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1.
PLoS One ; 16(4): e0250815, 2021.
Article in English | MEDLINE | ID: covidwho-1833533

ABSTRACT

BACKGROUND: COVID-19 is a respiratory infectious disease caused by SARS-CoV-2, and cardiovascular damage is commonly observed in affected patients. We sought to investigate the effect of SARS-CoV-2 infection on cardiac injury and hypertension during the current coronavirus pandemic. STUDY DESIGN AND METHODS: The clinical data of 366 hospitalized COVID-19-confirmed patients were analyzed. The clinical signs and laboratory findings were extracted from electronic medical records. Two independent, experienced clinicians reviewed and analyzed the data. RESULTS: Cardiac injury was found in 11.19% (30/268) of enrolled patients. 93.33% (28/30) of cardiac injury cases were in the severe group. The laboratory findings indicated that white blood cells, neutrophils, procalcitonin, C-reactive protein, lactate, and lactic dehydrogenase were positively associated with cardiac injury marker. Compared with healthy controls, the 190 patients without prior hypertension have higher AngⅡ level, of which 16 (8.42%) patients had a rise in blood pressure to the diagnostic criteria of hypertension during hospitalization, with a significantly increased level of the cTnI, procalcitonin, angiotensin-II (AngⅡ) than those normal blood pressure ones. Multivariate analysis indicated that elevated age, cTnI, the history of hypertension, and diabetes were independent predictors for illness severity. The predictive model, based on the four parameters and gender, has a good ability to identify the clinical severity of COVID-19 in hospitalized patients (area under the curve: 0.932, sensitivity: 98.67%, specificity: 75.68%). CONCLUSION: Hypertension, sometimes accompanied by elevated cTnI, may occur in COVID-19 patients and become a sequela. Enhancing Ang II signaling, driven by SARS-CoV-2 infection, might play an important role in the renin-angiotensin system, and consequently lead to the development of hypertension in COVID-19.


Subject(s)
COVID-19/complications , Heart Injuries/epidemiology , Hypertension/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19/metabolism , COVID-19/physiopathology , Comorbidity , Disease Progression , Female , Heart Injuries/virology , Hospitalization , Humans , Hypertension/physiopathology , Hypertension/virology , Male , Medical Records , Middle Aged , Pandemics , Renin-Angiotensin System , SARS-CoV-2/pathogenicity
2.
Med Sci Monit ; 28: e935474, 2022 Feb 28.
Article in English | MEDLINE | ID: covidwho-1771789

ABSTRACT

BACKGROUND The emergence of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and the sudden inflow of patients with severe COVID-19 (coronavirus disease 2019) symptoms increased demand for hospital and pre-hospital care, the latter being provided by emergency medical teams. The Polish Medical Air Rescue Services include the Helicopter Emergency Medical Service (HEMS) and the airplane-based Emergency Medical Service (EMS). This study aimed to present the experience of the Polish Medical Air Rescue Service during the first year of the COVID-19 pandemic and measures taken to protect patients, medical staff, and air crew from SARS-CoV-2 infection. MATERIAL AND METHODS We conducted a retrospective analysis of missions completed by the Polish Medical Air Rescue crews with respect to confirmed SARS-CoV-2 cases. We analyzed data from the medical records of the Polish Medical Air Rescue Service, which included flights to accidents and emergencies, and air patient transport missions, where medical assistance was provided to patients with confirmed SARS-CoV-2 infection in the first year of the pandemic in Poland. RESULTS Among the COVID-19 patients, the most common comorbidity was acute respiratory failure (41.58%). Emergency missions more often concerned older patients with sudden cardiac arrest, dyspnea, upper respiratory tract infection, stroke, and acute coronary syndromes. CONCLUSIONS During the first year of the COVID-19 pandemic in Poland, the Polish Medical Air Rescue Service implemented procedures to protect patients, medical staff, and air crew from SARS-CoV-2 infection. This study highlights the importance of using single-patient isolation units for patient transport between hospitals and for emergency hospital admissions when the SARS-CoV-2 status of the patients were unknown.


Subject(s)
Air Ambulances , COVID-19/prevention & control , Medical Staff , Occupational Diseases/prevention & control , Humans , Medical Records , Pandemics , Poland , Retrospective Studies , Transportation of Patients
3.
Medicine (Baltimore) ; 101(9): e27759, 2022 Mar 04.
Article in English | MEDLINE | ID: covidwho-1730756

ABSTRACT

ABSTRACT: A global public health crisis caused by the 2019 novel coronavirus disease (COVID-19) leads to considerable morbidity and mortality, which bring great challenge to respiratory medicine. Hydrogen-oxygen therapy contributes to treat severe respiratory diseases and improve lung functions, yet there is no information to support the clinical use of this therapy in the COVID-19 pneumonia.A retrospective study of medical records was carried out in Shishou Hospital of Traditional Chinese Medicine in Hubei, China. COVID-19 patients (aged ≥ 30 years) admitted to the hospital from January 29 to March 20, 2020 were subjected to control group (n = 12) who received routine therapy and case group (n = 12) who received additional hydrogen-oxygen therapy. The clinical characteristics of COVID-19 patients were analyzed. The physiological and biochemical indexes, including immune inflammation indicators, electrolytes, myocardial enzyme profile, and functions of liver and kidney, were examined and investigated before and after hydrogen-oxygen therapy.The results showed significant decreases in the neutrophil percentage and the concentration and abnormal proportion of C-reactive protein in COVID-19 patients received additional hydrogen-oxygen therapy.This novel therapeutic may alleviate clinical symptoms of COVID-19 patients by suppressing inflammation responses.


Subject(s)
COVID-19/therapy , Hydrogen/therapeutic use , Oxygen/therapeutic use , Adult , China/epidemiology , Female , Humans , Inflammation , Male , Medical Records , Middle Aged , Oxygen Inhalation Therapy , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
4.
J Clin Rheumatol ; 28(2): e623-e625, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1703382

ABSTRACT

BACKGROUND: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection produces a wide variety of inflammatory responses in children, including multisystem inflammatory syndrome in children, which has similar clinical manifestations as Kawasaki disease (KD). METHODS: We performed a chart review of all patients with KD-like illnesses from January 1, 2016, to May 31, 2020, at a tertiary care children's hospital within a larger health system. Relevant symptoms, comorbid illnesses, laboratory results, imaging studies, treatment, and outcomes were reviewed. Descriptive analyses to compare features over time were performed. RESULTS: We identified 81 cases of KD-like illnesses from January 1, 2016, to May 31, 2020. Few clinical features, such as gallbladder involvement, were more prevalent in 2020 than in previous years. A few patients in 2020 required more intensive treatment with interleukin 1 receptor antagonist therapy. There were no other clear differences in incidence, laboratory parameters, number of doses of intravenous immunoglobulin, or outcomes over the years of the study. CONCLUSIONS: There was no difference in incidence, laboratory parameters, or number of doses of intravenous immunoglobulin required for treatment of KD-like illnesses during the COVID-19 pandemic when compared with previous years at our institution. Kawasaki disease-like illnesses, including multisystem inflammatory syndrome in children, may not have changed substantially during the COVID-19 pandemic.


Subject(s)
COVID-19 , Mucocutaneous Lymph Node Syndrome , COVID-19/complications , Child , Humans , Medical Records , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/drug therapy , Mucocutaneous Lymph Node Syndrome/epidemiology , Pandemics , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
6.
J Am Geriatr Soc ; 70(2): 341-351, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1526379

ABSTRACT

BACKGROUND: Evaluating older adults with cognitive dysfunction in emergency departments (EDs) requires obtaining collateral information from sources other than the patient. Understanding the challenges emergency clinicians face in obtaining collateral information can inform development of interventions to improve geriatric emergency care and, more specifically, detection of ED delirium. The objective was to understand emergency clinicians' experiences obtaining collateral information on older adults with cognitive dysfunction, both before and during the COVID-19 pandemic. METHODS: From February to May 2021, we conducted semi-structured interviews with a purposive sample of 22 emergency physicians and advanced practice providers from two urban academic hospitals and one community hospital in the Northeast United States. Interviews lasted 10-20 min and were digitally recorded and transcribed. Interview transcripts were analyzed for dominant themes using a combined deductive-inductive approach. Responses regarding experiences before and during the pandemic were compared. RESULTS: Five major challenges emerged regarding (1) availability of caregivers, (2) reliability of sources, (3) language barriers, (4) time constraints, and (5) incomplete transfer documentation. Participants perceived all challenges, but those relating to transfer documentation were amplified by the COVID-19 pandemic. CONCLUSION: Emergency clinicians' perspectives can inform efforts to support caregiver presence at bedside and develop standardized communication tools to improve recognition of delirium and, more broadly, geriatric emergency care.


Subject(s)
Caregivers/psychology , Cognitive Dysfunction/diagnosis , Communication Barriers , Emergency Service, Hospital , Health Personnel/statistics & numerical data , Medical Records , Aged , COVID-19 , Female , Humans , Interviews as Topic , Male , New England , Qualitative Research
7.
MMWR Morb Mortal Wkly Rep ; 70(35): 1228-1232, 2021 Sep 03.
Article in English | MEDLINE | ID: covidwho-1411859

ABSTRACT

Viral infections are a common cause of myocarditis, an inflammation of the heart muscle (myocardium) that can result in hospitalization, heart failure, and sudden death (1). Emerging data suggest an association between COVID-19 and myocarditis (2-5). CDC assessed this association using a large, U.S. hospital-based administrative database of health care encounters from >900 hospitals. Myocarditis inpatient encounters were 42.3% higher in 2020 than in 2019. During March 2020-January 2021, the period that coincided with the COVID-19 pandemic, the risk for myocarditis was 0.146% among patients diagnosed with COVID-19 during an inpatient or hospital-based outpatient encounter and 0.009% among patients who were not diagnosed with COVID-19. After adjusting for patient and hospital characteristics, patients with COVID-19 during March 2020-January 2021 had, on average, 15.7 times the risk for myocarditis compared with those without COVID-19 (95% confidence interval [CI] = 14.1-17.2); by age, risk ratios ranged from approximately 7.0 for patients aged 16-39 years to >30.0 for patients aged <16 years or ≥75 years. Overall, myocarditis was uncommon among persons with and without COVID-19; however, COVID-19 was significantly associated with an increased risk for myocarditis, with risk varying by age group. These findings underscore the importance of implementing evidence-based COVID-19 prevention strategies, including vaccination, to reduce the public health impact of COVID-19 and its associated complications.


Subject(s)
COVID-19/complications , Myocarditis/virology , Adolescent , Adult , Aged , COVID-19/epidemiology , Databases, Factual , Female , Humans , Male , Medical Records , Middle Aged , Myocarditis/epidemiology , Risk Assessment , Risk Factors , United States/epidemiology , Young Adult
8.
S Afr Fam Pract (2004) ; 63(1): e1-e6, 2021 08 26.
Article in English | MEDLINE | ID: covidwho-1395089

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented international emergency, resulting in a need to adapt the existing healthcare systems, in order to enable ongoing patient care despite the current disruptions. Telemedicine may be a viable option to continue hospital workflow, however there are barriers to its implementation. We set out to establish what barriers might exist and to assess the viability of teleclinics within the province KwaZulu-Natal (KZN), as perceived by doctors. METHODS: This was a quantitative, observational, survey-based study targeted at medical doctors working in both the public as well as the private healthcare sector in University of KwaZulu-Natal (UKZN). RESULTS: One hundred and forty-seven (147) responses were included. The majority (86%) of respondents felt that telemedicine could provide a useful means to continuing hospital workflow, however, only 47% believed that it was a viable option for their unit. The major barrier identified was a feeling that doctors would-be at-increased medico-legal risk. Only 38.4% of doctors were familiar with the Health Professions Council of South Africa (HPCSA) guidelines on telemedicine usage. Other major barriers included: doctors feeling uncomfortable with not seeing a patient in person or not being able to perform a thorough physical examination. Other reasons identified as potential barriers were doctors foreseeing difficulty in accessing patient medical records and the absence of available systems to order investigations without the patient being physically present. CONCLUSION: Telemedicine is currently not widely utilised in KZN; although most doctors were of the opinion that it could be a useful tool in order to continue the workflow during the pandemic. The major barrier identified were issues surrounding medico-legal coverage.


Subject(s)
Attitude of Health Personnel , Medical Staff, Hospital/psychology , Remote Consultation/methods , Telephone , COVID-19/epidemiology , Female , Health Care Surveys , Humans , Liability, Legal , Male , Medical Records , Pandemics , Practice Guidelines as Topic , SARS-CoV-2 , South Africa/epidemiology
9.
Yearb Med Inform ; 30(1): 257-263, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1392950

ABSTRACT

OBJECTIVES: To analyze the content of publications within the medical NLP domain in 2020. METHODS: Automatic and manual preselection of publications to be reviewed, and selection of the best NLP papers of the year. Analysis of the important issues. RESULTS: Three best papers have been selected in 2020. We also propose an analysis of the content of the NLP publications in 2020, all topics included. CONCLUSION: The two main issues addressed in 2020 are related to the investigation of COVID-related questions and to the further adaptation and use of transformer models. Besides, the trends from the past years continue, such as diversification of languages processed and use of information from social networks.


Subject(s)
COVID-19 , Natural Language Processing , Social Networking , Clinical Trials as Topic , Humans , Medical Records , Mental Disorders
11.
Interface (Botucatu, Online) ; 25(supl.1): e200671, 2021.
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-1389005

ABSTRACT

O presente trabalho constitui uma narrativa das experiências do autor, médico psiquiatra e pesquisador em Saúde Coletiva, referente ao tempo de sua enfermidade de Covid-19, como expressa na própria memória, por meio de recordação, fluxo de consciência, registro de elementos factuais e reflexão crítica. O tempo na Unidade de Terapia Intensiva (UTI) foi esquecido e passou a ser lembrado segundo a lógica da fabulação, alucinatório-delirante. Os fatos temporais e clínicos são os que constam nos prontuários da UTI, da Enfermaria e da Equipe Domiciliar, de posse do autor. Espera-se oferecer à sociedade uma vivência singular de como a Covid-19 nos obriga a pensar o indivíduo, a coletividade e as políticas de saúde, por ocasião da primeira grande pandemia viral do mundo globalizado, que ainda não chegou ao seu termo. (AU)


This work presents a narrative of the author's experiences as a psychiatrist and public health researcher of his Covid-19 illness, as expressed in memory, through recall, stream of consciousness, recording of factual elements and critical reflection. The time in intensive care was forgotten and came to be remembered according to the logic of hallucinatory-delusional fabulation. The temporal and clinical facts are based on the intensive care unit, ward and homecare team's medical records in the author's possession. The author seeks to offer a singular experience of how Covid-19 makes us think about the individual, the collective and health policy in connection with the first great viral pandemic in the globalized world, which has not yet reached its end. (AU)


Este trabajo constituye una narrativa de las experiencias del autor, médico psiquiatra e investigador de salud colectiva, referente al tiempo de su enfermedad de Covid-19, como expresa en la propia memoria, por medio de recursos, flujo de conciencia, registro de elementos factuales y reflexión crítica. El tiempo en la UCI fue olvidado y pasó a recordarse según la lógica de la fabulación, alucinatoria-delirante. Los hechos temporales y clínicos son los que constan en las fichas de la UCI, de la enfermería y del equipo domiciliario, en poder del autor. Se espera ofrecer a la sociedad una vivencia singular de cómo la Covid-19 nos obliga a pensar el individuo, la colectividad y las políticas de salud, por ocasión de la 1ª gran pandemia viral del mundo globalizado, que todavía no ha llegado a su fin. (AU)


Subject(s)
Humans , Medical Records , Mental Health , COVID-19/psychology , Life Change Events
12.
BMJ ; 374: n1976, 2021 08 11.
Article in English | MEDLINE | ID: covidwho-1354571
13.
Emerg Med J ; 38(10): 794-797, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1346074

ABSTRACT

BACKGROUND: Exercise-induced hypoxia (EIH) has been assessed at ED triage as part of an assessment of COVID-19; however, evidence supporting this practice is incomplete. We assessed the use of a 1-minute sit-to-stand exercise test among ED patients admitted for suspected COVID-19. METHODS: A case note review of all ED patients assessed for suspected COVID-19 between March and May 2020 at Monklands University Hospital was conducted. Demographic characteristics, clinical parameters, baseline blood tests and radiographic findings, hospital length of stay, intensive care and maximum oxygen requirement were obtained for those admitted. Using logistic regression, the association between EIH at admission triage and COVID-19 diagnosis was explored adjusting for confounding clinical parameters. RESULTS: Of 127 ED patients admitted for possible COVID-19, 37 were ultimately diagnosed with COVID-19. 36.4% of patients with COVID-19 and EIH had a normal admission chest radiograph. In multivariate analysis, EIH was an independent predictor of COVID-19 (adjusted OR 3.73 (95% CI (1.25 to 11.15)), as were lymphocyte count, self-reported exertional dyspnoea, C-reactive peptide and radiographic changes. CONCLUSIONS: This observational study demonstrates an association between EIH and a COVID-19 diagnosis. Over one-third of patients with COVID-19 and EIH exhibited no radiographic changes. EIH may represent an additional tool to help predict a COVID-19 diagnosis at initial presentation and may assist in triaging need for admission.


Subject(s)
COVID-19 , Hypoxia/diagnosis , Patient Admission , SARS-CoV-2 , Triage , Emergency Service, Hospital , Female , Humans , Male , Medical Records , Middle Aged , Retrospective Studies , State Medicine , United Kingdom
15.
Int J Psychophysiol ; 167: 86-93, 2021 09.
Article in English | MEDLINE | ID: covidwho-1305246

ABSTRACT

COVID-19 has become a long-term problem, and global pandemic conditions may persist for years. Researchers are providing mounting evidence of relationships between COVID-19 lockdowns and sleep problems. However, few studies have investigated the impact of home isolation on sleep time perception, especially in comparable social isolation situations with similar pressures. Subjective sleep time perception parameters were derived from sleep diaries. Objective parameters were derived from actigraphy. Subjective and objective data were obtained between February 17 and February 27, 2020 from 70 adult participants subject to COVID-19 related lockdown provisions in China. We divided participants into a home stayers (HS) group (subject to full stay-at home orders) and an area-restricted workers (ARW) group (permitted to work at their nearby workplaces). The HS group demonstrated significantly delayed actigraphy-defined sleep onset time compared to self-reported sleep onset time; this effect was absent in the ARW group. Between-group differences in actigraphy-defined sleep onset time and significant between-group differences for actigraphy-defined and self-reported wake-up time were observed. HS group participants also presented significantly delayed actigraphy-defined wake-up time compared with self-reported wake-up time. No significant effect was found on total sleep time perception. Moreover, sleep/wake time misperception were found to be associated with daylight exposure and physical activity levels respectively. To the extent they are generalizable, these results suggest that lockdown restrictions can affect sleep onset and wake-up time perception but not total sleep time perception. Public health policy should consider such effects in the present pandemic situation and in future emergent public health situations.


Subject(s)
Actigraphy , COVID-19 , Medical Records , Pandemics , Quarantine/psychology , Self Report , Sleep , Adult , China , Communicable Disease Control , Exercise , Female , Humans , Light , Male , Middle Aged , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/etiology , Sleep Stages , Sleep Wake Disorders , Surveys and Questionnaires
16.
J Clin Rheumatol ; 28(2): e623-e625, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1276284

ABSTRACT

BACKGROUND: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection produces a wide variety of inflammatory responses in children, including multisystem inflammatory syndrome in children, which has similar clinical manifestations as Kawasaki disease (KD). METHODS: We performed a chart review of all patients with KD-like illnesses from January 1, 2016, to May 31, 2020, at a tertiary care children's hospital within a larger health system. Relevant symptoms, comorbid illnesses, laboratory results, imaging studies, treatment, and outcomes were reviewed. Descriptive analyses to compare features over time were performed. RESULTS: We identified 81 cases of KD-like illnesses from January 1, 2016, to May 31, 2020. Few clinical features, such as gallbladder involvement, were more prevalent in 2020 than in previous years. A few patients in 2020 required more intensive treatment with interleukin 1 receptor antagonist therapy. There were no other clear differences in incidence, laboratory parameters, number of doses of intravenous immunoglobulin, or outcomes over the years of the study. CONCLUSIONS: There was no difference in incidence, laboratory parameters, or number of doses of intravenous immunoglobulin required for treatment of KD-like illnesses during the COVID-19 pandemic when compared with previous years at our institution. Kawasaki disease-like illnesses, including multisystem inflammatory syndrome in children, may not have changed substantially during the COVID-19 pandemic.


Subject(s)
COVID-19 , Mucocutaneous Lymph Node Syndrome , COVID-19/complications , Child , Humans , Medical Records , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/drug therapy , Mucocutaneous Lymph Node Syndrome/epidemiology , Pandemics , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
17.
Int J Nurs Knowl ; 33(1): 57-63, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1258876

ABSTRACT

PURPOSE: To describe the nursing interventions provided to patients with COVID-19 using the Nursing Interventions Classification. METHOD: This is a retrospective study involving the review of 1,344 patient records of adults admitted to a specialty hospital for COVID-19 in Tabriz, Iran. The nursing intervention was used to classify documented nursing care and interventions provided to COVID-19-positive patients from February 20 to August 20, 2020. Data were analyzed descriptively using SPSS16. FINDINGS: The 10 most frequently documented nursing interventions across in-patient (ward) and intensive care unit (ICU) contexts included Admission Care (7310), Environmental Management (6486), Health Education (5510), Infection Protection (6550), Medication Administration (2300), Positioning (0840), Respiratory Monitoring (3350), Vital Signs Monitoring (6680), Nausea Management (1450), and Diarrhea Management (0460). No records of distraction, relaxation techniques, or massage for anxiety reduction were documented. CONCLUSION: This study used a common language to describe nursing interventions for patients with COVID-19 admitted to a tertiary hospital. IMPLICATIONS FOR NURSING PRACTICE: The most commonly identified nursing interventions for COVID-19 identified in this study provide evidence-based insight into nurses' scope of practice in the COVID-19 in-patient context.


Subject(s)
COVID-19 , Standardized Nursing Terminology , Adult , Humans , Medical Records , Retrospective Studies , SARS-CoV-2
18.
Clin Infect Dis ; 71(16): 2230-2232, 2020 11 19.
Article in English | MEDLINE | ID: covidwho-1233842

ABSTRACT

We report the observation that 14.5% of COVID-19 patients had positive RT-PCR testing again after discharge. We describe correlations between laboratory parameters and treatment duration (P = .002) and time to virus recrudescence (P = .008), suggesting the need for additional measures to confirm illness resolution in COVID-19 patients.


Subject(s)
COVID-19/diagnosis , Patient Discharge , Real-Time Polymerase Chain Reaction , Adolescent , Adult , Antiviral Agents/therapeutic use , COVID-19/drug therapy , COVID-19 Testing , Child , China , Female , Humans , Male , Medical Records , Middle Aged , RNA, Viral/genetics , SARS-CoV-2/isolation & purification , Young Adult
19.
PLoS One ; 16(4): e0250815, 2021.
Article in English | MEDLINE | ID: covidwho-1206205

ABSTRACT

BACKGROUND: COVID-19 is a respiratory infectious disease caused by SARS-CoV-2, and cardiovascular damage is commonly observed in affected patients. We sought to investigate the effect of SARS-CoV-2 infection on cardiac injury and hypertension during the current coronavirus pandemic. STUDY DESIGN AND METHODS: The clinical data of 366 hospitalized COVID-19-confirmed patients were analyzed. The clinical signs and laboratory findings were extracted from electronic medical records. Two independent, experienced clinicians reviewed and analyzed the data. RESULTS: Cardiac injury was found in 11.19% (30/268) of enrolled patients. 93.33% (28/30) of cardiac injury cases were in the severe group. The laboratory findings indicated that white blood cells, neutrophils, procalcitonin, C-reactive protein, lactate, and lactic dehydrogenase were positively associated with cardiac injury marker. Compared with healthy controls, the 190 patients without prior hypertension have higher AngⅡ level, of which 16 (8.42%) patients had a rise in blood pressure to the diagnostic criteria of hypertension during hospitalization, with a significantly increased level of the cTnI, procalcitonin, angiotensin-II (AngⅡ) than those normal blood pressure ones. Multivariate analysis indicated that elevated age, cTnI, the history of hypertension, and diabetes were independent predictors for illness severity. The predictive model, based on the four parameters and gender, has a good ability to identify the clinical severity of COVID-19 in hospitalized patients (area under the curve: 0.932, sensitivity: 98.67%, specificity: 75.68%). CONCLUSION: Hypertension, sometimes accompanied by elevated cTnI, may occur in COVID-19 patients and become a sequela. Enhancing Ang II signaling, driven by SARS-CoV-2 infection, might play an important role in the renin-angiotensin system, and consequently lead to the development of hypertension in COVID-19.


Subject(s)
COVID-19/complications , Heart Injuries/epidemiology , Hypertension/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19/metabolism , COVID-19/physiopathology , Comorbidity , Disease Progression , Female , Heart Injuries/virology , Hospitalization , Humans , Hypertension/physiopathology , Hypertension/virology , Male , Medical Records , Middle Aged , Pandemics , Renin-Angiotensin System , SARS-CoV-2/pathogenicity
20.
J Med Virol ; 93(2): 952-961, 2021 02.
Article in English | MEDLINE | ID: covidwho-1196431

ABSTRACT

Coronavirus disease 2019 (COVID-19) have become a pandemic in the world. This study is aim to explore risk factors for COVID-19 severity in the early stage and the correlation between the viral shedding and COVID-19 severity. We included inpatient with laboratory confirmed COVID-19 who had been discharged by 9 March 2020. The medical record data and dynamic change of biochemical indicators in-hospital were compared between common and severe patients. Eighty patients were included in this study. Multivariable regression demonstrated increasing odds of severity associated with the duration of fever (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.10-1.82, per day increase; P = .007), C-reactive protein (CRP) (OR, 1.26; 95% CI, 1.04-1.52; P = .02), and PO2 < 80 mm Hg (28.07, 95% CI, 1.50-524.12; P = .026) on admission. We found severe acute respiratory syndrome coronavirus 2 viral RNA could be long-term presence in respiratory tract and fecal sample, up to 43 and 46 days, respectively. However, the duration of viral shedding have no correlation with the COVID-19 severity. The duration of fever, elevated CRP and PO2 < 80 mm Hg on admission were associated with the COVID-19 severity in the early stage and there is no correlation between the viral shedding and COVID-19 severity.


Subject(s)
COVID-19/physiopathology , COVID-19/virology , SARS-CoV-2/pathogenicity , Virus Shedding , Adolescent , Adult , Aged , Aged, 80 and over , C-Reactive Protein/analysis , Feces/virology , Female , Fever/virology , Hospitalization/statistics & numerical data , Humans , Male , Medical Records , Middle Aged , Odds Ratio , Respiratory System/virology , Retrospective Studies , Risk Factors , SARS-CoV-2/physiology , Severity of Illness Index , Young Adult
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