhan and entered into recuperation. MethodsDuring the recuperation in March and June, 2020, 441 medical staff were participated to investigate the psychological symptoms on SCL-90. Student's t-test and one-way analysis of variance were chosen to analyze the data. ResultsOf the 441 participants, the positive ratio (i ≥ 2) of the ten dimensions and the average score of SCL-90 was from 3.17% to 13.61%. Compared respectively with the medical staff in front-line and the Chinese norms, the scores obviously decreased during the recuperation. Gender, occupation, professional ranks and titles, working position in Wuhan and the patient’s condition affected the scores of SCL-90, age and educational attainment had little effect. ConclusionsThese results showed that the recuperation had the positive impact on the psychological status of the medical staff after fighting against COVID-19, which is worthy of further promotion. Our findings also showed that a small number of medical staff still had the risk on the mental problem, which need continuous attention and intervention.