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1.
Biomed Res Int ; 2022: 9929038, 2022.
Article in English | MEDLINE | ID: covidwho-1968389

ABSTRACT

Background: Patients with severe coronavirus disease 2019 (COVID-19) who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality. This study evaluated the prognostic impact of AKI duration on in-hospital mortality in elder patients. Methods: We performed a retrospective study of 126 patients with confirmed COVID-19 with severe or critical disease who treated in the ICU from February 4, 2020, to April 16, 2020. AKI was defined according to the Kidney Disease Improving Global Outcomes serum creatinine (Scr) criteria. AKI patients were divided into transient AKI and persistent AKI groups based on whether Scr level returned to baseline within 48 h post-AKI. Results: In total, 107 patients were included in the final analysis. The mean age was 70 (64-78) years, and 69 (64.5%) patients were men. AKI occurred in 48 (44.9%) during their ICU stay. Of these, 11 (22.9%) had transient AKI, and 37 (77.9%) had persistent AKI. In-hospital mortality was 18.6% (n = 11) for patients without AKI, 72.7% (n = 8) for patients with transient AKI, and 86.5% (n = 32) for patients with persistent AKI (P < 0.001). Kaplan-Meier curve analysis revealed that patients with both transient AKI and persistent AKI had significantly higher death rates than those without AKI (log-rank P < 0.001). Multivariate Cox regression analysis revealed that transient and persistent AKI were an important risk factor for in-hospital mortality in older patients with severe COVID-19 even after adjustment for variables (hazard ratio [HR] = 2.582; 95% CI: 1.025-6.505; P = 0.044; and HR = 6.974; 95% CI: 3.334-14.588; P < 0.001). Conclusions: AKI duration can be an important predictive parameter in elder patients suffering from COVID-19 and are admitted to ICU. Among these patients, those exhibiting persistent AKI have a lower in-hospital survival rate than those with transient AKI, emphasizing the importance of identifying an appropriate treatment window for early intervention.


Subject(s)
Acute Kidney Injury , COVID-19 , Aged , COVID-19/complications , Female , Hospital Mortality , Humans , Intensive Care Units , Male , Retrospective Studies , Risk Factors
2.
Arch Virol ; 167(6): 1405-1420, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1864402

ABSTRACT

Coxsackievirus A19 (CV-A19) is an enterovirus belonging to the species Enterovirus C, and the prototype strain 8663 was isolated from a patient with Guillain-Barré syndrome in Japan. In this study, we determined the complete genome sequence of a CV-A19 isolate identified in a stool sample from a child with hand, foot, and mouth disease in Xinxiang, Henan, China, in 2019 and named it CV-A19 strain 2019103106/XX/CHN/2019 - 2019103106 for short. The genome of this virus consists of 7409 nucleotides, including a 6624-nucleotide open reading frame encoding a potential polyprotein precursor of 2207 amino acids. Compared with strain 8663, strain 2019103106 showed 85.1% nucleotide sequence identity in the complete genome and 85.6% identity in the VP1 coding region, reflecting their genetic divergence. Phylogenetic analysis of strain 2019103106 and other representative EV-C strains with sequences available in the GenBank database showed that CV-A19 strains could be grouped into two clusters based on the complete or 214-nucleotide partial VP1 coding regions, and 2019103106 belonged to cluster 1, with the closest relationship to CV-A19 strain SWG82 from Shandong, China. Phylogenetic trees based on the P2 and P3 coding regions highlighted the divergence between strains 2019103106 and 8663, implying that strain 2019103106 had undergone recombination. Further recombination analysis suggested that strains V18A-like CV-A1 and BBD26-like CV-A19 probably recombined to yield strain 2019103106. The present study points out the genetic diversity of CV-A19. It expands our understanding of the evolution of the CV-A19 genome, but more genome sequences of epidemic strains are needed to explain the phylogeny and evolutionary history of CV-A19 comprehensively.


Subject(s)
Coxsackievirus Infections , Enterovirus C, Human , Hand, Foot and Mouth Disease , Child , China/epidemiology , Enterovirus C, Human/genetics , Genome, Viral , Genomics , Hand, Foot and Mouth Disease/genetics , Humans , Nucleotides , Phylogeny , RNA, Viral/genetics
3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-307611

ABSTRACT

Background: Patients with severe coronavirus disease 2019 (COVID-19) who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality. This study evaluated the prognostic impact of AKI duration on in-hospital mortality in elder patients. Methods: We performed a retrospective study of 126 patients with confirmed COVID-19 with severe or critical disease who treated in the ICU from February 4, 2020, to April 16, 2020. AKI was defined according to the Kidney Disease Improving Global Outcomes serum creatinine (Scr) criteria. AKI patients were divided into transient AKI and persistent AKI groups based on whether Scr level returned to baseline within 48 h post-AKI. Results: In total, 107 patients were included in the final analysis. The mean age was 70 (64–78) years, and 69 (64.5%) patients were men. AKI occurred in 48 (44.9%) during their ICU stay. Of these, 11 (22.9%) had transient AKI, 37 (77.9%) had persistent AKI. In-hospital mortality was 18.6% (n =11) for patients without AKI, 72.7% (n=8) for patients with transient AKI, and 86.5% (n=32) for patients with persistent AKI (P<0.001). Kaplan–Meier curve analysis revealed that patients with both transient AKI and persistent AKI had significantly higher death rates than those without AKI (log-rank P <0.001). Multivariate Cox regression analysis revealed that transient and persistent AKI were an important risk factor for in-hospital mortality in older patients with severe COVID-19 even after adjustment for variables (hazard ratio [HR]=2.582;95% CI: 1.025–6.505;P =0.044;and HR=6.974;95% CI: 3.334–14.588;P <0.001). Conclusions: AKI duration is a useful parameter to predict of worse clinical outcomes in elder patients with COVID-19 in the ICU. Among AKI patients, those persistent AKI have a lower in-hospital survival rate than those transient AKI, emphasizing the importance of identifying an appropriate treatment window for early intervention.

4.
Chinese Journal of Contemporary Pediatrics ; 22(3):211-214, 2020.
Article in English | PMC | ID: covidwho-1389761

ABSTRACT

Since December 2019, the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has occurred in Wuhan, Hubei Province, China. The infected cases were noted mostly in adults, but rarely reported in children, especially neonates. Most children with SARS-CoV-2 infection present mainly with respiratory symptoms, but less commonly with gastrointestinal symptoms, and tend to have mild clinical symptoms. A neonate with SARS-CoV-2 infection, who had vomiting and milk refusal as the first symptom, was recently admitted to Wuhan Children's Hospital. After two weeks of treatment, the patient recovered gradually and was discharged. Here, this case is reported to improve the understanding of SARS-CoV-2 infection in neonates.

5.
Ann Transl Med ; 8(24): 1654, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1041387

ABSTRACT

BACKGROUND: The global outbreak of COVID-19 is a significant threat to public health. Among COVID-19 cases, critically ill patients account for most in-hospital deaths. Given the pressing clinical needs, identification of potential prognostic factors that would assist clinicians to determine appropriate therapeutic interventions is urgently needed. METHODS: A retrospective analysis of 171 critically ill COVID-19 patients from two medical centers in Wuhan was conducted. The training and validation cohorts were comprised of 77 and 94 patients, respectively. Univariate and multivariate Logistic regression analyses were used to identify independent prognostic factors, and the linear prediction index was established and externally validated. RESULTS: Blood urine nitrogen (BUN) and high-sensitive C-reactive protein (hs-CRP) were independent factors negatively correlated with patient survival in the training cohort. A linear prediction model, named as the CB index (hs-CRP combined with BUN), was established and logistic regression analysis showed that this was associated with a 13% increase in death rate, with high sensitivity (86.7%) and specificity (89.7%). Patients were then divided into a high-risk group (CB index >32) and low-risk group (CB index <32) and the high-risk group showed a 56.3-fold risk of death compared with the low-risk group. Importantly, these findings were readily recaptured in the validation cohort. The efficacy of the CB index in predicting prognosis in real-world patients was then determined, which showed that patients with a higher CB index had an increased risk of death in comparison to those with a lower CB index. CONCLUSIONS: The CB index may be an important prognostic factor in critically ill COVID-19 patients.

6.
Clin Interv Aging ; 15: 2095-2107, 2020.
Article in English | MEDLINE | ID: covidwho-930765

ABSTRACT

OBJECTIVE: Severe or critical patients with coronavirus disease 2019 (COVID-19) are at increased risk for developing acute kidney injury (AKI). However, the rate of AKI in patients of different severities and independent predictive factors associated with AKI are not well understood. PATIENTS AND METHODS: We enrolled 107 severely or critically ill elderly patients with COVID-19 who were admitted to the intensive care unit (ICU) in Wuhan, China. AKI was defined according to the 2012 KDIGO criteria. We explored the association between AKI and in-hospital mortality using logistic regression. A predictive nomogram was formulated to predict the AKI development of patients with COVID-19 based on multivariate logistic regression. RESULTS: A total of 107 elderly patients were enrolled during the study period. The mean age was 70 (64-78) years, and 69 (64.5%) were men. For the 107 patients, the degree of severity of COVID-19 was categorized as 37 patients with the severe type (34.6%) and 70 patients with the critical type (65.4%). Overall, 48 of the 107 patients (44.9%) developed AKI during their hospitalization, while AKI occurred in 7 (18.9%) out of the 37 severe patients and 41 (44.9%) out of the 70 critical patients. Of the AKI patients, 35.4% (17/48) required continuous renal replacement therapy, including 14.3% of AKI patients in severe cases and 39.0% of AKI patients in critical cases. Kaplan-Meier analysis demonstrated that patients with AKI had a significantly higher risk for in-hospital mortality than severely and critically ill patients without AKI. Multivariate logistic regression analysis showed that AKI (OR = 33.74; 95% CI = 3.34-341.29; P = 0.003), septic shock (OR = 15.58; 95% CI = 2.08-116.78; P = 0.008), invasive mechanical ventilation (OR = 18.44; 95% CI = 2.35-144.69; P = 0.006), and oxygenation index (OR = 0.99; 95% CI = 0.98-1.000; P = 0.014) were independent risk factors for in-hospital mortality. A nomogram was established based on the multivariate analysis results. The C-index for the developed AKI model was 0.935 (95% CI, 0.892-0.978); when 10-fold cross validation was used to validate the model, the corrected C-index was 0.825. CONCLUSION: AKI is common among COVID-19 patients admitted to the ICU and is recognized as a marker of disease severity. The proposed nomogram accurately predicted AKI development in ICU patients with COVID-19 based on individual characteristics. Therefore, the strategy for kidney protection against severe or critical pneumonia is appropriate.


Subject(s)
Acute Kidney Injury , Coronavirus Infections , Hospital Mortality , Pandemics , Pneumonia, Viral , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Aged , Betacoronavirus/isolation & purification , COVID-19 , China/epidemiology , Coronavirus Infections/complications , Coronavirus Infections/mortality , Critical Illness/mortality , Female , Humans , Intensive Care Units/statistics & numerical data , Male , Nomograms , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Prognosis , Retrospective Studies , Risk Factors , SARS-CoV-2 , Severity of Illness Index
7.
Eur Heart J ; 41(22): 2058-2066, 2020 06 07.
Article in English | MEDLINE | ID: covidwho-526907

ABSTRACT

AIMS: It remains unknown whether the treatment of hypertension influences the mortality of patients diagnosed with coronavirus disease 2019 (COVID-19). METHODS AND RESULTS: This is a retrospective observational study of all patients admitted with COVID-19 to Huo Shen Shan Hospital. The hospital was dedicated solely to the treatment of COVID-19 in Wuhan, China. Hypertension and the treatments were stratified according to the medical history or medications administrated prior to the infection. Among 2877 hospitalized patients, 29.5% (850/2877) had a history of hypertension. After adjustment for confounders, patients with hypertension had a two-fold increase in the relative risk of mortality as compared with patients without hypertension [4.0% vs. 1.1%, adjusted hazard ratio (HR) 2.12, 95% confidence interval (CI) 1.17-3.82, P = 0.013]. Patients with a history of hypertension but without antihypertensive treatment (n = 140) were associated with a significantly higher risk of mortality compared with those with antihypertensive treatments (n = 730) (7.9% vs. 3.2%, adjusted HR 2.17, 95% CI 1.03-4.57, P = 0.041). The mortality rates were similar between the renin-angiotensin-aldosterone system (RAAS) inhibitor (4/183) and non-RAAS inhibitor (19/527) cohorts (2.2% vs. 3.6%, adjusted HR 0.85, 95% CI 0.28-2.58, P = 0.774). However, in a study-level meta-analysis of four studies, the result showed that patients with RAAS inhibitor use tend to have a lower risk of mortality (relative risk 0.65, 95% CI 0.45-0.94, P = 0.20). CONCLUSION: While hypertension and the discontinuation of antihypertensive treatment are suspected to be related to increased risk of mortality, in this retrospective observational analysis, we did not detect any harm of RAAS inhibitors in patients infected with COVID-19. However, the results should be considered as exploratory and interpreted cautiously.


Subject(s)
Antihypertensive Agents/therapeutic use , Betacoronavirus , Coronavirus Infections/mortality , Hypertension/drug therapy , Pneumonia, Viral/mortality , Adult , Aged , Aged, 80 and over , COVID-19 , China/epidemiology , Coronavirus Infections/complications , Coronavirus Infections/therapy , Female , Follow-Up Studies , Humans , Hypertension/complications , Hypertension/mortality , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Retrospective Studies , SARS-CoV-2
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