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1.
J Coll Physicians Surg Pak ; 31(7): S99-S103, 2021 07.
Article in English | MEDLINE | ID: covidwho-1317396

ABSTRACT

OBJECTIVE: To analyse whether prealbumin could be a new biomarker for predicting mortality in severe COVID-19 patients. STUDY DESIGN: An observation study. PLACE AND DURATION OF STUDY: Intensive care units (ICU) of Sakarya University Training and Research Hospital, Sakarya, Turkey, from October 2020 to December 2020. METHODOLOGY: The data of 149 patients, who were admitted to the ICU were collected and analysed retrospectively. Routine blood samples were collected from all patients at the time of admission to the ICU; and 102 patients with the mortal course and 47 patients with the non-mortal course were included in the study. The data obtained from these patients were analyzed in the biostatistics programme.  Results: The median age of all patients was 68 years; while 94 of them were males (63.1%) and 55 of them were females (36.9%). Median levels of potassium (K) (p=0.04), uric acid (p=0.001), C-reactive protein (CRP) (p=0.004), and procalcitonin (PCT) (p<0.001) were significantly higher and median level of prealbumin (p=0.002) was significantly lower in the deceased group. The cut-off level of prealbumin for mortality was found as 0.085 g/L (p=0.002). Further analysis revealed that the risk of mortality was found as 2.193 times more in patients with prealbumin levels of <0.085 g/L (Odds Ratio (OR): 2.193, 95% CI: 1.084-4.434). CONCLUSION: As a result of this study, it was found that patients with lower levels of prealbumin at the time of admission to the ICU have a higher risk for mortality. It was showed that prealbumin can be a useful biomarker for predicting mortality in patients with severe COVID-19. Key Words: Prealbumin, COVID-19, Mortality, Prognostic biomarkers, Severe disease.


Subject(s)
COVID-19 , Prealbumin , Aged , Biomarkers , C-Reactive Protein/analysis , Female , Humans , Intensive Care Units , Male , Prealbumin/analysis , Prognosis , Retrospective Studies , SARS-CoV-2 , Turkey/epidemiology
2.
Cells ; 10(7)2021 07 13.
Article in English | MEDLINE | ID: covidwho-1314588

ABSTRACT

Transthyretin (TTR) is a tetrameric protein transporting hormones in the plasma and brain, which has many other activities that have not been fully acknowledged. TTR is a positive indicator of nutrition status and is negatively correlated with inflammation. TTR is a neuroprotective and oxidative-stress-suppressing factor. The TTR structure is destabilized by mutations, oxidative modifications, aging, proteolysis, and metal cations, including Ca2+. Destabilized TTR molecules form amyloid deposits, resulting in senile and familial amyloidopathies. This review links structural stability of TTR with the environmental factors, particularly oxidative stress and Ca2+, and the processes involved in the pathogenesis of TTR-related diseases. The roles of TTR in biomineralization, calcification, and osteoarticular and cardiovascular diseases are broadly discussed. The association of TTR-related diseases and vascular and ligament tissue calcification with TTR levels and TTR structure is presented. It is indicated that unaggregated TTR and TTR amyloid are bound by vicious cycles, and that TTR may have an as yet undetermined role(s) at the crossroads of calcification, blood coagulation, and immune response.


Subject(s)
Arthritis/metabolism , Cardiovascular Diseases/metabolism , Osteoporosis/metabolism , Prealbumin/metabolism , Amyloid/chemistry , Amyloid/metabolism , Amyloidosis/metabolism , Animals , Humans , Oxidative Stress , Prealbumin/chemistry , Protein Conformation , Protein Stability
3.
Am J Trop Med Hyg ; 105(3): 718-726, 2021 08 09.
Article in English | MEDLINE | ID: covidwho-1304790

ABSTRACT

Most critically ill patients experience malnutrition, resulting in a poor prognosis. This study aimed to evaluate the association of prealbumin (PAB) with the prognosis for severely and critically ill coronavirus disease 2019 (COVID-19) patients and explore factors related to this association. Patients with laboratory-confirmed COVID-19 from West Campus of Union Hospital in Wuhan from January 29, 2020 to March 31, 2020 were enrolled in this study. Patients were classified into the PAB1 (150-400 mg/L; N = 183) and PAB2 (< 150 mg/L; N = 225) groups. Data collection was performed using the hospital's electronic medical records system. The predictive value of PAB was evaluated by measuring the area under the receiver-operating characteristic (AUROC) curve. Patients were defined as severely or critically ill based on the Guidance for COVID-19 (7th edition) by the National Health Commission of China. During this analysis, 316 patients had severe cases and 65 had critical cases. A reduced PAB level was associated with a higher risk of mortality and a longer hospital stay. The AUROC curve for the prognosis based on the PAB level was 0.93, with sensitivity of 97.2% and specificity of 77.6%. For severe cases, a lower level of PAB was associated with a higher risk of malnutrition, higher NK cell counts, and lower B lymphocyte counts; these factors were not significant in critical cases. C-reactive protein and nutritional status mediated the association between PAB and prognosis. This retrospective analysis suggests that the PAB level on admission is an indicator of the prognosis for COVID-19.


Subject(s)
COVID-19/mortality , Prealbumin/analysis , SARS-CoV-2 , Adult , Aged , C-Reactive Protein/analysis , COVID-19/blood , Critical Illness , Female , Humans , Length of Stay , Male , Middle Aged , Prognosis , Retrospective Studies , Severity of Illness Index
4.
Eur Rev Med Pharmacol Sci ; 25(10): 3879-3885, 2021 May.
Article in English | MEDLINE | ID: covidwho-1264764

ABSTRACT

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the association between the prealbumin and severity and mortality in COVID-19. MATERIALS AND METHODS: We performed a systematic literature search from PubMed, Embase, and Scopus databases up until 2 February 2021. The primary outcome was the poor outcome, a composite of mortality and severity. Severe COVID-19 was defined as COVID-19 that fulfill the criteria for severe pneumonia or patients with acute respiratory distress syndrome/disease progression/need for intensive care unit or mechanical ventilation. The effect estimates were a mean difference between patients with and without a poor outcome in mg/dL and odds ratio (OR) per 1 mg/dL decrease in prealbumin level. The effect estimates were reported with their 95% confidence interval (95% CI). RESULTS: Nine studies comprising of 2104 patients were included in this systematic review and meta-analysis. Patients with poor outcome have lower prealbumin level (mean difference -71.48 mg/dL [95% CI -93.74, -49.22], p<0.001; I2: 85.9%). Every 1 mg/dL decrease in prealbumin level was associated with 1% increase in poor outcome (OR 0.992 [0.987, 0.997], p=0.004, I2: 81.7%). Meta-regression analysis showed that the association between the prealbumin level and poor outcome varies with gender (male) (coefficient: 3.50, R2: 100%, p<0.001), but not age, diabetes, hypertension, and chronic kidney disease. CONCLUSIONS: Low serum prealbumin was associated with poor outcomes in patients with COVID-19.


Subject(s)
COVID-19/pathology , Prealbumin/analysis , COVID-19/mortality , COVID-19/virology , Humans , Odds Ratio , SARS-CoV-2/isolation & purification , Severity of Illness Index , Sex Factors
5.
Orphanet J Rare Dis ; 16(1): 204, 2021 05 06.
Article in English | MEDLINE | ID: covidwho-1219017

ABSTRACT

BACKGROUND: The global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing the ongoing coronavirus disease 2019 (COVID-19) pandemic has raised serious concern for patients with chronic disease. A correlation has been identified between the severity of COVID-19 and a patient's preexisting comorbidities. Although COVID-19 primarily involves the respiratory system, dysfunction in multiple organ systems is common, particularly in the cardiovascular, gastrointestinal, immune, renal, and nervous systems. Patients with amyloid transthyretin (ATTR) amyloidosis represent a population particularly vulnerable to COVID-19 morbidity due to the multisystem nature of ATTR amyloidosis. MAIN BODY: ATTR amyloidosis is a clinically heterogeneous progressive disease, resulting from the accumulation of amyloid fibrils in various organs and tissues. Amyloid deposition causes multisystem clinical manifestations, including cardiomyopathy and polyneuropathy, along with gastrointestinal symptoms and renal dysfunction. Given the potential for exacerbation of organ dysfunction, physicians note possible unique challenges in the management of patients with ATTR amyloidosis who develop multiorgan complications from COVID-19. While the interplay between COVID-19 and ATTR amyloidosis is still being evaluated, physicians should consider that the heightened susceptibility of patients with ATTR amyloidosis to multiorgan complications might increase their risk for poor outcomes with COVID-19. CONCLUSION: Patients with ATTR amyloidosis are suspected to have a higher risk of morbidity and mortality due to age and underlying ATTR amyloidosis-related organ dysfunction. While further research is needed to characterize this risk and management implications, ATTR amyloidosis patients might require specialized management if they develop COVID-19. The risks of delaying diagnosis or interrupting treatment for patients with ATTR amyloidosis should be balanced with the risk of exposure in the health care setting. Both physicians and patients must adapt to a new construct for care during and possibly after the pandemic to ensure optimal health for patients with ATTR amyloidosis, minimizing treatment interruptions.


Subject(s)
Amyloid Neuropathies, Familial , COVID-19 , Amyloid , Humans , Pandemics , Prealbumin , SARS-CoV-2
6.
Eur J Heart Fail ; 23(6): 895-905, 2021 06.
Article in English | MEDLINE | ID: covidwho-1206759

ABSTRACT

Transthyretin amyloid cardiomyopathy (ATTR-CM) is a life-threatening condition with a heterogeneous clinical presentation. The recent availability of treatment for ATTR-CM has stimulated increased awareness of the disease and patient identification. Stratification of patients with ATTR-CM is critical for optimal management and treatment; however, monitoring disease progression is challenging and currently lacks best-practice guidance. In this report, experts with experience in treating amyloidosis and ATTR-CM developed consensus recommendations for monitoring the course of patients with ATTR-CM and proposed meaningful thresholds and frequency for specific parameters. A set of 11 measurable features across three separate domains were evaluated: (i) clinical and functional endpoints, (ii) biomarkers and laboratory markers, and (iii) imaging and electrocardiographic parameters. Experts recommended that one marker from each of the three domains provides the minimum requirements for assessing disease progression. Assessment of cardiac disease status should be part of a multiparametric evaluation in which progression, stability or improvement of other involved systems in transthyretin amyloidosis should also be considered. Additional data from placebo arms of clinical trials and future studies assessing ATTR-CM will help to elucidate, refine and define these and other measurements.


Subject(s)
Amyloid Neuropathies, Familial , Cardiomyopathies , Heart Failure , Amyloid Neuropathies, Familial/diagnosis , Cardiomyopathies/diagnosis , Consensus , Humans , Prealbumin/genetics
7.
J Med Virol ; 93(3): 1761-1765, 2021 03.
Article in English | MEDLINE | ID: covidwho-1196476

ABSTRACT

To determine the distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) respiratory viral loads (VL) during the acute phase of infection and their correlation with clinical presentation and inflammation-related biomarkers. Nasopharyngeal swabs from 453 adult SARS-CoV-2-infected patients from the Department of Infectious Diseases, Besançon, France, were collected at the time of admission or consultation for reverse transcriptase polymerase chain reaction (RT-PCR) analysis. Clinical information and concentrations of biological parameters (C-reactive protein [CRP], fibrinogen, lactate dehydrogenase [LDH], prealbumin) were noticed. Mean respiratory VL homogeneously decreased from 7.2 log10 copies/ml (95% confidence interval [CI]: 6.6-7.8) on the first day of symptoms until 4.6 log10 copies/ml (95% CI: 3.8-5.4) at day 10 (slope = -0.24; R2 = .95). VL were poorly correlated with COVID-19 symptoms and outcome, excepted for dyspnea and anosmia, which were significantly associated with lower VL (p < .05). CRP, fibrinogen, and LDH concentrations significantly increased over the first 10 days (median CRP concentrations from 36.8 mg/L at days 0-1 to 99.5 mg/L at days 8-10; p < .01), whereas prealbumin concentrations tended to decrease. Since SARS-CoV-2 respiratory VL regularly decrease in the acute phase of infection, determining the level of VL may help predicting the onset of virus shedding in a specific patient. However, the role of SARS-CoV-2 VL as a biomarker of severity is limited.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , COVID-19/epidemiology , Viral Load/methods , Adult , Aged , Aged, 80 and over , Anosmia/pathology , C-Reactive Protein/analysis , Dyspnea/pathology , Female , Fibrinogen/analysis , France/epidemiology , Humans , L-Lactate Dehydrogenase/blood , Male , Middle Aged , Nasopharynx/virology , Prealbumin/analysis , RNA, Viral/analysis , SARS-CoV-2 , Treatment Outcome , Virus Shedding , Young Adult
8.
Zhonghua Nei Ke Za Zhi ; 60(2): 134-138, 2021 Feb 01.
Article in Chinese | MEDLINE | ID: covidwho-1050652

ABSTRACT

Objective: To retrospectively analyze the relationship between serum C-reactive protein (CRP), serum cholinesterase (ChE), prealbumin (PA) and mortality in severe patients with coronavirus disease 2019 (COVID-19). Methods: During the period from January 29 to March 30, 2020, a total of 344 COVID-19 patients were admitted to west branch of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. One-hundred and ninety-two patients were diagnosed with common type and excluded, and 34 patients were transferred to LeiShenShan or other medical units. The remaining 118 patients were severe cases, and 18 cases were excluded due to incomplete data. A total of 100 severe COVID-19 patients were finally collected. According to the outcome, the patients were divided into death group (37 cases) and survival group(63 cases), and the levels of serum CRP, ChE and PA were compared. Statistical analysis were performed by SPSS25.0. Results: There were 53 male patients in this study. The level of CRP in death group was significantly more elevated compare to the survival group [(95.72±39.56) mg/L vs. (22.21±20.75) mg/L, P<0.01]. On the contrary, serum ChE in death group was remarkably decreased [(5 082±1 566) U/L vs. (7 075±1 680) U/L, P<0.01]. Also, serum PA in death group was significantly lower [(86.18±47.94) mg/L vs. (167.40±57.82) mg/L, P<0.01]. Univariate analysis showed that CRP and PA had an impact on the survival of critical patients, but multivariate Cox regression analysis suggested that CRP was the independent factor affecting the survival of critical patients. Conclusions: CRP is generally elevated in severe patients with COVID-19, and serum ChE and PA accordingly decrease. CRP and PA have influence on patients' survival, but only CRP demonstrates predictive value for prognosis in critical patients with COVID-19.


Subject(s)
C-Reactive Protein , COVID-19 , C-Reactive Protein/analysis , Cholinesterases , Humans , Male , Prealbumin , Prognosis , ROC Curve , Retrospective Studies , SARS-CoV-2
9.
J Clin Lab Anal ; 35(1): e23644, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-893229

ABSTRACT

OBJECTIVES: To investigate laboratory markers for COVID-19 progression in patients with different medical conditions. METHODS: We performed a multicenter retrospective study of 836 cases in Hubei. To avoid the collinearity among the indicators, principal component analysis (PCA) followed by partial least squares discriminant analysis (PLS-DA) was performed to obtain an overview of laboratory assessments. Multivariable logistic regression analysis and multivariable Cox proportional hazards regression analysis were respectively used to explore risk factors associated with disease severity and mortality. Survival analysis was performed in patients with the most common comorbidities. RESULTS: Lactate dehydrogenase (LDH) and prealbumin were associated with disease severity in patients with or without comorbidities, indicated by both PCA/PLS-DA and multivariable logistic regression analysis. The mortality risk was associated with age, LDH, C-reactive protein (CRP), D-dimer, and lymphopenia in patients with comorbidities. CRP was a risk factor associated with short-term mortality in patients with hypertension, but not liver diseases; additionally, D-dimer was a risk factor for death in patients with liver diseases. CONCLUSIONS: Lactate dehydrogenase was a reliable predictor associated with COVID-19 severity and mortality in patients with different medical conditions. Laboratory biomarkers for mortality risk were not identical in patients with comorbidities, suggesting multiple pathophysiological mechanisms following COVID-19 infection.


Subject(s)
Biomarkers/blood , COVID-19/etiology , Adult , Aged , C-Reactive Protein/analysis , COVID-19/epidemiology , Comorbidity , Diabetes Mellitus/epidemiology , Disease Progression , Female , Hospitalization/statistics & numerical data , Humans , Hypertension/epidemiology , L-Lactate Dehydrogenase/blood , Least-Squares Analysis , Liver Diseases/epidemiology , Male , Middle Aged , Prealbumin/analysis , Principal Component Analysis , Retrospective Studies , Survival Rate
11.
Nutrition ; 78: 110930, 2020 10.
Article in English | MEDLINE | ID: covidwho-731878

ABSTRACT

OBJECTIVES: High-risk patients ≥65 y of age with coronavirus disease 2019 (COVID-19) tended to have lower serum prealbumin concentrations. The aim of this study was to investigate the association of prealbumin at baseline on COVID-19-related mortality in elderly patients (≥65 y of age). METHODS: We non-selectively and consecutively collected participants from Tongji Hospital in Wuhan from January 17 to February 17, 2020. Univariate and multivariate logistic regression models were employed to evaluate the correlation between prealbumin and in-hospital outcomes (in-hospital mortality, admission to the intensive care unit [ICU], and mechanical ventilation) in elderly patients with COVID-19. Linear trend was performed by entering the median value of each category of prealbumin tertile as a continuous variable and was visually confirmed by using generalized additive models. Interaction and stratified analyses were conducted as well. RESULTS: We included 446 elderly patients with COVID-19 in the final analyses. In-hospital mortality was 14.79%. Of the 446 patients, 15.47% were admitted to the ICU and 21.3% required mechanical ventilation. Compared with patients in the highest tertile, the prealbumin of patients in the lowest tertile had a 19.09-fold higher risk for death [odds ratio (OR), 20.09; 95% confidence interval (CI), 3.62-111.64; P = 0.0006], 25.39-fold higher risk for ICU admission (OR, 26.39; 95% CI, 4.04-172.39; P = 0.0006), and 1.8-fold higher risk for mechanical ventilation (OR, 2.8; 95% CI, 1.15-6.78; P = 0.0227) after adjustment for potential confounders. There was a linear trend correlation between serum prealbumin concentration and risk for in-hospital mortality, ICU admission, and mechanical ventilation in elderly patients with COVID-19 infection. CONCLUSION: Prealbumin is an independent risk factor of in-hospital mortality for elderly patients with COVID-19. Assessment of prealbumin may help identify high-risk individuals ≥65 y of age with COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/blood , Coronavirus Infections/mortality , Hospital Mortality , Pneumonia, Viral/blood , Pneumonia, Viral/mortality , Prealbumin/analysis , Aged , Biomarkers/blood , COVID-19 , China/epidemiology , Female , Humans , Intensive Care Units/statistics & numerical data , Logistic Models , Male , Multivariate Analysis , Odds Ratio , Pandemics , Respiration, Artificial/statistics & numerical data , Risk Assessment , Risk Factors , SARS-CoV-2
12.
Saudi J Gastroenterol ; 26(5): 272-278, 2020.
Article in English | MEDLINE | ID: covidwho-706036

ABSTRACT

Background/Aims: We aimed to evaluate the distribution of abnormal liver-related biomarkers in patients with coronavirus disease (COVID-19) and explore the prognostic value of elevated liver enzymes and abnormal liver synthetic capacity with regards to patient mortality. Patients and Methods: This retrospective observational study included 80 laboratory-confirmed COVID-19 cases. Data were collected from the electronic medical record system by a trained team of physicians. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), albumin, and prealbumin levels at admission and on day 7 after admission were collected. The primary outcome of the current study was patient mortality. Results: Abnormal ALT, AST, TB, albumin, and prealbumin levels were observed in 11 (13.8%), 15 (18.8%), 5 (6.3%), 22 (27.5%), and 31 (38.8%) patients, respectively. Male gender correlated with elevated ALT and AST levels (p = 0.027 and 0.036, respectively). Higher levels of AST and lower levels of albumin and prealbumin were associated with patient mortality (p = 0.009, 0.002, and 0.003, respectively). Multivariate Cox regression analysis identified patient age (p = 0.013, HR 1.108) and prealbumin levels (p = 0.015, HR 0.986) as independent predictors for patient mortality. However, changes in liver-related biomarkers were not associated with poor outcome in multivariate analysis (p > 0.05). Conclusions: Abnormalities in albumin and prealbumin levels are common among COVID-19 patients and hypoprealbuminemia independently predicts adverse outcome and should be carefully considered in clinical practice. Moreover, changes in liver-related biomarkers is not a salient feature of COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/blood , Liver Diseases/blood , Pneumonia, Viral/blood , Prealbumin/metabolism , Aged , Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Bilirubin/blood , Biomarkers/blood , COVID-19 , Comorbidity , Coronavirus Infections/epidemiology , Female , Follow-Up Studies , Humans , Liver Diseases/epidemiology , Liver Function Tests , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Prognosis , Retrospective Studies , SARS-CoV-2 , Saudi Arabia/epidemiology
14.
Epidemiol Infect ; 148: e164, 2020 07 27.
Article in English | MEDLINE | ID: covidwho-679966

ABSTRACT

The emergence of 2019 novel coronavirus disease (COVID-19) is currently a global concern. In this study, our goal was to explore the changing expression levels of acute-phase reaction proteins (APRPs) in the serum of COVID-19 patients and to elucidate the immunological characteristics of COVID-19. In the study design, we recruited 72 COVID-19 patients, including 22 cases of mild degree, 38 cases of moderate degree and 12 cases of severe degree. We also recruited 20 patients with community-acquired pneumonia (CAP) and 20 normal control subjects as a comparison. Fasting venous blood was taken to detect the content of complement 3 (C3), complement 4 (C4), C-reactive protein (CRP), serum amyloid A (SAA) and prealbumin (PA). When compared the COVID-19 group with the CAP and normal control groups, respectively, the mean value of CRP and SAA in the COVID-19 group (including mild, moderate and severe patients) had increased significantly (P < 0.01), whereas the mean values of C3, C4 and PA decreased (P < 0.01). For the asymptomatic or mild symptomatic patients with COVID-19, the actual aggravation of disease may be more advanced than the clinical appearances. Meanwhile, the statistical analyses indicated that the development of COVID-19 brought about a significant increase in the content of CRP and SAA (P < 0.01), and a decline in the content of C3, C4 and PA (P < 0.01). These findings suggested that the changes in the level of APRPs could be used as indicators to identify the degree and progression of COVID-19, and the significant changes might demonstrate the aggravation of disease. This study provided a new approach to improve the clinical management plan and prognosis of COVID-19.


Subject(s)
Acute-Phase Proteins/analysis , Acute-Phase Proteins/biosynthesis , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Adult , Aged , C-Reactive Protein/analysis , C-Reactive Protein/biosynthesis , COVID-19 , Case-Control Studies , Community-Acquired Infections/blood , Community-Acquired Infections/immunology , Complement C3/analysis , Complement C3/biosynthesis , Complement C4/analysis , Complement C4/biosynthesis , Coronavirus Infections/blood , Coronavirus Infections/immunology , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia/blood , Pneumonia/immunology , Pneumonia, Viral/blood , Pneumonia, Viral/immunology , Prealbumin/analysis , Prealbumin/biosynthesis , Prognosis , Serum Amyloid A Protein/analysis , Serum Amyloid A Protein/biosynthesis , Severity of Illness Index , Young Adult
17.
PLoS Med ; 17(6): e1003130, 2020 06.
Article in English | MEDLINE | ID: covidwho-599408

ABSTRACT

BACKGROUND: As of April 18, 2020, over 2,000,000 patients had been diagnosed with coronavirus disease-2019 (COVID-19) globally, and more than 140,000 deaths had been reported. The clinical and epidemiological characteristics of adult patients have been documented recently. However, information on pediatric patients is limited. We describe the clinical and epidemiological characteristics of pediatric patients to provide valuable insight into the early diagnosis and assessment of COVID-19 in children. METHODS AND FINDINGS: This retrospective, observational study involves a case series performed at 4 hospitals in West China. Thirty-four pediatric patients with COVID-19 were included from January 27 to February 23, 2020. The final follow-up visit was completed by March 16, 2020. Clinical and epidemiological characteristics were analyzed on the basis of demographic data, medical history, laboratory tests, radiological findings, and treatment information. Data analysis was performed for 34 pediatrics patients with COVID-19 aged from 1 to 144 months (median 33.00, interquartile range 10.00-94.25), among whom 14 males (41%) were included. All the patients in the current study presented mild (18%) or moderate (82%) forms of COVID-19. A total of 48% of patients were noted to be without a history of exposure to an identified source. Mixed infections of other respiratory pathogens were reported in 16 patients (47%). Comorbidities were reported in 6 patients (18%). The most common initial symptoms were fever (76%) and cough (62%). Expectoration (21%), vomiting (12%), and diarrhea (12%) were also reported in a considerable portion of cases. A substantial increase was detected in serum amyloid A for 17 patients (among 20 patients with available data; 85%) and in high-sensitivity C-reactive protein for 17 patients (among 29 patients with available data; 59%), whereas a decrease in prealbumin was noticed in 25 patients (among 32 patients with available data; 78%). In addition, significant increases in the levels of lactate dehydrogenase and α-hydroxybutyrate dehydrogenase were detected in 28 patients (among 34 patients with available data; 82%) and 25 patients (among 34 patients with available data; 74%), respectively. Patchy lesions in lobules were detected by chest computed tomographic scans in 28 patients (82%). Ground-glass opacities, which were a typical feature in adults, were rare in pediatric patients (3%). Rapid radiologic progression and a late-onset pattern of lesions in the lobules were also noticed. Lesions in lobules still existed in 24 (among 32 patients with lesions; 75%) patients that were discharged, although the main symptoms disappeared a few days after treatment. All patients were discharged, and the median duration of hospitalization was 10.00 (8.00-14.25) days. The current study was limited by the small sample size and a lack of dynamic detection of inflammatory markers. CONCLUSIONS: Our data systemically presented the clinical and epidemiological features, as well as the outcomes, of pediatric patients with COVID-19. Stratified analysis was performed between mild and moderate cases. The findings offer new insight into early identification and intervention in pediatric patients with COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Lung/diagnostic imaging , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Betacoronavirus , C-Reactive Protein/metabolism , COVID-19 , Child , Child, Preschool , China/epidemiology , Coinfection/epidemiology , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/metabolism , Cough/epidemiology , Cough/physiopathology , Diarrhea/epidemiology , Diarrhea/physiopathology , Female , Fever/epidemiology , Fever/physiopathology , Humans , Hydroxybutyrate Dehydrogenase/metabolism , Infant , L-Lactate Dehydrogenase/metabolism , Length of Stay/statistics & numerical data , Male , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/metabolism , Prealbumin/metabolism , Retrospective Studies , SARS-CoV-2 , Serum Amyloid A Protein/metabolism , Severity of Illness Index , Tomography, X-Ray Computed , Vomiting/epidemiology , Vomiting/physiopathology
18.
Microb Biotechnol ; 13(4): 844-887, 2020 07.
Article in English | MEDLINE | ID: covidwho-260009

ABSTRACT

We have recently argued that, because microbes have pervasive - often vital - influences on our lives, and that therefore their roles must be taken into account in many of the decisions we face, society must become microbiology-literate, through the introduction of relevant microbiology topics in school curricula (Timmis et al. 2019. Environ Microbiol 21: 1513-1528). The current coronavirus pandemic is a stark example of why microbiology literacy is such a crucial enabler of informed policy decisions, particularly those involving preparedness of public-health systems for disease outbreaks and pandemics. However, a significant barrier to attaining widespread appreciation of microbial contributions to our well-being and that of the planet is the fact that microbes are seldom visible: most people are only peripherally aware of them, except when they fall ill with an infection. And it is disease, rather than all of the positive activities mediated by microbes, that colours public perception of 'germs' and endows them with their poor image. It is imperative to render microbes visible, to give them life and form for children (and adults), and to counter prevalent misconceptions, through exposure to imagination-capturing images of microbes and examples of their beneficial outputs, accompanied by a balanced narrative. This will engender automatic mental associations between everyday information inputs, as well as visual, olfactory and tactile experiences, on the one hand, and the responsible microbes/microbial communities, on the other hand. Such associations, in turn, will promote awareness of microbes and of the many positive and vital consequences of their actions, and facilitate and encourage incorporation of such consequences into relevant decision-making processes. While teaching microbiology topics in primary and secondary school is key to this objective, a strategic programme to expose children directly and personally to natural and managed microbial processes, and the results of their actions, through carefully planned class excursions to local venues, can be instrumental in bringing microbes to life for children and, collaterally, their families. In order to encourage the embedding of microbiology-centric class excursions in current curricula, we suggest and illustrate here some possibilities relating to the topics of food (a favourite pre-occupation of most children), agriculture (together with horticulture and aquaculture), health and medicine, the environment and biotechnology. And, although not all of the microbially relevant infrastructure will be within reach of schools, there is usually access to a market, local food store, wastewater treatment plant, farm, surface water body, etc., all of which can provide opportunities to explore microbiology in action. If children sometimes consider the present to be mundane, even boring, they are usually excited with both the past and the future so, where possible, visits to local museums (the past) and research institutions advancing knowledge frontiers (the future) are strongly recommended, as is a tapping into the natural enthusiasm of local researchers to leverage the educational value of excursions and virtual excursions. Children are also fascinated by the unknown, so, paradoxically, the invisibility of microbes makes them especially fascinating objects for visualization and exploration. In outlining some of the options for microbiology excursions, providing suggestions for discussion topics and considering their educational value, we strive to extend the vistas of current class excursions and to: (i) inspire teachers and school managers to incorporate more microbiology excursions into curricula; (ii) encourage microbiologists to support school excursions and generally get involved in bringing microbes to life for children; (iii) urge leaders of organizations (biopharma, food industries, universities, etc.) to give school outreach activities a more prominent place in their mission portfolios, and (iv) convey to policymakers the benefits of providing schools with funds, materials and flexibility for educational endeavours beyond the classroom.


Subject(s)
Amyloidosis , Prealbumin , Adult , Benzoxazoles , Child , Humans
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