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Objective: To explore the active ingredients, targets, pathways and molecular mechanism of Xinjia Xiangru Decoction in the possible treatment of new coronavirus pneumonia (COVID-19) through network pharmacology and molecular docking technology.
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Hypertension is thought to be a contributor to mortality in coronavirus disease 2019 (COVID-19) patients; however, that view is controversial, and limited clinical data on the outcomes of COVID-19 in patients with hypertension are available. This study was designed to confirm whether hypertension affects the outcomes of COVID-19. A total of 983 patients with COVID-19 (female, 48%; male, 52%) were enrolled. The COVID-19 patients with hypertension (332, 34%) were older (median age, 72 years versus 58 years; P<0.001); had more comorbidities such as cardio-cerebrovascular diseases, liver and kidney damage; and had a greater inflammatory response than nonhypertensive patients (651, 66%). Significantly higher odds of 60-day mortality (p=0.017) were observed in the hypertensive group, but no significant difference in 28-day mortality (P=0.615) or total 60-day mortality (P=0.791) was observed after adjustment in multivariate analysis. In the hypertensive group, even after adjustment in multivariate analysis, the subgroup of patients 70 years old and older had higher 28-day mortality and total 60-day mortality rates than the other age subgroups (both p<0.05). A total of 297 (89%) COVID-19 patients with hypertension survived, and 35 (11%) died. In addition, compared with hypertensive patients who survived COVID-19, nonsurvivors had more preexisting conditions, including cardiovascular diseases and stroke, higher blood pressure on admission, more severe inflammation, and more liver and kidney damage.In conclusion, hypertension does not directly affect the in-hospital outcome of COVID-19. However, in the hypertensive population aged 70 years and older with COVID-19, the 28- and 60-day mortality rates were significantly elevated.Funding: This work was supported by grants from the PLA Logistics Research Project of China [18CXZ030, 17CXZ008].Declaration of Interests: None.Ethics Approval Statement: This study was approved by the Ethics Committee of the General Hospital of the Southern Theater Command (Number: Hospital Ethics [2020]-8), and the need to obtain informed consent was waived.
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COVID-19 , Cardio-Renal Syndrome , Hypertension , Cardiovascular DiseasesABSTRACT
This paper investigates the impact of economic policy uncertainty (EPU) on the crash risk of US stock market during the COVID-19 pandemic. To this end, we use the GARCH-S (GARCH with skewness) model to estimate daily skewness as a proxy for the stock market crash risk. The empirical results show the significantly negative correlation between EPU and stock market crash risk, indicating the aggravation of EPU increase the crash risk. Moreover, the negative correlation gets stronger after the global COVID-19 outbreak, which shows the crash risk of the US stock market will be more affected by EPU during the pandemic.
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COVID-19ABSTRACT
This paper studies the heterogeneous effects of the COVID-19 outbreak on stock prices in China and its hidden mechanisms from multi perspectives. First, we confirm the recent conclusion that the spread of the epidemic has a significant negative impact on stock market returns. However, this effect is heterogeneous for different industries. In particular, stocks not only in the pharmaceutical manufacturing industry but also in its upstream industry, the chemical industry, even benefit from the epidemic. Second, we construct a fear sentiment index by using data from searching volume of COVID-19 related words and find that the fear sentiment can directly cause the stock price to fall. Moreover, the panic will exacerbate the negative impact of the epidemic on stock returns. Third, and most importantly, we demonstrate the underlying mechanisms from four firm characteristics. The results show that companies with high asset intensity, low labor intensity, high inventory-to-revenues ratio, and small market value are more negatively affected. We argue that the labor employment in state-owned enterprises is less flexible, so for labor-intensive state-owned firms, their stock performance worsens because of higher idle labor costs. Our evidence also strongly supports this hypothesis. Finally, we create a brand new index based on the WIOD input-output database to measure the relative position of an industry in the supply chain. Our findings show that companies located downstream are more vulnerable to the COVID-19 outbreak.
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COVID-19ABSTRACT
Background Coronavirus disease 2019 (COVID-19) has spread around the world and caused many deaths, but little is known about the risk factors for death in critically patients.Methods we collected demographic and clinical data on all severe inpatients with COVID-19 .We used univariable and multivariable Cox regression methods to determine the independent risk factors related to likelihood of 28-day and 60-day survival, performing survival curve analysis.Results Of 325 patients enrolled in the study, Multi-factor Cox analysis showed increasing odds of in-hospital death associated with basic illness (hazard ratio [HR] 6.455, 95% Confidence Interval [CI] 1.658–25.139, P = 0.007), lymphopenia (HR 0.373, 95% CI 0.148–0.944, P = 0.037), higher Sequential Organ Failure Assessment (SOFA) score on admission (HR 1.171, 95% CI 1.013–1.354, P = 0.033) and being critically ill (HR 0.191, 95% CI 0.053–0.687, P = 0.011). Increasing 28-day and 60-day mortality, declining survival time and more serious inflammation and organ failure were associated with lymphocyte count ≤ 0.8 × 109/L, SOFA score > 3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 7, PaO2/FiO2 ≤ 200 mmHg, IL-6 > 120 pg/ml, and CRP > 52 mg/L.Conclusions Being critically ill and lymphocyte count, SOFA score, APACHE II score, PaO2/FiO2, IL-6, and CRP on admission were associated with poor prognosis in COVID-19 patients.
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Multiple Organ Failure , Death , COVID-19 , Inflammation , LymphopeniaABSTRACT
This study investigates the impact of the COVID-19 pandemic on the stock market crash risk in China. For this purpose, we first estimated the conditional skewness of the return distribution from a GARCH with skewness (GARCH-S) model as the proxy for the equity market crash risk of the Shanghai Stock Exchange. We then constructed a fear index for COVID-19 using data from the Baidu Index. Based on the findings, conditional skewness reacts negatively to daily growth in total confirmed cases, indicating that the pandemic increases stock market crash risk. Moreover, the fear sentiment exacerbates such risk, especially with regard to the impact of COVID-19. In other words, when the fear sentiment is high, the stock market crash risk is more strongly affected by the pandemic. Our evidence is robust for the number of daily deaths and global cases.
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COVID-19 , DeathABSTRACT
Objective: To explore the clinical application value of chest CT quantitative pulmonary inflammation index (PII) in the evaluation of the course and treatment outcome of COVID-19 pneumonia.Methods: One hundred and eighteen patients with COVID-19 pneumonia diagnosed by RT-PCR were analyzed retrospectively. The correlation between chest CT PII, clinical symptoms and laboratory examinations during the entire hospitalization period was compared.Results: The average age of the patients was 46.0 ± 15 (range: 1-74) years. Of the 118 patients, 62 are male (52.5%) and 56 are female (47.5%). Among them, 116 patients recovered and were discharged, 2 patients died, and the median length of hospital stay was 22 (range: 9-41) days. On admission, 76.3% of the patients presented with fever, and the laboratory studies showed a decrease in lymphocyte (LYM) count and an increase in lactate dehydrogenase (LDH) levels, C-reactive protein(CRP) levels , and erythrocyte sedimentation rate (ESR). Within the studies’ chest CTs, the median number of involved lung lobes was 4 (range: 0-5) and the median number of involved lung segments was 9 (range 0-20). The left lower lobe and the right lower lobe were the areas most likely to be involved (89.0% and 83.9%), and 84.7% of the patients had inflammatory changes in both lungs. The main manifestations on chest CT were ground glass opacities (31.4%), ground glass opacities and consolidation (20.3%), ground glass opacities and reticular patterns (32.2%), mixed type (13.6%), and white lungs (1.7%); common accompanying signs included linear opacities (55.9%), air bronchograms (46.6%), thick small vessel shadows (36.4%), and pleural hypertrophy (13.6%). The chest CT at discharge showed complete absorption of lesions in 19 cases (16.1%), but not in the remaining 99 cases. Lesions remained in a median of 3 lung lobes (range: 0-5). Residual lesions remained in a median of 5 lung segments (range: 0-20). The residual lesions mainly presented as ground glass opacities (61.0%), and the main accompanying sign was linear opacities (59.3%). Based on chest CT, the median maximum PII of lungs was 30.0% (range: 0-97.5%), and the median PII after discharge in the patients excluding the two deaths was 12.5% (range: 0-53.0%). PII was significantly negatively correlated with the LYM count and significantly positively correlated with body temperature, LDH, CRP, and ESR. There was no significant correlation between the PII and the white blood cell count, but the grade of PII correlated well with the clinical classification.Conclusion: PII can be used to monitor the severity and the treatment outcome of COVID-19 pneumonia, provide help for clinical classification, assist in treatment plan adjustments and aid assessments for discharge.
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Lung Diseases , Fever , Pneumonia , Hypertrophy , COVID-19ABSTRACT
Importance: Coronavirus disease 2019 (COVID-19) has become pandemic, causing more than 1.5 million infections and over ten-thousands of deaths in a short period of time worldwide. However, little is known about its pathological mechanism, and reports on clinical study on specific treatment are few. Objective: The purpose of this study is to determine the clinical efficacy of intravenous immunoglobulin (IVIG) therapy in COVID-19 patients. Design, setting and participants: This multicenter retrospective cohort study enrolled 325 adult critical COVID-19 patients, including severe type and critical type, according to the clinical classification defined by National Health Commission of China, in 8 government designated treatment centers in China from Dec 23, 2019 to Mar 31, 2020. Demographic, clinical, treatment, and laboratory data as well as prognosis were extracted from electronic medical records. Exposure: IVIG was exposure factor. Main outcomes and measures: Primary outcomes were the 28-day and 60-day mortality, and secondary outcomes were the total length of in-hospital and the total duration of the disease. Meanwhile, the parameters of inflammation responses and organ functions were measured. The risk factors were determined by COX proportional hazards model. The subgroup analysis was carried out according to clinical classification of COVID-19, IVIG dosage, and timing. Results: In the enrolled 325 patients, 222 (68%) were severe type and 103 (32%) were critical type; 42 (13%) died in 28-day within hospitalization, and 54 (17%) died within 60-day; The death in 60-day includes 6 (3%) severe type patients and 48 (47%) critical type patients. 174 cases were used IVIG, and 151 cases were not. Compared with the baseline characteristics between two groups, the results showed that the patients in IVIG group presented higher Acute Physiology and Chronic Health Evaluation (APACHII) score and Sequential Organ Failure Assessment (SOFA) score, higher plasm levels of IL-6 and lactate, and lower lymphocyte count and oxygenation index (all P<0.05). The 28-day and 60-day mortality were not improved with IVIG in overall cohort. The in-hospital stay and the total duration of disease were longer in IVIG group (P<0.001). Risk factors were clinical classifications (hazards ratio 0.126, 95% confidence interval 0.039-0.413, P=0.001), and using IVIG (hazards ratio 0.252, 95% confidence interval 0.107-0.591, P=0.002) with COX proportional hazards model. Subgroup analysis showed that only in patients with critical type, IVIG could significantly reduce the 28-day mortality, decrease the inflammatory response, and improve some organ functions (all P<0.05); and application of IVIG in the early stage (admission[≤]7 days) with a high dose (>15 g/d) exhibited significant reduction of 60-day mortality in the critical type patients. Conclusions and Relevance: Early administration of IVIG with high dose improves the prognosis of critical type patients with COVID-19. This study provides important information on clinical application of the IVIG in treatment of SARS-CoV-2 infection, including patient selection and administration timing and dosage.