Role of Prealbumin in Predicting the Prognosis of Severely and Critically Ill COVID-19 Patients.

Most critically ill patients experience malnutrition, resulting in a poor prognosis. This study aimed to evaluate the association of prealbumin (PAB) with the prognosis for severely and critically ill coronavirus disease 2019 (COVID-19) patients and explore factors related to this association. Patients with laboratory-confirmed COVID-19 from West Campus of Union Hospital in Wuhan from January 29, 2020 to March 31, 2020 were enrolled in this study. Patients were classified into the PAB1 (150-400 mg/L; N = 183) and PAB2 (< 150 mg/L; N = 225) groups. Data collection was performed using the hospital's electronic medical records system. The predictive value of PAB was evaluated by measuring the area under the receiver-operating characteristic (AUROC) curve. Patients were defined as severely or critically ill based on the Guidance for COVID-19 (7th edition) by the National Health Commission of China. During this analysis, 316 patients had severe cases and 65 had critical cases. A reduced PAB level was associated with a higher risk of mortality and a longer hospital stay. The AUROC curve for the prognosis based on the PAB level was 0.93, with sensitivity of 97.2% and specificity of 77.6%. For severe cases, a lower level of PAB was associated with a higher risk of malnutrition, higher NK cell counts, and lower B lymphocyte counts; these factors were not significant in critical cases. C-reactive protein and nutritional status mediated the association between PAB and prognosis. This retrospective analysis suggests that the PAB level on admission is an indicator of the prognosis for COVID-19.

Discussion on the prevention and treatment of COVID-19 causing lung disease and heart damage based on Lei Zhongyi's theory of intermingled phlegm blood stasis and toxin

Novel coronavirus infection not only damages lung function, but also causes myocardial injury, elevated myocardial enzymes and heart failure, especially for patients with basic heart diseases who develop COVID-19, the first consideration should be the protection of cardiac function. Based on the theory of intermingled phlegm, blood stasis and toxin of heart disease put forward by Master Lei Zhongyi, the dialectical treatment thinking of COVID-19 patients from the concept of damage of phlegm, blood stasis and toxin to the heart were discussed. During the diagnosis, critical stage and recovery period of COVID-19, expectorant and blood-activating agents, heat and detoxification agents can be added to promote lung and asthma, free Bizheng and remove blood stasis, calm the heart and calm the mind, and promote the recovery of cardiopulmonary functions.

Evaluation of Nutrition Risk and Its Association With Mortality Risk in Severely and Critically Ill COVID-19 Patients.

BACKGROUND: The nutrition status of coronavirus disease 2019 patients is unknown. This study evaluates clinical and nutrition characteristics of severely and critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and investigates the relationship between nutrition risk and clinical outcomes. METHODS: A retrospective, observational study was conducted at West Campus of Union Hospital in Wuhan. Patients confirmed with SARS-CoV-2 infection by a nucleic acid-positive test and identified as severely or critically ill were enrolled in this study. Clinical data and outcomes information were collected and nutrition risk was assessed using Nutritional Risk Screening 2002 (NRS). RESULTS: In total, 413 patients were enrolled in this study, including 346 severely and 67 critically ill patients. Most patients, especially critically ill patients, had significant changes in nutrition-related parameters and inflammatory markers. As for nutrition risk, the critically ill patients had significantly higher proportion of high NRS scores (P < .001), which were correlated with inflammatory and nutrition-related markers. Among 342 patients with NRS score ≥3, only 84 (of 342, 25%) received nutrition support. Critically ill patients and those with higher NRS score had a higher risk of mortality and longer stay in hospital. In logistic regression models, 1-unit increase in NRS score was associated with the risk of mortality increasing by 1.23 times (adjusted odds ratio, 2.23; 95% CI, 1.10-4.51; P = .026). CONCLUSIONS: Most severely and critically ill patients infected with SARS-CoV-2 are at nutrition risk. The patients with higher nutrition risk have worse outcome and require nutrition therapy.

Discussion on the selection of ACEI and ARB for the patients with COVID-19 and hypertension from ACE2

With the wide spread of COVID-19, some studies have confirmed that novel coronavirus enters the cell through the binding of spike protein and ACE2 protein, which has the risk of causing the virus to enter the cell to accelerate its transmission. ACEI and ARB are the key drugs for the treatment of hypertension and are widely used in clinic. They are good for ventricular and vascular remodeling in patients with hypertension, coronary heart disease and heart failure. ACEI and ARB drugs may increase the expression of ACE2 in lung tissue and increase the risk of aggravation of the disease. According to the advice of hypertension experts: for mild ordinary COVID-19 patients with hypertension, we stopped immediately. During the discontinuation period, temporary replacement therepy with diuretics, dipine and vasodilation hypotensive drugs can be considered.