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2.
Int J Immunopathol Pharmacol ; 35: 20587384211048567, 2021.
Article in English | MEDLINE | ID: covidwho-1463208

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) had become a worldwide health threat. Early prediction of the severity of COVID-19 patients was important for reducing death rate and controlling this disease. METHODS AND MATERIALS: A total of 301 patients confirmed with COVID-19 in Wuhan from 8 February to 10 April 2020 were included. Clinical data were collected and analyzed. Diagnostic and prognostic utility of blood cell counts and lymphocyte subsets in COVID-19 patients were investigated. The receiver operator characteristic curve (ROC) was used in discriminating the mild and severe/critical cases. RESULTS: There were difference in blood cell counts and lymphocyte subsets among mild, severe and critical patients, which were also influenced by comorbidities and duration of disease. The area under the ROC of lymphocyte, CD3+ T cells, CD4+ T cells, and CD8+ T cells were 0.718, 0.721, 0.718, and 0.670, which were higher than that of other hematological parameters. The optimal threshold was 1205, 691, 402, and 177 per µl, respectively. Patients with higher counts of lymphocyte, CD3+ T cells, CD4+ T cells, or CD8+ T cells were correlated with shorter length of stay in hospital (p < 0.05). Multivariable Cox regression analysis showed disease severity, CD3+ T cells counts and time when the nucleic acid turned negative were independent risk factors for in-hospital death of COVID-19 patients (p < 0.05). CONCLUSION: Blood cell counts and lymphocyte subsets correlated with severity of COVID-19.


Subject(s)
COVID-19/immunology , Lymphocyte Subsets/immunology , Adult , Aged , Aged, 80 and over , CD4 Lymphocyte Count , COVID-19/diagnosis , COVID-19/mortality , COVID-19/virology , China , Female , Hospital Mortality , Host-Pathogen Interactions , Humans , Lymphocyte Subsets/virology , Male , Middle Aged , Phenotype , Predictive Value of Tests , Prognosis , Retrospective Studies , SARS-CoV-2/immunology , SARS-CoV-2/pathogenicity , Severity of Illness Index , Time Factors , Young Adult
3.
J Med Virol ; 93(7): 4265-4272, 2021 07.
Article in English | MEDLINE | ID: covidwho-1263087

ABSTRACT

Several descriptive studies have reported that higher neutrophil count (NC) may be correlated with poor prognosis in patients with confirmed COVID-19 infection. However, the findings from these studies are limited by methodology and data analysis. This study is a cohort study. We nonselectively and consecutively collected a total of 663 participants in a Chinese hospital from January 7 to February 28. Standardized and two-piecewise Cox regression model were employed to evaluate the association between baseline neutrophil count (bNC), neutrophil count change rate (NCR), and death. bNC had a U-shaped association with death. In the range of 0.1 to ≤1.49 × 109 /L (hazard ratio [HR] = 0.19, 95% confidence interval [CI] = 0.05-0.66) and >3.55 × 109 /L of bNC (HR = 2.82, 95% CI = 1.19-6.67), the trends on bNC with mortality were opposite. By recursive algorithm, the bNC at which the risk of the death was lower in the range of >1.49 to ≤3.55 × 109 /L (HR = 13.64, 95% CI = 0.25-74.71). In addition, we find that NCRs (NCR1 and NCR2) are not associated with COVID-19-related deaths. Compared with NCR, bNC has the potential to be used for early risk stratification in patients with COVID-19 infection. The relationship between bNC and mortality was U-shaped. The safe range of bNC was 1.64-4.0 × 109 /L. Identifying the correlation may be helpful for early risk stratification and medical decision-making.


Subject(s)
COVID-19/immunology , COVID-19/mortality , Neutrophils/immunology , SARS-CoV-2/immunology , China , Female , Hospitalization/statistics & numerical data , Humans , Lymphocyte Count , Male , Middle Aged , Prognosis , Retrospective Studies , Risk , Risk Factors
4.
Diabetes ; 70(5): 1061-1069, 2021 05.
Article in English | MEDLINE | ID: covidwho-1088886

ABSTRACT

Obesity has caused wide concerns due to its high prevalence in patients with severe coronavirus disease 2019 (COVID-19). Coexistence of diabetes and obesity could cause an even higher risk of severe outcomes due to immunity dysfunction. We conducted a retrospective study in 1,637 adult patients who were admitted into an acute hospital in Wuhan, China. Propensity score-matched logistic regression was used to estimate the risks of severe pneumonia and requiring in-hospital oxygen therapy associated with obesity. After adjustment for age, sex, and comorbidities, obesity was significantly associated with higher odds of severe pneumonia (odds ratio [OR] 1.47 [95% CI 1.15-1.88]; P = 0.002) and oxygen therapy (OR 1.40 [95% CI 1.10-1.79]; P = 0.007). Higher ORs of severe pneumonia due to obesity were observed in men, older adults, and those with diabetes. Among patients with diabetes, overweight increased the odds of requiring in-hospital oxygen therapy by 0.68 times (P = 0.014) and obesity increased the odds by 1.06 times (P = 0.028). A linear dose-response curve between BMI and severe outcomes was observed in all patients, whereas a U-shaped curve was observed in those with diabetes. Our findings provide important evidence to support obesity as an independent risk factor for severe outcomes of COVID-19 infection in the early phase of the ongoing pandemic.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Obesity/epidemiology , Age Factors , Aged , Body Mass Index , COVID-19/physiopathology , COVID-19/therapy , China/epidemiology , Extracorporeal Membrane Oxygenation , Female , Humans , Intensive Care Units , Male , Middle Aged , Odds Ratio , Overweight/epidemiology , Oxygen Inhalation Therapy , Respiration, Artificial , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Sex Factors
5.
Shock ; 56(3): 360-367, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1028641

ABSTRACT

PURPOSE: Rhabdomyolysis (RM) has been associated with many viral infectious diseases, and associated with poor outcomes. We aim to evaluate the clinical features and outcomes of RM in patients with coronavirus disease 2019 (COVID-19). METHOD: This was 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%. Compared with patients without RM, those with RM tended to have a higher risk of deterioration. Patients with RM also constituted a greater percentage of patients admitted to the intensive care unit (90.9% vs. 5.3%, P < 0.001) and a greater percentage of patients undergoing mechanical ventilation (86.4% vs. 2.7% P < 0.001). Moreover, patients with RM had laboratory test abnormalities, including the presence of markers of inflammation, activation of coagulation, and kidney injury. Patients with RM also had a higher risk of in-hospital death (P < 0.001). Cox's proportional hazard regression model analysis confirmed that RM indicators, including peak creatine kinase levels > 1,000 IU/L (HR = 6.46, 95% CI: 3.02-13.86) and peak serum myoglobin concentrations > 1,000 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 delayed viral clearance. CONCLUSION: RM might be an important contributing factor to adverse outcomes in COVID-19 patients. The early detection and effective intervention of RM may help reduce mortality among COVID-19 patients.


Subject(s)
COVID-19/complications , COVID-19/mortality , Hospital Mortality , Rhabdomyolysis/complications , Rhabdomyolysis/mortality , Adolescent , Adult , Aged , Aged, 80 and over , China/epidemiology , Female , Hospitalization , Humans , Incidence , Intensive Care Units , Male , Middle Aged , Muscle, Skeletal/physiopathology , Proportional Hazards Models , Respiration, Artificial , Retrospective Studies , SARS-CoV-2 , Treatment Outcome , Young Adult
6.
BMC Infect Dis ; 20(1): 899, 2020 Nov 30.
Article in English | MEDLINE | ID: covidwho-949123

ABSTRACT

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 χ2-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.


Subject(s)
COVID-19/epidemiology , COVID-19/mortality , Heart Diseases/epidemiology , Nomograms , Pandemics , Patient Admission , SARS-CoV-2/genetics , Adult , Aged , Aged, 80 and over , C-Reactive Protein/analysis , COVID-19/blood , COVID-19/virology , China/epidemiology , Chronic Disease/epidemiology , Comorbidity , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Lymphocytes , Male , Middle Aged , Prognosis , ROC Curve , Retrospective Studies , Risk Assessment/methods , Risk Factors , Survival Rate
7.
Hypertens Res ; 43(11): 1267-1276, 2020 11.
Article in English | MEDLINE | ID: covidwho-733529

ABSTRACT

Hypertension is a common comorbidity in hospitalized patients with COVID-19 infection. This study aimed to estimate the risks of adverse events associated with in-hospital blood pressure (BP) control and the effects of angiotensin II receptor blocker (ARB) prescription in COVID-19 patients with concomitant hypertension. In this retrospective cohort study, the anonymized medical records of COVID-19 patients were retrieved from an acute field hospital in Wuhan, China. Clinical data, drug prescriptions, and laboratory investigations were collected for individual patients with diagnosed hypertension on admission. Cox proportional hazards models were used to estimate the risks of adverse outcomes associated with BP control during the hospital stay. Of 803 hypertensive patients, 67 (8.3%) were admitted to the ICU, 30 (3.7%) had respiratory failure, 26 (3.2%) had heart failure, and 35 (4.8%) died. After adjustment for confounders, the significant predictors of heart failure were average systolic blood pressure (SBP) (hazard ratio (HR) per 10 mmHg 1.89, 95% confidence interval (CI): 1.15, 3.13) and pulse pressure (HR per 10 mmHg 2.71, 95% CI: 1.39, 5.29). The standard deviations of SBP and diastolic BP were independently associated with mortality and ICU admission. The risk estimates of poor BP control were comparable between patients receiving ARBs and those not receiving ARBs, with the only exception of a high risk of heart failure in the non-ARB group. Poor BP control was independently associated with higher risks of adverse outcomes of COVID-19. ARB drugs did not increase the risks of adverse events in hypertensive patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Hypertension/complications , Pneumonia, Viral/complications , Aged , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Blood Pressure/drug effects , COVID-19 , Coronavirus Infections/mortality , Female , Humans , Hypertension/drug therapy , Hypertension/physiopathology , Male , Middle Aged , Pandemics , Pneumonia, Viral/mortality , Proportional Hazards Models , Retrospective Studies , SARS-CoV-2
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