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1.
Frontiers in molecular biosciences ; 7:157-157, 2020.
Article | WHO COVID | ID: covidwho-689155

ABSTRACT

Introduction: A recently emerging respiratory disease named coronavirus disease 2019 (COVID-19) has quickly spread across the world This disease is initiated by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and uncontrolled cytokine storm, but it remains unknown as to whether a robust antibody response is related to clinical deterioration and poor outcome in COVID-19 patients Methods: Anti-SARS-CoV-2 IgG and IgM antibodies were determined by chemiluminescence analysis (CLIA) in COVID-19 patients at a single center in Wuhan Median IgG and IgM levels in acute and convalescent-phase sera (within 35 days) for all included patients were calculated and compared between severe and non-severe patients Immune response phenotyping based on the late IgG levels and neutrophil-to-lymphocyte ratio (NLR) was characterized to stratified patients into different disease severities and outcomes Results: A total of 222 patients were included in this study IgG was first detected on day 4 of illness, and its peak levels occurred in the fourth week Severe cases were more frequently found in patients with high IgG levels, compared to those with low IgG levels (51 8 vs 32 3%;p = 0 008) Severity rates for patients with NLR(hi)IgG(hi), NLR(hi)IgG(lo), NLR(lo)IgG(hi), and NLR(lo)IgG(lo) phenotype were 72 3, 48 5, 33 3, and 15 6%, respectively (p < 0 0001) Furthermore, severe patients with NLR(hi)IgG(hi), NLR(hi)IgG(lo) had higher inflammatory cytokines levels including IL-2, IL-6 and IL-10, and decreased CD4+ T cell count compared to those with NLR(lo)IgG(lo) phenotype (p < 0 05) Recovery rates for severe patients with NLR(hi)IgG(hi), NLR(hi)IgG(lo), NLR(lo)IgG(hi), and NLR(lo)IgG(lo) phenotype were 58 8% (20/34), 68 8% (11/16), 80 0% (4/5), and 100% (12/12), respectively (p = 0 0592) Dead cases only occurred in NLR(hi)IgG(hi) and NLR(hi)IgG(lo) phenotypes Conclusions: COVID-19 severity is associated with increased IgG response, and an immune response phenotyping based on the late IgG response and NLR could act as a simple complementary tool to discriminate between severe and non-severe COVID-19 patients, and further predict their clinical outcome

2.
Acad Emerg Med ; 27(6): 461-468, 2020 06.
Article in English | MEDLINE | ID: covidwho-686322

ABSTRACT

OBJECTIVES: Rapid and early severity-of-illness assessment appears to be important for critically ill patients with novel coronavirus disease (COVID-19). This study aimed to evaluate the performance of the rapid scoring system on admission of these patients. METHODS: A total of 138 medical records of critically ill patients with COVID-19 were included in the study. Demographic and clinical characteristics on admission used for calculating Modified Early Warning Score (MEWS) and Rapid Emergency Medicine Score (REMS) and outcomes (survival or death) were collected for each case and extracted for analysis. All patients were divided into two age subgroups (<65 years and ≥65 years). The receiver operating characteristic (ROC) curve analyses were performed for overall patients and both subgroups. RESULTS: The median [25th quartile, 75th quartile] of MEWS of survivors versus nonsurvivors were 1 [1, 2] and 2 [1, 3] and those of REMS were 5 [2, 6] and 7 [6, 10], respectively. In overall analysis, the area under the ROC curve for the REMS in predicting mortality was 0.833 (95% confidence interval [CI] = 0.737 to 0.928), higher than that of MEWS (0.677, 95% CI = 0.541 to 0.813). An optimal cutoff of REMS (≥6) had a sensitivity of 89.5%, a specificity of 69.8%, a positive predictive value of 39.5%, and a negative predictive value of 96.8%. In the analysis of subgroup of patients aged <65 years, the area under the ROC curve for the REMS in predicting mortality was 0.863 (95% CI = 0.743 to 0.941), higher than that of MEWS (0.603, 95% CI = 0.462 to 0.732). CONCLUSION: To our knowledge, this study was the first exploration on rapid scoring systems for critically ill patients with COVID-19. The REMS could provide emergency clinicians with an effective adjunct risk stratification tool for critically ill patients with COVID-19, especially for the patients aged <65 years. The effectiveness of REMS for screening these patients is attributed to its high negative predictive value.


Subject(s)
Coronavirus Infections/mortality , Hospital Mortality , Pneumonia, Viral/mortality , Adult , Age Factors , Aged , Aged, 80 and over , Betacoronavirus , Blood Pressure , Cerebrovascular Disorders/epidemiology , China , Comorbidity , Coronavirus , Critical Illness , Early Warning Score , Emergency Medicine , Female , Glasgow Coma Scale , Humans , Lung Diseases/epidemiology , Male , Middle Aged , Oxygen/metabolism , Pandemics , Prognosis , ROC Curve , Respiratory Rate , Retrospective Studies , Risk Assessment , Sensitivity and Specificity
3.
The American Journal of Emergency Medicine ; 2020.
Article | WHO COVID | ID: covidwho-639959

ABSTRACT

Objectives The assessment of illness severity at admission can contribute to decreased mortality in patients with the coronavirus disease (COVID-19) This study was conducted to evaluate the effectiveness of the Sequential Organ Failure Assessment (SOFA) and Quick Sequential Organ Failure Assessment (qSOFA) scoring systems at admission for the prediction of mortality risk in COVID-19 patients Methods We included 140 critically ill COVID-19 patients Data on demographics, clinical characteristics, and laboratory findings at admission were used to calculate SOFA and qSOFA against the in-hospital outcomes (survival or death) that were ascertained from the medical records The predictive accuracy of both scoring systems was evaluated by the receiver operating characteristic (ROC) curve analysis Results The area under the ROC curve for SOFA in predicting mortality was 0 890 (95% CI: 0 826–0 955), which was higher than that of qSOFA (0 742, 95% CI 0 657–0 816) An optimal cutoff of ≥3 for SOFA had sensitivity, specificity, positive predictive value, and negative predictive value of 90 00%, 83 18%, 50 00%, and 97 80%, respectively Conclusions This novel report indicates that SOFA could function as an effective adjunctive risk-stratification tool at admission for critical COVID-19 patients The performance of qSOFA is accepted but inferior to that of SOFA

4.
PLoS One ; 15(7): e0235458, 2020.
Article in English | MEDLINE | ID: covidwho-638588

ABSTRACT

A recently developed pneumonia caused by SARS-CoV-2 bursting in Wuhan, China, has quickly spread across the world. We report the clinical characteristics of 82 cases of death from COVID-19 in a single center. Clinical data on 82 death cases laboratory-confirmed as SARS-CoV-2 infection were obtained from a Wuhan local hospital's electronic medical records according to previously designed standardized data collection forms. All patients were local residents of Wuhan, and a large proportion of them were diagnosed with severe illness when admitted. Due to the overwhelming of our system, a total of 14 patients (17.1%) were treated in the ICU, 83% of deaths never received Critical Care Support, only 40% had mechanical ventilation support despite 100% needing oxygen and the leading cause of death being pulmonary. Most of the patients who died were male (65.9%). More than half of the patients who died were older than 60 years (80.5%), and the median age was 72.5 years. The bulk of the patients who died had comorbidities (76.8%), including hypertension (56.1%), heart disease (20.7%), diabetes (18.3%), cerebrovascular disease (12.2%), and cancer (7.3%). Respiratory failure remained the leading cause of death (69.5%), followed by sepsis/MOF (28.0%), cardiac failure (14.6%), hemorrhage (6.1%), and renal failure (3.7%). Furthermore, respiratory, cardiac, hemorrhagic, hepatic, and renal damage were found in 100%, 89%, 80.5%, 78.0%, and 31.7% of patients, respectively. On admission, lymphopenia (89.2%), neutrophilia (74.3%), and thrombocytopenia (24.3%) were usually observed. Most patients had a high neutrophil-to-lymphocyte ratio of >5 (94.5%), high systemic immune-inflammation index of >500 (89.2%), and increased C-reactive protein (100%), lactate dehydrogenase (93.2%), and D-dimer (97.1%) levels. A high level of IL-6 (>10 pg/ml) was observed in all detected patients. The median time from initial symptoms to death was 15 days (IQR 11-20), and a significant association between aspartate aminotransferase (p = 0.002), alanine aminotransferase (p = 0.037) and time from initial symptoms to death was remarkably observed. Older males with comorbidities are more likely to develop severe disease and even die from SARS-CoV-2 infection. Respiratory failure is the main cause of COVID-19, but the virus itself and cytokine release syndrome-mediated damage to other organs, including cardiac, renal, hepatic, and hemorrhagic damage, should be taken seriously as well.


Subject(s)
Coronavirus Infections/mortality , Coronavirus Infections/pathology , Pneumonia, Viral/mortality , Pneumonia, Viral/pathology , Adult , Age Factors , Aged , Betacoronavirus , Cause of Death , China/epidemiology , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Respiratory Insufficiency/pathology , Retrospective Studies
5.
Acad Emerg Med ; 27(6): 461-468, 2020 06.
Article in English | MEDLINE | ID: covidwho-88721

ABSTRACT

OBJECTIVES: Rapid and early severity-of-illness assessment appears to be important for critically ill patients with novel coronavirus disease (COVID-19). This study aimed to evaluate the performance of the rapid scoring system on admission of these patients. METHODS: A total of 138 medical records of critically ill patients with COVID-19 were included in the study. Demographic and clinical characteristics on admission used for calculating Modified Early Warning Score (MEWS) and Rapid Emergency Medicine Score (REMS) and outcomes (survival or death) were collected for each case and extracted for analysis. All patients were divided into two age subgroups (<65 years and ≥65 years). The receiver operating characteristic (ROC) curve analyses were performed for overall patients and both subgroups. RESULTS: The median [25th quartile, 75th quartile] of MEWS of survivors versus nonsurvivors were 1 [1, 2] and 2 [1, 3] and those of REMS were 5 [2, 6] and 7 [6, 10], respectively. In overall analysis, the area under the ROC curve for the REMS in predicting mortality was 0.833 (95% confidence interval [CI] = 0.737 to 0.928), higher than that of MEWS (0.677, 95% CI = 0.541 to 0.813). An optimal cutoff of REMS (≥6) had a sensitivity of 89.5%, a specificity of 69.8%, a positive predictive value of 39.5%, and a negative predictive value of 96.8%. In the analysis of subgroup of patients aged <65 years, the area under the ROC curve for the REMS in predicting mortality was 0.863 (95% CI = 0.743 to 0.941), higher than that of MEWS (0.603, 95% CI = 0.462 to 0.732). CONCLUSION: To our knowledge, this study was the first exploration on rapid scoring systems for critically ill patients with COVID-19. The REMS could provide emergency clinicians with an effective adjunct risk stratification tool for critically ill patients with COVID-19, especially for the patients aged <65 years. The effectiveness of REMS for screening these patients is attributed to its high negative predictive value.


Subject(s)
Coronavirus Infections/mortality , Hospital Mortality , Pneumonia, Viral/mortality , Adult , Age Factors , Aged , Aged, 80 and over , Betacoronavirus , Blood Pressure , Cerebrovascular Disorders/epidemiology , China , Comorbidity , Coronavirus , Critical Illness , Early Warning Score , Emergency Medicine , Female , Glasgow Coma Scale , Humans , Lung Diseases/epidemiology , Male , Middle Aged , Oxygen/metabolism , Pandemics , Prognosis , ROC Curve , Respiratory Rate , Retrospective Studies , Risk Assessment , Sensitivity and Specificity
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