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1.
Preprint in English | SSRN | ID: ppcovidwho-293491

ABSTRACT

The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) raised a global pandemic and caused over 4.2 million deaths worldwide. However, there is no specific treatment for COVID-19 patients. In this study, we noticed that male COVID-19 patients had a higher severe rate than females, and IL-6 levels act as an independent risk factor for COVID-19 patients. Using single-cell RNA sequencing (scRNA-seq), we identified a macrophage and a fibroblast cell clusters that secreted IL-6 in COVID-19 lungs were specific in COVID-19 lung microenvironment. Gene Set Enrichment Analysis (GSEA), transcriptional factors (TFs) prediction and chromatin immunoprecipitation sequencing (ChIP-seq) revealed that the macrophage and fibroblast inducing the cytokine storm syndrome (CSS) in severe COVID-19 patients, and the trinity of AR, HIF-1α and YY1 regulates the progression of CSS. Our results firstly explained the mechanism of sex disproportion of COVID-19 and provided a novel rationale for combined therapeutic approach for COVID-19 treatment.

2.
Int J Disaster Risk Reduct ; 65: 102577, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1428007

ABSTRACT

COVID-19 should not be the world's last public health disaster, so there is an urgent need to learn from COVID-19 to prepare better for the next public health disaster. This study aims to understand the factors that make people wear a face mask at the beginning of an outbreak of public health disaster. Semi-structured interviews were conducted during April 2020 in China, one month after the COVID-19 was declared a pandemic. The respondents were members of the public living in China, covering two age groups: young adults and older adults. They were recruited using a convenient sample and snowball sampling strategy. The results were analysed using content analysis. Seventeen subjects were recruited, among which nine were young adults (average age = 26.4; SD = 10.5), and eight were older adults (average age = 60.4; SD = 12.1). This study found that environmental factors, personal factors, factors concerning wearing masks, specific circumstances, and development of the pandemic were the common factors considered by both young adults and older adults. This study should help the authority formulate prevention policies better to reduce the risk of an outbreak if there is a new virus outbreak in the future, unfortunately.

3.
Front Cardiovasc Med ; 8: 710946, 2021.
Article in English | MEDLINE | ID: covidwho-1399130

ABSTRACT

Objectives: To evaluate the impact of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) on the inflammatory response and viral clearance in coronavirus disease 2019 (COVID-19) patients. Methods: We included 229 patients with confirmed COVID-19 in a multicenter, retrospective cohort study. Propensity score matching at a ratio of 1:3 was introduced to eliminate potential confounders. Patients were assigned to the ACEI/ARB group (n = 38) or control group (n = 114) according to whether they were current users of medication. Results: Compared to the control group, patients in the ACEI/ARB group had lower levels of plasma IL-1ß [(6.20 ± 0.38) vs. (9.30 ± 0.31) pg/ml, P = 0.020], IL-6 [(31.86 ± 4.07) vs. (48.47 ± 3.11) pg/ml, P = 0.041], IL-8 [(34.66 ± 1.90) vs. (47.93 ± 1.21) pg/ml, P = 0.027], and TNF-α [(6.11 ± 0.88) vs. (12.73 ± 0.26) pg/ml, P < 0.01]. Current users of ACEIs/ARBs seemed to have a higher rate of vasoconstrictive agents (20 vs. 6%, P < 0.01) than the control group. Decreased lymphocyte counts [(0.76 ± 0.31) vs. (1.01 ± 0.45)*109/L, P = 0.027] and elevated plasma levels of IL-10 [(9.91 ± 0.42) vs. (5.26 ± 0.21) pg/ml, P = 0.012] were also important discoveries in the ACEI/ARB group. Patients in the ACEI/ARB group had a prolonged duration of viral shedding [(24 ± 5) vs. (18 ± 5) days, P = 0.034] and increased length of hospitalization [(24 ± 11) vs. (15 ± 7) days, P < 0.01]. These trends were similar in patients with hypertension. Conclusions: Our findings did not provide evidence for a significant association between ACEI/ARB treatment and COVID-19 mortality. ACEIs/ARBs might decrease proinflammatory cytokines, but antiviral treatment should be enforced, and hemodynamics should be monitored closely. Since the limited influence on the ACEI/ARB treatment, they should not be withdrawn if there was no formal contraindication.

4.
J Intensive Care ; 9(1): 49, 2021 Aug 06.
Article in English | MEDLINE | ID: covidwho-1342829

ABSTRACT

BACKGROUND: Systemic inflammation relates to the initiation and progression of acute respiratory distress syndrome (ARDS). Neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW)/albumin ratio have been reported to be predictive prognostic biomarkers in ARDS patients. However, the role of monocyte-to-lymphocyte ratio (MLR) as a prognostic inflammatory biomarker in a variety of diseases is rarely mentioned in ARDS. In this study, we explored the relationship between MLR and disease severity in ARDS patients and compared it with other indicators associated with 28-day mortality in patients with ARDS. METHODS: We retrospectively included 268 patients who fulfilled the Berlin definition of ARDS and were admitted to a single institute from 2016 to 2020. Clinical characteristics and experimental test data were collected from medical records within 24 h after the ARDS diagnosis. MLR, NLR, and RDW/albumin ratio levels were calculated. The primary clinical outcome was 28-day mortality. Logistic regression analysis was used to illustrate the relationship between indicators and 28-day mortality. Receiver operating characteristic (ROC) curve was used to evaluate the area under the curve (AUC), and propensity score matching (PSM) was employed to validate our findings. RESULTS: The median MLR values were higher for non-survivors than for survivors before and after matching (P<0.001, P=0.001, respectively). MLR values were significantly associated with 28-day mortality (OR 2.956; 95% CI 1.873-4.665; P<0.001). MLR and NLR indicators were combined for predictive efficacy analysis, and its AUC reached 0.750. There was a significant increase in 28-day mortality depending on the increasing MLR level: low MLR group 38 (20.4%), high MLR group 47 (57.3%) (P<0.001). CONCLUSIONS: Higher MLR values were associated with 28-day mortality in patients with ARDS. Further investigation is required to verify this relationship with prospectively collected data.

5.
Infect Drug Resist ; 14: 2667-2674, 2021.
Article in English | MEDLINE | ID: covidwho-1319550

ABSTRACT

Background: The World Health Organization (WHO) strongly suggests using corticosteroids in patients with severe coronavirus disease 2019 (COVID-19). Similarly, a large randomized controlled clinical trial (RCT) in the UK found that dexamethasone effectively reduced the mortality rate in severe COVID-19 patients. However, the safety profile of corticosteroids has been a controversial area of study. Case Description: A case of a COVID-19 patient is described and the clinical characteristics are observed as the mildly symptomatic patient progresses into a critically ill patient and during their dramatic improvement with corticosteroid therapy in the early stage of the deterioration process with COVID-19 pneumonia. Conclusion: The most suitable timing and dosage for the use of corticosteroids to maximize its effect during the worsening of COVID-19 pneumonia are discussed. One of the main pathophysiological hypotheses for severe COVID-19 patients is related to cytokine storm and virus load, which can be effectively treated with corticosteroid therapy.

6.
PLoS One ; 15(11): e0241540, 2020.
Article in English | MEDLINE | ID: covidwho-914234

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread to the world. Whether there is an association between lifestyle behaviors and the acquisition of COVID-19 remains unclear. METHODS: In this case-control study, we recruited 105 patients with SARS-CoV-2 infection as a case group from the Wuhan Tongji Hospital (Wuhan, China). For each case two control subjects were recruited. Participants were randomly selected from communities in Wuhan and matched for sex, age (± 2yrs), and pre-existing comorbidities (hypertension and diabetes). RESULTS: A total of 105 patients diagnosed with COVID-19 and 210 controls were included. Compared with control group, the case group had higher proportions of lack of sleep (30.5% vs. 14.8%, P = 0.001) and increased physical activities (56.2% vs. 32.9%, P < 0.001). And patients in the case group were more likely to have alopecia (28.6% vs. 10.0%, P < 0.001) than people from the control group. Overall, we found that lack of sleep [adjusted odds ratio (OR) 1.56, 95% confidence interval (CI) 1.03-2.39)], physical activities (≥ 5 times a week) (adjusted OR 2.05, 95%CI 1.39-3.02) and alopecia (adjusted OR 1.73, 95%CI 1.13-2.66) were independent risk factors for COVID-19 infection. Conversely, low-dose alcohol intake (<100g alcohol per week), hand hygiene, and fruits intake (daily) were significantly associated with a decrease in morbidity. CONCLUSIONS: Individual lifestyle behaviors and health status can affect the occurrence of COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Health Status , Life Style , Pneumonia, Viral/epidemiology , Adult , Aged , Alcohol Drinking , Betacoronavirus , COVID-19 , Case-Control Studies , China , Comorbidity , Exercise , Female , Humans , Logistic Models , Male , Middle Aged , Pandemics , Risk Factors , SARS-CoV-2 , Sleep
8.
Crit Care Med ; 48(11): e1079-e1086, 2020 11.
Article in English | MEDLINE | ID: covidwho-725837

ABSTRACT

OBJECTIVES: An ongoing outbreak of coronavirus disease 2019 is spreading globally. Acute hypoxemic respiratory failure is the most common complication of coronavirus disease 2019. However, the clinical effectiveness of early high-flow nasal oxygen treatment in patients with coronavirus disease 2019 with acute hypoxemic respiratory failure has not been explored. This study aimed to analyze the effectiveness of high-flow nasal oxygen treatment and to identify the variables predicting high-flow nasal oxygen treatment failure in coronavirus disease 2019 patients with acute hypoxemic respiratory failure. DESIGN: A multicenter, retrospective cohort study. SETTING: Three tertiary hospitals in Wuhan, China. PATIENTS: Forty-three confirmed coronavirus disease 2019 adult patients with acute hypoxemic respiratory failure treated with high-flow nasal oxygen. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Mean age of the enrolled patients was 63.0 ± 9.7 years; female patients accounted for 41.9%. High-flow nasal oxygen failure (defined as upgrading respiratory support to positive pressure ventilation or death) was observed in 20 patients (46.5%), of which 13 (30.2%) required endotracheal intubation. Patients with high-flow nasal oxygen success had a higher median oxygen saturation (96.0% vs 93.0%; p < 0.001) at admission than those with high-flow nasal oxygen failure. High-flow nasal oxygen failure was more likely in patients who were older (p = 0.030) and male (p = 0.037), had a significant increase in respiratory rate and a significant decrease in the ratio of oxygen saturation/FIO2 to respiratory rate index within 3 days of high-flow nasal oxygen treatment. In a multivariate logistic regression analysis model, male and lower oxygen saturation at admission remained independent predictors of high-flow nasal oxygen failure. The hospital mortality rate of the cohort was 32.5%; however, the hospital mortality rate in patients with high-flow nasal oxygen failure was 65%. CONCLUSIONS: High-flow nasal oxygen may be effective for treating coronavirus disease 2019 patients with mild to moderate acute hypoxemic respiratory failure. However, high-flow nasal oxygen failure was associated with a poor prognosis. Male and lower oxygenation at admission were the two strong predictors of high-flow nasal oxygen failure.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Hypoxia/therapy , Intubation, Intratracheal/methods , Pneumonia, Viral/therapy , Adult , Aged , COVID-19 , Cohort Studies , Coronavirus Infections/complications , Female , Humans , Hypoxia/etiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Positive-Pressure Respiration , Respiratory Insufficiency/therapy , Retrospective Studies , SARS-CoV-2
9.
BMC Infect Dis ; 20(1): 519, 2020 Jul 16.
Article in English | MEDLINE | ID: covidwho-651141

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan and has quickly spread across the world. The mortality rate in critically ill patients with COVID-19 is high. This study analyzed clinical and biochemical parameters between mild and severe patients, helping to identify severe or critical patients early. METHODS: In this single center, cross-sectional study, 143 patients were included and divided to mild/moderate and sever/critical groups. Correlation between the disease criticality and clinical features and peripheral blood biochemical markers was analyzed. Cut-off values for critically ill patients were speculated through the ROC curve. RESULTS: Significantly, disease severity was associated with age (r = 0.458, P < 0.001), comorbidities (r = 0.445, P < 0.001), white cell count (r = 0.229, P = 0.006), neutrophil count (r = 0.238, P = 0.004), lymphocyte count (r = - 0.295, P < 0.001), albumin (r = - 0.603, P < 0.001), high-density lipoprotein cholesterol (r = - 0.362, P < 0.001), serum potassium (r = - 0.237, P = 0.004), plasma glucose (r = 0.383, P < 0.001), total bilirubin (r = 0.340, P < 0.001), serum amyloid A (r = 0.58, P < 0.001), procalcitonin (r = 0.345, P < 0.001), C-reactive protein (r = 0.477, P < 0.001), lactate dehydrogenase (r = 0.548, P < 0.001), aspartate aminotransferase (r = 0.342, P < 0.001), alanine aminotransferase (r = 0.264, P = 0.001), erythrocyte sedimentation rate (r = 0.284, P = 0.001) and D-dimer (r = 0.477, P < 0.001) . CONCLUSIONS: With the following parameters such as age > 52 years, C-reactive protein > 64.79 mg/L, lactate dehydrogenase > 245 U/L, D-dimer > 0.96 µg/mL, serum amyloid A > 100.02 mg/L, or albumin < 36 g/L, the progress of COVID-19 to critical stage should be closely observed and possibly prevented. Lymphocyte count, serum potassium, high-density lipoprotein cholesterol and procalcitonin may also be a prognostic indicator.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Adult , Aged , Betacoronavirus/pathogenicity , Biomarkers/blood , COVID-19 , China/epidemiology , Cholesterol, HDL/blood , Coronavirus Infections/blood , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Female , Humans , Lymphocyte Count , Male , Middle Aged , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/epidemiology , Potassium/blood , Procalcitonin/blood , SARS-CoV-2
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