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The clinical and epidemiological features of acute kidney injury in severe and extremely severe pneumonia associated with coronavirus disease-2019 (COVID-19) are considered. An observational prospective study was conducted with the inclusion of 117 patients, including 75 men and 42 women, suffering from severe and extremely severe pneumonia associated with COVID-19, who were treated in the intensive care unit of the 1586th Military Clinical Hospital in 2020-2022. Acute kidney injury was diagnosed in 21 (17.9%) patients (stage 1 in 10, stage 2 in 4, and stage 3 in 7 patients), kidney dysfunction was recorded in 22 (8.8%) patients (serum creatinine was higher than normal, but does not reach the diagnostic criteria of Kidney Disease Improving Global Outcomes). Four patients underwent renal replacement therapy. The probability of kidney damage increases with age (the average age of the patients with acute kidney damage is 65 (58;71) years, and those without acute kidney damage was 47.5 (41;55) years;p = 0.0001). Compared with patients without acute kidney injury, patients with acute kidney injury scored higher on the scales NEW (p = 0.000975), SMRT-CO (p = 0.011555), and Sequential Organ Failure Assessment (p = 0.000042). Among those suffering from acute kidney injury, significantly more pronounced manifestations of systemic inflammation were determined (leukocytes, p = 0.047324;platelets, p = 0.001230;ferritin, p = 0.048614;and D-dimer, p = 0.004496). In the general cohort, the mortality rate was 22.2%, whereas a significant intergroup difference in mortality was observed, i.e., 52.4% in patients with acute kidney injury and 15.62% in those without acute kidney injury (Chi-squared criterion, 13.468;p < 0.001). Invasive artificial lung ventilation was performed in 19.66% of the patients, and a significant intergroup difference was identified, with 66.7% in patients with acute kidney injury and 9.38% in patients without acute kidney injury (Chi-squared criterion, 35.810;p < 0.001). The durations of treatment in the intensive care unit in patients with and without acute kidney injury were 9 (7;14) and 6 (4;10) days, respectively. After the treatment, all patients with acute kidney injury had fully recovered kidney function upon discharge. In general, acute kidney injury occurs in almost every fifth patient with severe and extremely severe pneumonia associated with COVID-19, aggravates the condition of patients, and increases mortality. The alertness of doctors regarding acute kidney injury and early diagnosis and timely nephroprotective treatment may reduce the possibility of adverse disease outcomes.
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Objective: To retrospectively analyze the clinical characteristics of 95 patients with severe coronavirus disease 2019 (COVID-19) admitted to Hankou Hospital of Wuhan, and provide evidence for clinical diagnosis and treatment of severe cases. Methods: From January to March 2020, 95 patients with severe COVID-19 were admitted to a designated Hankou Hospital of Wuhan. The clinical manifestations, laboratory examinations, chest CT, respiratory support, drug treatment, and outcomes were collected and analyzed. Results: Among the 95 patients, there were 76(80.0%) severe cases (severe group) and 19 (20.0%) critically ill cases (critically ill group);the average ages of the two groups were (56.9 .. 14.0) and (66.2 .. 14.1) years old, respectively. The main symptoms included fever [85 (89.5%)], cough [73 (76.8%)] dyspnea [57 (60.0%)], sputum expectoration [32 (33.7%)], diarrhea [20 (21.1%)], etc. The initial symptom was fever [64 (67.4%)], followed by cough [17 (17.9%)]. The main comorbidities were hypertension [29 (30.5%)], diabetes [18 (18.9%), coronary heart disease [12 (12.6%)], etc. Liver injury was the most frequently seen complication which occurred in 35 patients (36.8%), while myocardial damage in 20 patients (21.1%), heart failure in 10 patients (10.5%), and renal damage in 8 patients (8.4%). The level of urea nitrogen [7.5 (3.1-36.6) mmol/L], creatinine [88.0 (46.0-681.0) mol/L], aspartate aminotransferase (AST) [49.0 (8.0-2 290.0) U/L], total bilirubin [12.4 (6.8-112.4) mol/L], white blood cells [8.7 (2.7-16.3) .. 109], neutrophil count [7.9 (1.0-14.6) .. 109/L], high-sensitivity C-reactive protein (hsCRP) [35.6 (0.1-37.9) mg/L] and procalcitonin (PCT) [0.3 (0.1-9.6) ng/mL] in the critically ill group were higher than the severe group [4.5 (1.5-14.6) mmol/L, 70.0 (34.0-149.0) mol/L, 30.5 (10.0-184.0) U/L, 7.8 (1.4-24.5) mol/L, 4.5 (1.7- 10.7) .. 109/L 3.1 (0.6-9.1) .. 109/L, 31.8 (0.1- 40.4) mg/L, 0.1 (0.0- 1.2) ng/mL], and the difference were statistically significant (P all < 0.05);the albumin level reflecting nutritional status [30.2 (24.6-36.4) g/L] was lower than the severe group [35.2(23.5-44.5)g/L], and the difference was statistically significant (P < 0.001). Chest computed tomographic scans showed bilateral ground glass opacity or patchy shadows in the lungs of all patients. A total of 77 patients (82.1%) were discharged, and 13 patients (13.7%) died;of which, the mortality of the critically ill group was 68.4% (13 out of 19). Conclusions: The majority of patients with severe COVID- 19 were elderly. The main clinical manifestations were fever, cough, and dyspnea. Most patients had underlying diseases such as hypertension, diabetes and coronary heart disease. The occurrence of organ dysfunctions such as liver injury, cardiac damage, heart failure and kidney injury might be an important cause of death. The mortality of severe patients with COVID-19 was high, and treatment was even tough.
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Objective: To investigate the changes and significance of various indicators in patients with severe coronavirus disease 2019(COVID-19)pneumonia combined with type 2 diabetes mellitus(T2DM), and provide a theoretical basis for early clinical disease prediction, diagnosis and treatment. Method: A retrospective analysis of 80 patients with severe COVID-19 pneumonia in Wuhan Ninth Hospital from January to April 2020, among them, 42 cases were combined with type 2diabetes mellitus(COVID-19 combined with T2DM group), and 38 cases were not combined with type 2 diabetes mellitus(COVID-19 without T2DM group), including age,gender, medical history, laboratory examinations, and disease outcome were analyzed.
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During second wave of COVID-19 pandemic, increase in incidence of typhoid was observed in different cities of Pakistan. Rapid diagnostic tests for COVID-19 and typhoid are less sensitive and confirmatory tests are required to diagnose the infection. Moreover, COVID-19 IgM mimic Salmonella typhi IgM and have same clinical presentations as typhoid. Muzaffargarh is a district of province Punjab. Being a hotspot for COVID-19, it also has high prevalence of Typhoid. Therefore, in this study we aim to evaluate the cross antigenicity of COVID-19 IgM with Salmonella typhi IgM. 593 patients were enrolled in study with informed consent. Blood samples were collected from patients and laboratory biomarkers were analyzed. Data was recorded and statistical analysis was done. Among study participants, 64% were males while 36% were females. All the laboratory biomarkers were elevated in all the patients. Different age groups didn't exhibit difference in all laboratory biomarkers except ferritin. Significant difference was observed in creatinine, LDH and ferritin levels in male and female patients. It can be concluded that all age groups are under same risk. However, disease severity is higher in male population.
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Background: Coronavirus disease 19 (COVID-19) can have a severe presentation characterized by a dysregulated immune response requiring admission to the intensive care unit (ICU) [mmunomodula- tory treatments like tocilizumab were found to improve inflammatory markers and lung injury over time. We aim to evaluate the effectiveness of toeilizumab treatment 011 critically ill patients with severe COVID-19. Materials and methods: We conducted a multi-center retrospective cohort study of 154 adult patients admitted to the ICU for severe COVID-1 9 pneumonia between March 1 5 and May 8.2020. Data were obtained by electron- ic medical record (EMR) review. The primary outcome of interest was mortality.
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OBJECTIVE: To investigate the diagnosis and clinical characteristics of 10 cases of clustered Chlamydia pneumoniae pneumonia during the prevention and control of the COVID-19 pandemic. METHODS: The clinical data of 10 patients with clustered Chlamydia pneumoniae infection in a college diagnosed and treated by the Third Medical Center of the PLA General Hospital from Mar. 10, 2021 to Mar. 17, 2021 were retrospectively analyzed, the clinical characteristics of Chlamydia pneumoniae infection were summarized, and the diagnosis and treatment plan was selected quickly and accurately. RESULTS: All 10 cases with Chlamydia pneumoniae pneumonia infection had no history of contact with live or dead birds, 80% of them had cough symptom, 50% of them had fever symptom. Laboratory test results showed that 80% of patients had white blood cell count in normal range, 60% of patients had increased c-reactive protein level to varying degrees, 70% of patients had creatine kinase above normal, creatinine and procalcitonin were all normal, and some coagulation function indexes were abnormal. Lung CT scan showed increased density of unilateral lung floccus, nodules or spots, with air bronchial signs and even consolidation. The results of respiratory tract five-link card showed that all 10 patients were positive for Chlamydia pneumoniae immunoglobulin M(IgM) antibody. The nucleic acid sequence of Chlamydia pneumoniae was detected by metagenomics next-generation sequencing(mNGS)in 2 patients after hospitalization. 10 patients were treated with moxifloxacin hydrochloride and sodium chloride injection and moxifloxacin hydrochloride tables in sequences, all of which were cured. After 1 month, the outpatient reexamination of lung CT showed that the inflammation was basically absorbed. CONCLUSION: Chlamydia pneumoniae infection can cause outbreak through respiratory transmission, which tend to occur in the spring. The combination of respiratory pathogen antibody detection and mNGS technology can improve the efficiency of clinical diagnosis and treatment.
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Objective: To investigate a reasonable threshold d total bilirubin for the diagnosis of hepatitis B virus - related acute - on -chronic liver failure (HBV - ACLF), and to realize accurate early diagnosis.
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Objective: To investigate the value of urinary al - microglobulin (al - MC) and N - acetyl - - D -glucosaminidase/urinary creatinine (NAG/UCr) in monitoring renal injury in patients with chronic hepatitis B virus (HBV) - related liver diseases.
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Objective: To investigate the clinical characteristics of corona virus disease 2019 (COVID-19) patients in Wuhan City, and the correlation between inflammatory factors and severity.
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The aetiology of acute kidney injury (AKI) associated with COVID-19 is multifactorial, involving factors specific to the disease itself (viral tropism, proinflammatory cytokines, coagulopathy with thrombotic microangiopathy, rhabdomyolysis), and nonspecific factors linked to the disease itself. The diagnosis of AKI is made using the diagnostic criteria of the KDIGO definition, through frequent monitoring of creatinine and urinary output in order to carry out early detection of renal involvement. These factors act in different stages of the pre-hospital and intra-hospital evolution. There are no specific measures for prevention and treatment of acute kidney injury associated with CO-VID-19, but immunomodulatory treatment (corticosteroids) and coagulopathy (heparin) could contribute to reduce the incidence and magnitude of it. Prevention of the development of AKI is not always possible, and can be achieved by optimising therapeutic actions directed at the non-specific factors referred to below. Some of the measures to treat the non-specific factors involved in the development of acute kidney injury are also discussed in this article.
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Introduction. Coronavirus Disease 2019 (COVID-19) can present pulmonary and extra pulmonary manifestations. One of the common complications caused by the disease is acute kidney injury (AKI). This study aims to assess the prevalence of kidney dysfunction in COVID-19 in-patients and its relationship to the outcomes of hospitalization in COVID-19 patients of a tertiary teaching hospital in Mashhad, Iran. Methods. A consecutive cohort study was carried out on patients' record extracted from hospital information system (HIS system) admitted in a tertiary teaching hospital following a major outbreak in Mashhad in 2020. Serum creatinine concentration and other laboratory parameters were extracted from HIS system. Incidence rate for acute kidney injury (AKI) according KDGO criteria was examined during the study. Outcomes, including mortality, and hospital length of stay was analyzed. Results. We included 715 COVID-19 patients that135 (21.3%) of whom died in the hospital and 488(77.3%) of studied patients have recovered. The mean age of the patients was 59.45 .. 16.83 years old, including 452 males (63.3%) patients. The mortality rate was higher for men compared to women (P = 0.005). The greatest change in mean creatinine was observed between first day of hospitalization (1.31 .. 1.33) and second day of hospitalization (1.81 .. 1.95). During the study period, AKI occurred in 17.84% of patients. The greatest percentage of AKI was observed on the 2nd and 7th days of hospitalization, which were 27.1% and 24.3%, respectively. This study demonstrated that patients with elevated creatinine and kidney impairment had higher risk of mortality (P < 0.0001). Mortality status had a direct and significant correlation with age, CRP, Urea and albumin in serum during hospitalization(P < 0.05). However, length of hospitalization was not associated with AKI (P = 0.465). Conclusion. There was a great prevalence of kidney impairment in hospitalized COVID-19 patients. After adjustment for confounders, kidney impairment indicators were associated with higher risk of in hospital death. Therefore, it is critical that clinicians consider serum factors indicating kidney impairment in hospitalized COVID-19 patients.