[Analysis of differences and influencing factors of liver injury associated with different strains of 2019-nCoV infection].

Objective: To analyze whether there are differences and related influencing factors in liver injury associated with different strains of 2019-nCoV/SARS-CoV-2 infection. Methods: Data of epidemiology, clinical symptoms, laboratory tests, and treatment outcomes of patients with COVID-19 infection confirmed with Alpha and Delta virus strain in Zhejiang Province were retrospectively collected. Statistical analysis was performed using independent samples t-test or Mann-Whitney U test, χ2 test or Fisher's exact test, and logistic regression analysis. Results: A total of 788 and 381 cases with Alpha and Delta virus strain were included. Vaccination ratio was 0% in Alpha and 85.30% in Delta group (P<0.001), The proportion of patients with fever (80.71% vs. 40.94%, P<0.001) was significantly higher in Alpha than Delta strain group. The proportion of critical ill patients was significantly higher in Delta group (9.90% vs. 1.57%, respectively, P<0.001). The virus negative conversion time was significantly longer in Delta than Alpha group (22 d vs. 11 d, P<0.001), but the incidence of liver injury was significantly higher in Alpha than Delta group (20.05% vs. 13.91%, P=0.011). Univariate analysis showed that Alpha virus strain infection, male sex, body mass index, chronic liver disease, fever, diarrhea, shortness of breath, severe/critical illness, elevated creatine kinase (CK), elevated international normalized ratio (INR) and an elevated neutrophil/lymphocyte ratio was significantly associated with an increased risk of liver injury occurrence, and in patients with pharyngeal pain the risk of liver injury occurrence was significantly reduced. Multivariate analysis showed that shortness of breath [OR, 2.667 (CI: 1.389-5.122); P=0.003], increased CK [OR, 2.544 (CI: 1.414-4.576); P=0.002] and increased INR [OR, 1.721] (CI: 1.074-2.758); P=0.024] was significantly associated with an increased risk of liver injury occurrence, and in patients with pharyngeal pain the risk of liver injury occurrence was significantly reduced [OR, 0.424 (CI: 0.254-0.709); P=0.001]. Conclusion: Although the virulence of the Delta is stronger than Alpha strain, most patients infected with Delta strain vaccinated against COVID-19 in Zhejiang province had milder clinical symptoms and a lower incidence and degree of liver injury. Notably, the infection risk even remains after vaccination; however, symptoms and the incidence of severe and critical illness can be significantly reduced.

Clinical characteristics and treatment strategies of 79 patients with COVID-19

Aim To analyze the clinical characteristics of patients of corona virus disease 2019 (COVID-19), and summarize the treatment experience, aiming to provide diagnostic and treatment reference for the front-line clinicians. Methods Seventy-nine patients with COVID-19 admitted to the Infectious Hospital of Anhui Provincial Hospital from January 22 to February 18, 2020 were selected as the research subjects. There were 55 cases in general group and 24 cases in severe and critical group. The clinical data of the two groups were collected and compared, including general conditions, clinical symptoms, signs, laboratory tests, computed tomography imaging of the lungs and complications. Results The average age of 79 COVID-19 patients was 45. 1 ± 16. 6 years, and forty-five of them are males. The severe and critical group was older than the general group. Besides, there were more males and comorbidities. In terms of laboratory tests, the lymphocyte (LYM) count and albumin (A L B) decreased more significantly in the severe and critical groups. Moreover, the percentage of neutrophils (N E U), c-reactive protein (CRP), D-dimer, lactate dehydrogenase (L D H), troponin I (cTnl) and urea nitrogen (BUN) increased significantly. Among all the patients, the types of antiviral drugs in severe and critical group were significantly more than those in general group;moreover, the glucocorticoids, gamma globulin and oxygen inhalation by nasal catheter were used more frequently in severe and critical patients. By the time of February 18, one patient died of acute large area cerebral infarction, 34 patients were discharged from hospital, and the rest were still receiving treatment. Conclusions The elderly patients with multiple cardiovascular diseases are more likely to get severe and critical COVID-19. They usually combine multiple organ or system abnormalities. Clinicians should make timely judgment and adjust the treatment plan according to the clinical symptoms, signs and laboratory examination results.