Risk Factors of In-hospital Death in COVID-19 Patients：a Meta-analysis

Background The worldwide COVID-19 pandemic has turned into a global catastrophic public health crisis，and the conclusion about the risk factors of hospital death in COVID-19 patients is not uniform. Objective To explore risk factors of in-hospital death in patients with COVID-19 by a meta-analysis. Methods Case-control studies about risk factors of in-hospital death in COVID-19 patients were searched from databases of the Cochrane Library，ScienceDirect，PubMed，Medline，Wanfang Data，CNKI and CQVIP from inception to October 1，2021. Literature screening，data extraction and methodological quality assessment were conducted. Meta-analysis was performed using Stata 15.1. Meta-regression was used to explore the potential sources of heterogeneity. Results Eighty studies were included which involving 405 157 cases〔349 923 were survivors（86.37%），and 55 234 deaths（13.63%）〕，that were rated as being of high quality by the Newcastle-Ottawa Scale. Meta-analysis showed that being male〔OR=1.49，95%CI（1.41，1.57），P<0.001），older age〔WMD=10.44，95%CI（9.79，11.09），P<0.001〕，dyspnoea〔OR=2.09，95%CI（1.80，2.43），P<0.001〕，fatigue〔OR=1.49，95%CI（1.31，1.69），P<0.001〕，obesity〔OR=1.46，95%CI（1.43，1.50），P<0.001〕，smoking〔OR=1.18，95%CI （1.14，1.23），P<0.001〕，stroke〔OR=2.26，95%CI（1.41，3.62），P<0.001〕，kidney disease〔OR=3.62，95%CI （3.26，4.03），P<0.001〕，cardiovascular disease〔OR=2.34，95%CI（2.21，2.47），P<0.001〕，hypertension〔OR=2.23，95%CI（2.10，2.37），P<0.001〕，diabetes〔OR=1.84，95%CI（1.74，1.94），P<0.001〕，cancer〔OR=1.86，95%CI （1.69，2.05），P<0.001〕，pulmonary disease〔OR=2.38，95%CI（2.19，2.58），P<0.001〕，liver disease〔OR=1.65，95%CI（1.36，2.01），P<0.001〕，elevated levels of white blood cell count〔WMD=2.03，95%CI（1.74，2.32），P<0.001〕，neutrophil count〔WMD=1.77，95%CI（1.49，2.05），P<0.001〕，total bilirubin〔WMD=3.19，95%CI（1.96，4.42），P<0.001〕，aspartate transaminase〔WMD=13.02，95%CI（11.70，14.34），P<0.001〕，alanine transaminase 〔WMD=2.76，95%CI（1.68，3.85），P<0.001〕，lactate dehydrogenase〔WMD=166.91，95%CI（150.17，183.64），P<0.001〕，blood urea nitrogen〔WMD=3.11，95%CI（2.61，3.60），P<0.001〕，serum creatinine〔WMD=22.06，95%CI （19.41，24.72），P<0.001〕，C-reactive protein〔WMD=76.45，95%CI （71.33，81.56），P<0.001〕，interleukin-6 〔WMD=28.21，95%CI（14.98，41.44），P<0.001〕，and erythrocyte sedimentation rate〔WMD=8.48，95%CI（5.79，11.17），P<0.001〕were associated with increased risk of in-hospital death for patients with COVID-19，while myalgia〔OR=0.73，95%CI（0.62，0.85），P<0.001〕，cough〔OR=0.87，95%CI（0.78，0.97），P=0.013〕，vomiting〔OR=0.73，95%CI （0.54，0.98），P=0.030〕，diarrhoea〔OR=0.79，95%CI（0.69，0.92），P=0.001〕，headache〔OR=0.55，95%CI（0.45，0.68），P<0.001〕，asthma〔OR=0.73，95%CI（0.69，0.78），P<0.001〕，low body mass index〔WMD=-0.58，95%CI （-1.10，-0.06），P=0.029〕，decreased lymphocyte count〔WMD=-0.36，95%CI（-0.39，-0.32），P<0.001〕，decreased platelet count 〔WMD=-38.26，95%CI（-44.37，-32.15），P<0.001〕，increased D-dimer〔WMD=0.79，95%CI（0.63，0.95），P<0.001〕，longer prothrombin time〔WMD=0.78，95%CI（0.61，0.94），P<0.001〕，lower albumin〔WMD =-1.88，95%CI（-2.35，-1.40），P<0.001〕，increased procalcitonin〔WMD=0.27，95%CI（0.24，0.31），P<0.001〕，and increased cardiac troponin〔WMD=0.04，95%CI（0.03，0.04），P<0.001〕were associated with decreased risk of in-hospital death due to COVID-19. According to the meta-regression result，the heterogeneity in gender，renal disease，cardiovascular diseases，asthma，white blood cell count，neutrophil count，platelet count，hemoglobin，and urea nitrogen differed siangificnatly by country（P<0.05）. Conclusion The risk of in-hospital death due to COVID-19 may be increased by 25 factors（including being male，older age，dyspnoea，fatigue，obesity，smoking，stroke，kidney disease，cardiovascular disease，hypertension，diabetes，cancer，pulmonary disease，liver disease，elevated levels of white blood cells，neutrophil count，total bilirubin，aspartate transaminase，alanine transaminase，lactate dehydrogenase，blood urea nitrogen，serum creatinine，C-reactive protein，interleukin-6，and erythrocyte sedimentation rate），and may be decreased by 13 factors（including myalgia，cough，vomiting，diarrhoea，headache，asthma，low body mass index，decreased lymphocyte count and platelet count，increased D-dimer，longer prothrombin time，lower albumin，increased procalcitonin and cardiac troponin）. The conclusion drawn from this study needs to be further confirmed by high-quality，multicenter，large-sample，real-world studies. © 2023 Chinese General Practice. All rights reserved.

[Effects of vaccines on the viral negative conversion of children with COVID-19].

Objective: To explore the effect of vaccination on viral negative conversion of children with COVID-19. Methods: A retrospective cohort study was conducted. A cohort of 189 children aged 3-14 years with COVID-19 admitted to Renji Hospital (South branch) of Shanghai Jiao Tong University School of Medicine from April 7th to May 19th 2022 was enrolled in the study. According to the vaccination status, the infected children were divided into an unvaccinated group and a vaccinated group. Age, gender, severity, clinical manifestations, and laboratory tests, etc. were compared between groups, by rank sum test or chi-square test. The effects of vaccination on viral negative conversion were analyzed by a Cox mixed-effects regression model. Additionally, a questionnaire survey was conducted among the parents of unvaccinated children to analyze the reasons for not being vaccinated. Results: A total of 189 children aged 3-14 years were enrolled, including 95 males (50.3%) and 94 females (49.7%), aged 5.7 (4.1,8.6) years. There were 117 cases (61.9%) in the unvaccinated group and 72 cases (38.1%) in the vaccinated group. The age of the vaccinated group was higher than that of the unvaccinated group (8.8 (6.8, 10.6) vs. 4.5 (3.6, 5.9) years, Z=9.45, P<0.001). No significant differences were found in clinical manifestations, disease severity, and laboratory results between groups (all P>0.05), except for the occurrence rate of cough symptoms, which was significantly higher in the vaccinated group than in the non-vaccinated group (68.1% (49/72) vs. 50.4% (59/117),χ2=5.67, P=0.017). The Kaplan-Meier survival curve and Cox mixed-effects regression model showed that the time to the viral negative conversion was significantly shorter in the vaccinated group compared with the unvaccinated group (8 (7, 10) vs. 11 (9, 12) d, Z=5.20, P<0.001; adjusted HR=2.19 (95%CI 1.62-2.97)). For questionnaire survey on the reasons for not receiving a vaccination, 115 questionnaires were distributed and 112 valid questionnaires (97.4%) were collected. The main reasons for not being vaccinated were that parents thought that their children were not in the range of appropriate age for vaccination (51 cases, 45.5%) and children were in special physical conditions (47 cases, 42.0%). Conclusion: Vaccination can effectively shorten the negative conversion time of children with COVID-19 and targeted programs should be developed to increase eligible children's vaccination rate for SARS-CoV-2 vaccination.

Volume sweep imaging lung teleultrasound for detection of COVID-19 in Peru: a multicentre pilot study.

OBJECTIVES: Pulmonary disease is a significant cause of morbidity and mortality in adults and children, but most of the world lacks diagnostic imaging for its assessment. Lung ultrasound is a portable, low-cost, and highly accurate imaging modality for assessment of pulmonary pathology including pneumonia, but its deployment is limited secondary to a lack of trained sonographers. In this study, we piloted a low-cost lung teleultrasound system in rural Peru during the COVID-19 pandemic using lung ultrasound volume sweep imaging (VSI) that can be operated by an individual without prior ultrasound training circumventing many obstacles to ultrasound deployment. DESIGN: Pilot study. SETTING: Study activities took place in five health centres in rural Peru. PARTICIPANTS: There were 213 participants presenting to rural health clinics. INTERVENTIONS: Individuals without prior ultrasound experience in rural Peru underwent brief training on how to use the teleultrasound system and perform lung ultrasound VSI. Subsequently, patients attending clinic were scanned by these previously ultrasound-naïve operators with the teleultrasound system. PRIMARY AND SECONDARY OUTCOME MEASURES: Radiologists examined the ultrasound imaging to assess its diagnostic value and identify any pathology. A random subset of 20% of the scans were analysed for inter-reader reliability. RESULTS: Lung VSI teleultrasound examinations underwent detailed analysis by two cardiothoracic attending radiologists. Of the examinations, 202 were rated of diagnostic image quality (94.8%, 95% CI 90.9% to 97.4%). There was 91% agreement between radiologists on lung ultrasound interpretation among a 20% sample of all examinations (κ=0.76, 95% CI 0.53 to 0.98). Radiologists were able to identify sequelae of COVID-19 with the predominant finding being B-lines. CONCLUSION: Lung VSI teleultrasound performed by individuals without prior training allowed diagnostic imaging of the lungs and identification of sequelae of COVID-19 infection. Deployment of lung VSI teleultrasound holds potential as a low-cost means to improve access to imaging around the world.