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1.
Advanced Intelligent Systems ; 4(4), 2022.
Article in English | ProQuest Central | ID: covidwho-1802035

ABSTRACT

Skin‐like electrical sensor has been widely employed for wearable human healthcare monitoring but is limited by electromagnetic interferences, poor waterproof performance, and point‐type measurement. Herein, a skin‐like and stretchable optical fiber (SSOF) sensor with excellent stretchability (up to 100%), flexibility, and excellent compliance with skin is reported. A hybrid coding based on the light intensity difference of two fiber Bragg gratings (FBGs) is created to achieve the resistance for light power fluctuations and the capability of distributed measurement. The SSOF sensor has outstanding durability (>10 000 cycles), waterproofness, and impact resistance. And it can stably work in heat (55 °C) or cold (≈0 °C) environment as well. Furthermore, the SSOF sensor‐based human–computer interaction system is created to achieve the distributed monitoring of physiological parameters and human full‐body movement leading to the enormous potential for virtual reality (VR) and rehabilitation therapy.

2.
J Evid Based Med ; 15(1): 3-5, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1788882
3.
Signal Transduct Target Ther ; 7(1): 112, 2022 Apr 02.
Article in English | MEDLINE | ID: covidwho-1773956

ABSTRACT

Critical coronavirus disease 2019 (COVID-19) is associated with high mortality and potential genetic factors have been reported to be involved in the development of critical COVID-19. We performed a genome-wide association study to identify the genetic factors responsible for developing critical COVID-19. 632 critical patients with COVID-19 and 3021 healthy controls from the Chinese population were recruited. First, we identified a genome-wide significant difference of IL-6 rs2069837 (p = 9.73 × 10-15, OR = 0.41) between 437 critical patients with COVID-19 and 2551 normal controls in the discovery cohort. When replicated these findings in a set of 195 patients with critical COVID-19 and 470 healthy controls, we detected significant association of rs2069837 with COVID-19 (p = 8.89 × 10-3, OR = 0.67). This variant surpassed the formal threshold for genome-wide significance (combined p = 4.64 × 10-16, OR = 0.49). Further analysis revealed that there was a significantly stronger expression of IL-6 in the serum from patients with critical COVID-19 than in that from patients with asymptomatic COVID-19. An in vitro assay showed that the A to G allele changes in rs2069837 within IL-6 obviously decreased the luciferase expression activity. When analyzing the effect of this variant on the IL-6 in the serum based on the rs2069837 genotype, we found that the A to G variation in rs2069837 decreased the expression of IL-6, especially in the male. Overall, we identified a genetic variant in IL-6 that protects against critical conditions with COVID-19 though decreasing IL-6 expression in the serum.


Subject(s)
COVID-19 , Interleukin-6/genetics , COVID-19/genetics , Genetic Predisposition to Disease/genetics , Genome-Wide Association Study , Humans , Male , Polymorphism, Single Nucleotide/genetics
4.
Antimicrob Agents Chemother ; 66(3): e0204521, 2022 03 15.
Article in English | MEDLINE | ID: covidwho-1759274

ABSTRACT

Recombinant human severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) monoclonal antibody JS016 showed neutralizing and therapeutic effects in preclinical studies. The clinical efficacy and safety of the therapy needed to be evaluated. In this phase 2/3, multicenter, randomized, open-label, controlled trial, hospitalized patients with moderate or severe coronavirus disease 2019 (COVID-19) were randomly assigned in a 1:1 ratio to receive standard care or standard care plus a single intravenous infusion of JS016. The primary outcome was a six-level ordinal scale of clinical status on day 28 since randomization. Secondary outcomes include adverse events, 28-day mortality, ventilator-free days within 28 days, length of hospital stay, and negative conversion rate of SARS-CoV-2 nucleic acid on day 14. A total of 199 patients were randomized, and 197 (99 in the JS016 group and 98 in the control group) were analyzed. Most patients, 95 (96%) in the JS016 group and 97 (99%) in the control group were in the best category on day 28 since randomization. The odds ratio of being in a better clinical status was 0.31 (95% confidence interval [CI], 0.03 to 3.19; P = 0.33). Few adverse events occurred in both groups (3% in the JS016 group and 1% in the control group, respectively; P = 0.34). SARS-CoV-2 neutralizing antibody JS016 did not show clinical efficacy among hospitalized Chinese patients with moderate to severe COVID-19 disease. Further studies are needed to assess the efficacy of the neutralizing antibody to prevent disease deterioration and its benefits among groups of patients specified by disease course and severity. (This study has been registered at ClinicalTrials.gov under identifier NCT04931238.).


Subject(s)
COVID-19 , Antibodies, Monoclonal, Humanized , Antibodies, Neutralizing/therapeutic use , COVID-19/drug therapy , China , Humans , SARS-CoV-2 , Treatment Outcome
5.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-315210

ABSTRACT

Background: Evidence of glucocorticoids on viral clearance delay of COVID-19 patients is not clear. Methods: In this systematic review and meta-analysis, we searched studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, and ClinicalTrials.gov from 2002 to December 2, 2020. We mainly pooled the adjusted hazard ratios (HRs), mean difference (MD) or risk ratios (RRs) of viral clearance delay and did subgroup analyses by doses and the severity of illness. Results: One trial and 38 observational studies, with a total of 7119 patients, were identified. Glucocorticoids treatment was associated with delayed viral clearance in COVID-19 (Adjusted HR 1.71, 95% CI 1.51 to 1.94, I 2 =22%, PI 1.45 to 2.01), based on moderate-quality evidence. In subgroup analyses, risk of viral clearance delay was significantly higher among COVID-19 patients being mild or moderate ill (adjusted HR 1.94, 95% CI 1.39 to 2.70, I 2 =52%;MD 2.59, 95% CI 1.21 to 3.97, I 2 =24%), but not in those of being severe or critical ill (adjusted HR 1.85, 95% CI 1.05 to 3.26;MD 0.22, 95% CI -1.85 to 2.29, I 2 =56%);taking high doses (adjusted HR 1.49, 95% CI 1.03 to 2.15;unadjusted RR 1.47, 95% CI 1.12 to 1.94) rather taking low doses (adjusted HR 1.39, 95% CI 0.93 to 2.08;unadjusted RR 1.33, 95% CI 1.00 to 1.77) or pulse (unadjusted RR 1.85, 95% CI 0.66 to 5.19). Conclusions: Glucocorticoids treatment delayed viral clearance in COVID-19 patients of being mild or moderate ill or taking a high dose, rather in those of being severe or critical ill or taking low dose or pulse.

6.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-315209

ABSTRACT

Background: The response to glucocorticoids treatment may be different between Covid-19 and SARS. Methods: In this systematic review and meta-analysis, we searched studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, ClinicalTrials.gov, ICTRP from 2002 to October 7, 2020. We used fixed-effects and random-effects models to compute the risk ratio of death in the group receiving glucocorticoids treatment and the control group for COVID-19 and SARS, respectively. Results: Ten trials and 71 observational studies, with a total of 45935 patients, were identified. Glucocorticoids treatment, was associated with decreased all-cause mortality both in COVID-19 (risk ratio, 0.88;95% confidence interval, 0.82 to 0.94;I 2 =26%) and SARS (0.48;0.29 to 0.79;10%), based on high quality evidence, as well as decreased all-cause mortality-including composite outcome of COVID-19 (0.89;0.82 to 0.98;0%). In subgroup analyses, all-cause mortality was significantly lower among COVID-19 patients being accompanied by severe ARDS but not mild ARDS, taking low-dose or pulse glucocorticoids, being critically severe but not only severe, being of critical severity and old but not young, being of critical severity and men but not women, non-early taking glucocorticoids and taking dexamethasone or methylprednisolone;but for SARS, lower mortality were observed among those who were taking medium-high dose glucocorticoids, being severe or critically severe, early taking glucocorticoids, and taking dexamethasone or prednisolone. Conclusions: Glucocorticoids treatment reduced mortality in COVID-19 and SARS patients of critical severity;however, different curative effects existed between the two diseases among subpopulations, mainly regarding sex- and age-specific effects, optimal doses and use timing of glucocorticoids.

7.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-325388

ABSTRACT

Background: During the COVID-19 pandemic, a phenomenon emerged in which some patients with severe disease were critically ill and could not be discharged from the ICU even though they exhibited negative viral tests. In general, continuous negative viral tests are thought to indicate that the virus has been cleared from the body and that the patients can be considered "recovered". However, because these patients were still critically ill, they obviously had not truly recovered from the disease. We sought to investigate why these patients were still critically ill even though they exhibited negative viral tests by analyzing the gene expression profiles of their peripheral immune cells using transcriptome sequencing. Methods: Fourteen severe COVID-19 patients with at least 3 negative virus tests but were still in critical ill and could not be discharged from the ICU were enrolled. Blood samples from 14 patients and 5 healthy donors were collected. Total RNA was extracted from nucleated cells for RNA-Sequencing. FeatureCounts v1.5.0-p3 was used to count the reads numbers mapped to each gene. Results: All enrolled patients, regardless of changes in genes related to different symptoms and inflammatory responses, showed universally and severely decreased expression of adaptive immunity-related genes, especially those related to T/B cell arms and HLA molecules, and that these patients exhibited long-term secondary infections. This adaptive immune suppression is unlikely due to classic immune checkpoint molecules such as PD-1 or long-term use of glucocorticoids but may be caused by an unknown mechanism that has not yet been discovered. Conclusions: Our findings strongly suggest that an initial recovery of these severe COVID-19 patients, as indicated by negative viral tests, may not indicate actual recovery. They still suffer from secondary infections for a long period of time because of severe adaptive immunosuppression and need to receive a variety of antibiotics, antifungal drugs, or combination therapies. Appropriate methods should be used to detect their adaptive immune function, and appropriate immunotherapy that can activate the adaptive immune response should be developed. Trial registration: Not applicable (this study does not involve intervention on human participants).

8.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-323678

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pneumonia, outbreak in Wuhan, China, has led to a global pandemic. The high mortality of COVID-19 patients makes it significant to evaluate possible disease progression. This study was designed to explore the prognostic value of Controlling Nutritional Status (CONUT) score in patients with COVID-19. Methods Patients diagnosed with COVID-19 of a single center in Wuhan, China from January 2020 to February 2020 were enrolled in this study. Logistic regression analysis was performed to find independent risk factor of mortality. Receiver operating characteristics (ROC) curve was drawn to evaluate the prognostic value of CONUT score. Results Among 442 included patients, there were 79 non-survivors with mortality of 17.9%. Compared with survivors, the median age (p < 0.001) and male ratio (p = 0.042) were higher in non-survivors. Non-survivors had higher incidence of comorbidities including hypertension (p < 0.001), chronic lung disease (p = 0.001) and cardiovascular disease (p = 0.005). Complications such as respiratory failure(p < 0.001), acute kidney injury (AKI) (p < 0.001) occurred more frequently in non-survivors. Multivariate logistic regression analysis showed that CONUT (p = 0.002), lactate dehydrogenase (LDH) (p < 0.001), C-reactive protein (CRP) (p = 0.020) were risk factor of mortality in COVID-19 patients. Area under the ROC curve (AUC) of CONUT and Nutrition risk screening 2002 (NRS2002) score were 0.813 and 0.795, respectively. Comprised of CONUT, LDH, CRP, the constructed prognostic model had higher AUC of 0.923 (Z = 3.5210, p < 0.001). Conclusion CONUT is an independent risk factor of mortality in COVID-19 patients. Evaluating CONUT is beneficial for clinicians to predict the progression of COVID-19 patients and strengthen monitoring and management to improve prognosis.

9.
PLoS One ; 16(12): e0261437, 2021.
Article in English | MEDLINE | ID: covidwho-1581743

ABSTRACT

BACKGROUND AND OBJECTIVES: At present, the focus of the fighting against COVID-19 in China is shifting to strictly prevent the entrance of cases from abroad and disease transmission. Therefore, it is extremely urgent to better understand the clinical features of imported cases from overseas countries, which is conductive to formulate the corresponding countermeasures. This study aimed to describe the clinical features of COVID-19 cases imported from Russia through the Suifenhe port, in order to identify baseline and clinical data associated with disease progression and present corresponding countermeasures. METHODS: All COVID-19 cases imported from Russia through the Suifenhe port were included in this retrospective study. According to the "Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (seventh edition)", imported COVID-19 cases were divided into asymptomatic infection, mild, moderate, severe, and critical groups. Baseline and clinical data, including age, gender, comorbidities, disease severity, symptoms at onset, body temperature, white blood cell (WBC) count, lymphocyte (LYMPH) count, lymphocyte percentage (LYM%), C-reactive protein (CRP), oxygenation index (OI), and the use therapeutic modalities were obtained on admission, and then compared between groups. RESULTS: A total of 375 COVID-19 cases imported from Russia through Suifenhe port were included, of whom the asymptomatic infection, mild, moderate, severe, and critical groups accounted for 4.0%, 13.9%, 75.5%, 5.3%, and 1.3%, respectively. The majority of the imported COVID-19 cases were men (61.9%) with a median age of 38.72 years who had no comorbidity (87.7%). Nearly one-third of them (33.1%) were asymptomatic at onset, and common initial symptoms included fever (36.5%), cough (36.0%), pharyngeal discomfort (12.3%), expectoration (8.0%), and chest tightness (5.3%). In total, 180 (48%) and 4 (1.1%) enrolled imported cases received nasal tube oxygen inhalation therapy and high-flow oxygen absorption, respectively; the remaining patients did not undergo oxygen therapy. The values of age, body temperature, WBC, LYMPH, LYM%, CRP, and OI were 38.72 ± 10.50, 35.10 ± 7.92, 5.59 ± 1.97, 1.67 ± 0.68, 31.05 ± 10.22, 8.00 ± 14.75, and 389.03 ± 74.07, respectively. Gender, age, LYMPH, LYM%, symptoms at onset, cough, fever, other rare symptoms, and oxygen therapy showed significant differences between groups (P = 0.036, < 0.001, < 0.001, < 0.001, < 0.001, < 0.001, < 0.001, = 0.045, < 0.001, respectively). CONCLUSIONS: Compared with domestic confirmed patients, COVID-19 patients who arrived at China from Russia through the Suifenhe port had significantly different clinical features, and the differences in gender, age, LYMPH, LYM%, symptoms at onset, cough, fever, other rare symptoms, and oxygen therapy between groups were statistically significant. Therefore, detailed and comprehensive countermeasures were developed to manage and prevent another outbreak based on these clinical features.


Subject(s)
COVID-19/epidemiology , COVID-19/etiology , Adolescent , Adult , Aged , COVID-19/therapy , China/epidemiology , Comorbidity , Cough/virology , Female , Humans , Lymphocyte Count , Male , Middle Aged , Retrospective Studies , Russia , Severity of Illness Index , Young Adult
10.
Comput Biol Med ; 141: 105123, 2022 02.
Article in English | MEDLINE | ID: covidwho-1588037

ABSTRACT

This article presents a systematic overview of artificial intelligence (AI) and computer vision strategies for diagnosing the coronavirus disease of 2019 (COVID-19) using computerized tomography (CT) medical images. We analyzed the previous review works and found that all of them ignored classifying and categorizing COVID-19 literature based on computer vision tasks, such as classification, segmentation, and detection. Most of the COVID-19 CT diagnosis methods comprehensively use segmentation and classification tasks. Moreover, most of the review articles are diverse and cover CT as well as X-ray images. Therefore, we focused on the COVID-19 diagnostic methods based on CT images. Well-known search engines and databases such as Google, Google Scholar, Kaggle, Baidu, IEEE Xplore, Web of Science, PubMed, ScienceDirect, and Scopus were utilized to collect relevant studies. After deep analysis, we collected 114 studies and reported highly enriched information for each selected research. According to our analysis, AI and computer vision have substantial potential for rapid COVID-19 diagnosis as they could significantly assist in automating the diagnosis process. Accurate and efficient models will have real-time clinical implications, though further research is still required. Categorization of literature based on computer vision tasks could be helpful for future research; therefore, this review article will provide a good foundation for conducting such research.


Subject(s)
Artificial Intelligence , COVID-19 , COVID-19 Testing , Computers , Humans , SARS-CoV-2 , Tomography, X-Ray Computed
11.
Front Immunol ; 12: 755579, 2021.
Article in English | MEDLINE | ID: covidwho-1556334

ABSTRACT

During the COVID-19 pandemic, a phenomenon emerged in which some patients with severe disease were critically ill and could not be discharged from the ICU even though they exhibited negative viral tests. To explore the underlying mechanism, we collected blood samples from these patients and analyzed the gene expression profiles of peripheral immune cells. We found that all enrolled patients, regardless of changes in genes related to different symptoms and inflammatory responses, showed universally and severely decreased expression of adaptive immunity-related genes, especially those related to T/B cell arms and HLA molecules, and that these patients exhibited long-term secondary infections. In addition, no significant change was found in the expression of classic immunosuppression molecules including PD-1, PD-L1, and CTLA-4, suggesting that the adaptive immune suppression may not be due to the change of these genes. According to the published literatures and our data, this adaptive immunosuppression is likely to be caused by the "dysregulated host response" to severe infection, similar to the immunosuppression that exists in other severely infected patients with sepsis.


Subject(s)
Adaptive Immunity/immunology , COVID-19/immunology , Immune Tolerance/immunology , Adaptive Immunity/genetics , Aged , COVID-19/diagnosis , COVID-19/genetics , Coinfection/diagnosis , Coinfection/genetics , Coinfection/immunology , Cross-Sectional Studies , Cytokine Release Syndrome/genetics , Female , Gene Expression Profiling , Humans , Immune Tolerance/genetics , Inflammation/genetics , Intensive Care Units , Male , Middle Aged , Patient Discharge , SARS-CoV-2/isolation & purification , Smell/genetics , Taste/genetics
12.
Front Med (Lausanne) ; 8: 699227, 2021.
Article in English | MEDLINE | ID: covidwho-1506271

ABSTRACT

Background: The novel coronavirus disease 2019 (COVID-19) pandemic has become a global health crisis affecting over 200 countries worldwide. Extracorporeal membrane oxygenation (ECMO) has been increasingly used in the management of COVID-19-associated end-stage respiratory failure. However, the exact effect of ECMO in the management of these patients, especially with regards to complications and mortality, is unclear. Methods: This is the largest retrospective study of ECMO treated COVID-19 patients in China. A total of 50 ECMO-treated COVID-19 patients were recruited. We describe the main characteristics, the clinical features, ventilator parameters, ECMO-related variables and management details, and complications and outcomes of COVID-19 patients with severe acute respiratory distress syndrome (ARDS) that required ECMO support. Results: For those patients with ECMO support, 21 patients survived and 29 died (mortality rate: 58.0%). Among those who survived, PaO2 (66.3 mmHg [59.5-74.0 mmHg] and PaO2/FiO2 (68.0 mmHg [61.0-76.0 mmHg]) were higher in the survivors than those of non-survivors (PaO2: 56.8 mmHg (49.0-65.0 mmHg), PaO2/FiO2 (58.2 mmHg (49.0-68.0 mmHg), all P < 0.01) prior to ECMO. Patients who achieved negative fluid balance in the early resuscitation phase (within 3 days) had a higher survival rate than those who did not (P = 0.0003). Conclusions: In this study of 50 cases of ECMO-treated COVID-19 patients, a low PO2/FIO2 ratio before ECMO commencement may indicate a poor prognosis. Negative fluid balance in the early resuscitation phase during ECMO treatment was a predictor of increased survival post-ECMO treatment.

13.
Front Med (Lausanne) ; 8: 659793, 2021.
Article in English | MEDLINE | ID: covidwho-1497084

ABSTRACT

Background: Extracorporeal membrane oxygenation (ECMO) might benefit critically ill COVID-19 patients. But the considerations besides indications guiding ECMO initiation under extreme pressure during the COVID-19 epidemic was not clear. We aimed to analyze the clinical characteristics and in-hospital mortality of severe critically ill COVID-19 patients supported with ECMO and without ECMO, exploring potential parameters for guiding the initiation during the COVID-19 epidemic. Methods: Observational cohort study of all the critically ill patients indicated for ECMO support from January 1 to May 1, 2020, in all 62 authorized hospitals in Wuhan, China. Results: Among the 168 patients enrolled, 74 patients actually received ECMO support and 94 not were analyzed. The in-hospital mortality of the ECMO supported patients was significantly lower than non-ECMO ones (71.6 vs. 85.1%, P = 0.033), but the role of ECMO was affected by patients' age (Logistic regression OR 0.62, P = 0.24). As for the ECMO patients, the median age was 58 (47-66) years old and 62.2% (46/74) were male. The 28-day, 60-day, and 90-day mortality of these ECMO supported patients were 32.4, 68.9, and 74.3% respectively. Patients survived to discharge were younger (49 vs. 62 years, P = 0.042), demonstrated higher lymphocyte count (886 vs. 638 cells/uL, P = 0.022), and better CO2 removal (PaCO2 immediately after ECMO initiation 39.7 vs. 46.9 mmHg, P = 0.041). Age was an independent risk factor for in-hospital mortality of the ECMO supported patients, and a cutoff age of 51 years enabled prediction of in-hospital mortality with a sensitivity of 84.3% and specificity of 55%. The surviving ECMO supported patients had longer ICU and hospital stays (26 vs. 18 days, P = 0.018; 49 vs. 29 days, P = 0.001 respectively), and ECMO procedure was widely carried out after the supplement of medical resources after February 15 (67.6%, 50/74). Conclusions: ECMO might be a benefit for severe critically ill COVID-19 patients at the early stage of epidemic, although the in-hospital mortality was still high. To initiate ECMO therapy under tremendous pressure, patients' age, lymphocyte count, and adequacy of medical resources should be fully considered.

14.
BMC Infect Dis ; 21(1): 1063, 2021 Oct 14.
Article in English | MEDLINE | ID: covidwho-1468048

ABSTRACT

BACKGROUND: Evidence of glucocorticoids on viral clearance delay of COVID-19 patients is not clear. METHODS: In this systematic review and meta-analysis, we searched for studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, and ClinicalTrials.gov from 2019 to April 20, 2021. We mainly pooled the risk ratios (RRs) and mean difference (MD) for viral clearance delay and did subgroup analyses by the severity of illness and doses of glucocorticoids. RESULTS: 38 studies with a total of 9572 patients were identified. Glucocorticoids treatment was associated with delayed viral clearance in COVID-19 patients (adjusted RR 1.52, 95% CI 1.29 to 1.80, I2 = 52%), based on moderate-quality evidence. In subgroup analyses, risk of viral clearance delay was significant both for COVID-19 patients being mild or moderate ill (adjusted RR 1.86, 95% CI 1.35 to 2.57, I2 = 48%), and for patients of being severe or critical ill (adjusted RR 1.59, 95% CI 1.23 to 2.07, I2 = 0%); however, this risk significantly increased for patients taking high doses (unadjusted RR 1.85, 95% CI 1.08 to 3.18; MD 7.19, 95% CI 2.78 to 11.61) or medium doses (adjusted RR 1.86, 95% CI 0.96 to 3.62, I2 = 45%; MD 3.98, 95% CI 3.07 to 4.88, I2 = 4%), rather those taking low doses (adjusted RR 1.38, 95% CI 0.94 to 2.02, I2 = 59%; MD 1.46, 95% CI -0.79 to 3.70, I2 = 82%). CONCLUSIONS: Glucocorticoids treatment delayed viral clearance in COVID-19 patients of taking high doses or medium doses, rather in those of taking low doses of glucocorticoids.


Subject(s)
COVID-19 , Glucocorticoids , Glucocorticoids/therapeutic use , Humans , SARS-CoV-2
15.
Int J Gen Med ; 14: 5313-5322, 2021.
Article in English | MEDLINE | ID: covidwho-1414027

ABSTRACT

BACKGROUND: Electrolyte disturbances are commonly observed in patients with coronavirus disease 2019 (COVID-19) and associated with outcome in these patients. Our study was designed to examine whether hypophosphatemia is associated with mortality in COVID-19 patients. METHODS: Patients diagnosed with COVID-19 and hospitalized in Renmin Hospital of Wuhan University between January 30 and February 24, 2020 were included in this study. Patients were divided into two groups, a hypophosphatemia group and a non-hypophosphatemia group, based on a serum phosphate level of 0.8 mmol/L. Logistic regression was performed to analyze the relationship between hypophosphatemia and mortality. A locally weighted scatterplot smoothing (LOWESS) curve was plotted to show the detailed association between mortality rate and serum phosphate level. A Kaplan-Meier survival curve was drawn to compare the difference in cumulative survival between the two groups. RESULTS: Hypophosphatemia at admission occurred in 33 patients, with an incidence of 7.6%. The hypophosphatemia group had a significantly higher incidence of respiratory failure (54.5% vs 32.6%, p=0.013) and mortality (57.6% vs 15.2%, p<0.001). Multivariate logistic regression indicated that age (OR=1.059, p<0.001), oxygen saturation (OR=0.733, p<0.001), white blood cells (OR=1.428, p<0.001), lymphocytes (OR=0.075, p<0.001) and hypophosphatemia (OR=3.636, p=0.015) were independently associated with mortality in the included patients. The hypophosphatemia group had significantly shorter survival than the non-hypophosphatemia group (p<0.001). CONCLUSION: Hypophosphatemia at admission is associated with increased mortality in COVID-19 patients. More attention and medical care should be given to COVID-19 patients with hypophosphatemia at admission.

16.
Wien Klin Wochenschr ; 133(17-18): 882-891, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1338216

ABSTRACT

PURPOSE: The aim of this study was to determine whether the neutrophil to lymphocyte ratio (NLR) can predict severe Coronavirus disease 2019 (COVID-19). PATIENTS AND METHODS: A multicenter case-control study was conducted to investigate whether the NLR can help predict the severity of COVID-19. Patients confirmed to have COVID-19 between 16 January 2020 and 15 March 2020 were enrolled. Furthermore, meta-analyses were conducted based on both previous studies and our case-control study. RESULTS: In the case-control study, 213 patients (severe: 81) were included. The results suggested that the NLR was an independent risk factor (odds ratio [OR], 1.155, 95% confidence interval [95% CI]: 1.043-1.279, P = 0.006) and a great predictor (the area under the ROC curve was 0.728, 95% CI: 0.656-0.800) for severe COVID-19. In total, 18 datasets from 16 studies combined with our case-control study (severe: 1211; non-severe: 5838) were included in the meta-analyses and the results showed that the NLR of the severe COVID-19 group was significantly higher than that of the non-severe group (SMD = 1.10, 95% CI: 0.90-1.31, P < 0.001). Based on the 2â€¯× 2 data from 6 studies, the SROC of NLR for predicting severe COVID-19 was 0.802, with a sensitivity of 0.67 (95% CI: 0.61-0.72) and a specificity of 0.75 (95% CI: 0.73-0.78). CONCLUSION: Based on a multicenter case-control study and a meta-analysis, we found that the initial NLR was a great predictor of severe COVID-19.


Subject(s)
COVID-19 , Neutrophils , Case-Control Studies , Humans , Lymphocyte Count , Lymphocytes , Multicenter Studies as Topic , Prognosis , Retrospective Studies , SARS-CoV-2
17.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(6): 744-747, 2021 Jun.
Article in Chinese | MEDLINE | ID: covidwho-1323330

ABSTRACT

OBJECTIVE: To investigate the clinical practice of Chinese respiratory therapists (RTs) participating in the treatment of coronavirus disease 2019 (COVID-19) patients and summarize the experience and role of RTs in the treatment of pandemic infectious diseases. METHODS: A self-designed questionnaire was used to investigate the RTs who treated COVID-19 patients in 31 provinces, cities and autonomous regions in China. The survey questionnaire included the basic work of RTs, the specific work of the treatment for COVID-19 patients and problems encountered at work. RESULTS: A total of 126 questionnaires were issued and 40 valid questionnaires were collected from RTs who treated COVID-19 patients at 22 COVID-19 designated hospitals in 8 provinces and municipalities. This included 7 hospitals in Wuhan, the epicenter of the epidemic. In their medical team, RTs accounted for 2.9% (1.5%, 6.7%) of medical staff, the working experience of the RTs was about (6.2±5.4) years, the ratio of RTs to beds was about 1:11 (1:5, 1:26), and 85.0% (34/40) of RTs were transferred from other hospitals. 97.5% (39/40) of RTs were involved in formulating individual respiratory care strategies in their medical teams, and they were all involved in the evaluation of respiratory care and decision-making as well as the early identification of deterioration of respiratory function. All RTs [100% (40/40)] indicated that they would actively monitor patients' respiratory status, increase the means and frequency of the monitoring, implement standardized oxygen therapy, prevent ventilator-associated lung injury (VALI), and standardize the management of artificial airway. However, less than 50% of RTs had carried out stress and strain, transpulmonary pressure, partial pressure of end-tidal carbon dioxide (PetCO2), end-expiratory lung volume, electrical impedance tomography (EIT) and other respiratory function monitoring. 85% of RTs conducted training and education related to respiratory care and formulated relevant standard operating procedures for their medical teams. More than 90% of RTs led the implementation of high-flow nasal cannula oxygen therapy (HFNC), pulmonary protective mechanical ventilation, prone ventilation, pulmonary rehabilitation, airway management, transfer of critical patients, and other respiratory treatment. CONCLUSIONS: RTs performed their professional role fully in the assessment, decision-making, and clinical practice in the treatment of COVID-19 patients. However, the manpower shortage of RTs is extremely prominent, the practical experience has provided the basis for the future treatment of infectious respiratory diseases and effectively promoted the development of respiratory care in China.


Subject(s)
COVID-19 , China , Humans , Pandemics , Respiration, Artificial , SARS-CoV-2
18.
Shock ; 56(2): 215-228, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1316855

ABSTRACT

BACKGROUND: The response to glucocorticoids treatment may be different between coronavirus disease 2019 (Covid-19) and severe acute respiratory syndrome (SARS). METHODS: In this systematic review and meta-analysis, we searched studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, ClinicalTrials.gov, International Clinical Trials Registry Platform from 2002 to October 7, 2020. We used fixed-effects and random-effects models to compute the risk ratio of death in the group receiving glucocorticoids treatment and the control group for COVID-19 and SARS, respectively. RESULTS: Ten trials and 71 observational studies, with a total of 45,935 patients, were identified. Glucocorticoids treatment was associated with decreased all-cause mortality both in COVID-19 (risk ratio, 0.88; 95% confidence interval, 0.82-0.94; I2 = 26%) and SARS (0.48; 0.29-0.79; 10%), based on high-quality evidence, as well as decreased all-cause mortality-including composite outcome of COVID-19 (0.89; 0.82-0.98; 0%). In subgroup analyses, all-cause mortality was significantly lower among COVID-19 patients being accompanied by severe ARDS but not mild ARDS, taking low-dose or pulse glucocorticoids, being critically severe but not only severe, being of critical severity and old but not young, being of critical severity and men but not women, non-early taking glucocorticoids, taking dexamethasone or methylprednisolone, and with the increased inflammatory state; but for SARS, lower mortality was observed among those who were taking medium-high dose glucocorticoids, being severe or critically severe, early taking glucocorticoids, and taking methylprednisolone or prednisolone. CONCLUSIONS: Glucocorticoids treatment reduced mortality in COVID-19 and SARS patients of critical severity; however, different curative effects existed between the two diseases among subpopulations, mainly regarding sex- and age-specific effects, optimal doses, and use timing of glucocorticoids.


Subject(s)
COVID-19/drug therapy , Glucocorticoids/therapeutic use , Pandemics , SARS-CoV-2 , COVID-19/mortality , Global Health , Humans , Survival Rate/trends
19.
BMC Geriatr ; 21(1): 355, 2021 06 10.
Article in English | MEDLINE | ID: covidwho-1266472

ABSTRACT

BACKGROUND: Since the outbreak of COVID-19, it has been documented that old age and underlying illnesses are associated with poor prognosis among COVID-19 patients. However, it is unknown whether sarcopenia, a common geriatric syndrome, is associated with poor prognosis among older COVID-19 patients. The aim of our prospective cohort study is to investigate the association between sarcopenia risk and severe disease among COVID-19 patients aged ≥60 years. METHOD: A prospective cohort study of 114 hospitalized older patients (≥60 years) with confirmed COVID-19 pneumonia between 7 February, 2020 and 6 April, 2020. Epidemiological, socio-demographic, clinical and laboratory data on admission and outcome data were extracted from electronic medical records. All patients were assessed for sarcopenia on admission using the SARC-F scale and the outcome was the development of the severe disease within 60 days. We used the Cox proportional hazards model to identify the association between sarcopenia and progression of disease defined as severe cases in a total of 2908 person-days. RESULT: Of 114 patients (mean age 69.52 ± 7.25 years, 50% woman), 38 (33%) had a high risk of sarcopenia while 76 (67%) did not. We found that 43 (38%) patients progressed to severe cases. COVID-19 patients with higher risk sarcopenia were more likely to develop severe disease than those without (68% versus 22%, p < 0.001). After adjustment for demographic and clinical factors, higher risk sarcopenia was associated with a higher hazard of severe condition [hazard ratio = 2.87 (95% CI, 1.33-6.16)]. CONCLUSION: We found that COVID-19 patients with higher sarcopenia risk were more likely to develop severe condition. A clinician-friendly assessment of sarcopenia could help in early warning of older patients at high-risk with severe COVID-19 pneumonia.


Subject(s)
COVID-19 , Sarcopenia , Aged , Female , Geriatric Assessment , Humans , Proportional Hazards Models , Prospective Studies , SARS-CoV-2 , Sarcopenia/diagnosis , Sarcopenia/epidemiology , Surveys and Questionnaires
20.
J Clin Lab Anal ; 35(6): e23805, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1241507

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) has been reported developing commonly in coronavirus disease 2019 (COVID-19) patients and could increase the risk of poor outcomes in these patients. We design this study to explore the value of serum procalcitonin (PCT) on predicting AKI and construct risk score for predicting AKI in COVID-19 patients. METHODS: Patients diagnosed with COVID-19 and hospitalized in Renmin Hospital of Wuhan University between January 30 and February 24, 2020, were included. The least absolute shrinkage and selection operator (LASSO) regression was performed to identify the strongest predictors of AKI. Multivariate logistic regression analysis was conducted to find independent risk factors for AKI and construct risk score using odds ratio (OR) value of those risk factors. Receiver operating characteristics (ROC) curves were plotted, and area under the ROC curve (AUC) value was calculated to evaluate the predictive value of single PCT level and the constructed risk score. RESULTS: Among 389 included COVID-19 patients, 28 (7.2%) patients developed AKI. LASSO regression showed hypertension, saturation of arterial oxygen (SaO2 ), PCT, and blood urea nitrogen (BUN) were the strongest predictors for AKI. After multivariate logistic regression analysis, only SaO2 (<0.001), PCT (p = 0.004), and BUN (p = 0.005) were independently associated with development of AKI in COVID-19 patients. The AUC of single PCT and constructed risk score was 0. 881 and 0.928, respectively. CONCLUSION: PCT level is correlated with AKI in COVID-19 patients. The efficient risk score consisted of SaO2 , PCT, and BUN is readily accessible for physicians to evaluate the possibility of AKI in COVID-19 patients.


Subject(s)
Acute Kidney Injury , COVID-19 , Procalcitonin/blood , Acute Kidney Injury/blood , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/virology , Adult , Aged , Aged, 80 and over , Biomarkers/blood , COVID-19/complications , COVID-19/epidemiology , China , Female , Humans , Male , Middle Aged , Risk Assessment , Risk Factors , SARS-CoV-2
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