Increased nutrition risk is associated with a prolonged negative conversion of viral RNA in children and adolescents with COVID-19.

BACKGROUND: This study aimed to determine the factors affecting the time to negative conversion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children and adolescents, with particular reference to nutrition risk assessment on admission. METHODS: This retrospective observational study was conducted in a sentinel hospital for novel coronavirus in Quanzhou, China. The study population comprised children and adolescents with COVID-19 admitted to the isolation wards between March 25 and April 12, 2022. Based on the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), nutrition risk screening was performed within 24 h of admission. Univariate and multivariate analyses were used to identify independent factors for the time to negative viral RNA conversion. RESULTS: A total of 185 patients with confirmed COVID-19 were included in this study. The median time to viral RNA conversion (from the first day of a positive nucleic acid test to the first day of consecutive negative results) was 15 days (IQR 12-18 days), ranging from 4 to 25 days. High nutrition risk (hazard ratio [HR]: 0.543, 95% CI: 0.334-0.881) and fever (HR: 0.663; 95% CI: 0.483-0.910) were independent factors influencing the negative conversion of SARS-CoV-2 RNA. CONCLUSION: High nutrition risk and fever were independently associated with delayed viral clearance in children and adolescents with SARS-CoV-2 infection, so these factors should be considered during the treatment plans for infected children and adolescents.

Evaluation of a Point-of-Care Testing Analyzer for Measuring Peripheral Blood Leukocytes.

White blood cell (WBC) is an important indicator of inflammation in the body, and it can help distinguish between bacterial and viral infections. At present, most primary medical institutions in China have a poor percentage of adoption of blood-testing technology, and a hematology detection system with a high price to performance ratio and easy operation is urgently needed in primary healthcare centers. This paper introduces the principle and operation procedures of a point-of-care testing (POCT) card-based leukocyte analyzer (evaluated system), which was used to detect WBC indexes such as neutrophils, lymphocytes, and intermediate group cells (including eosinophils, basophils, and monocytes) in whole blood. The results from the evaluated system were compared to those from two commercial automatic hematology analyzers (reference system). The correlation and consistency between the evaluated system and the commercial reference systems were analyzed. The results showed that WBC count and number of granulocytes detected by the evaluated and reference systems showed a strong positive correlation (rs = 0.972 and 0.973, respectively), while the number of lymphocytes showed a relatively low correlation (rs = 0.851). A Bland-Altman plot showed that the major difference between the values detected by the evaluated system and the reference systems is within 95% limits of agreement (LoA), indicating that the two systems are in good agreement. In conclusion, the evaluated system has an excellent correlation, robust consistency, and a reliable comparison with the results of the widely used automatic hematology analyzers. It is ideal for WBC detection in primary medical institutions where a full-automatic five-category hematology analyzer is unavailable, especially during the COVID-19 normalized prevention and control period.

Krebs Von den Lungen-6 as a predictive indicator for the risk of secondary pulmonary fibrosis and its reversibility in COVID-19 patients.

Dysregulated immune response and abnormal repairment could cause secondary pulmonary fibrosis of varying severity in COVID-19, especially for the elders. The Krebs Von den Lungen-6 (KL-6) as a sensitive marker reflects the degree of fibrosis and this study will focus on analyzing the evaluative efficacy and predictive role of KL-6 in COVID-19 secondary pulmonary fibrosis. The study lasted more than three months and included total 289 COVID-19 patients who were divided into moderate (n=226) and severe groups (n=63) according to the severity of illness. Clinical information such as inflammation indicators, radiological results and lung function tests were collected. The time points of nucleic acid test were also recorded. Furthermore, based on Chest radiology detection, it was identified that 80 (27.7%) patients developed reversible pulmonary fibrosis and 34 (11.8%) patients developed irreversible pulmonary fibrosis. Receiver operating characteristic (ROC) curve analysis shows that KL-6 could diagnose the severity of COVID-19 (AUC=0.862) and predict the occurrence of pulmonary fibrosis (AUC = 0.741) and irreversible pulmonary fibrosis (AUC=0.872). Importantly, the cross-correlation analysis demonstrates that KL-6 rises earlier than the development of lung radiology fibrosis, thus also illuminating the predictive function of KL-6. We set specific values (505U/mL and 674U/mL) for KL-6 in order to assess the risk of pulmonary fibrosis after SARS-CoV-2 infection. The survival curves for days in hospital show that the higher the KL-6 levels, the longer the hospital stay (P<0.0001). In conclusion, KL-6 could be used as an important predictor to evaluate the secondary pulmonary fibrosis degree for COVID-19.

Predictive effects of IgA and IgG combination to assess pulmonary exudation progression in COVID-19 patients.

Our study intended to longitudinally explore the prediction effect of immunoglobulin A (IgA) on pulmonary exudation progression in COVID-19 patients. The serum IgA was tested with chemiluminescence method. Autoregressive moving average model was used to extrapolate the IgA levels before hospital admission. The positive rate of IgA and IgG in our cohort was 97% and 79.0%, respectively. In this study, the IgA levels peaks within 10-15 days after admission, while the IgG levels peaks at admission. We found that the time difference between their peaks was about 10 days. Viral RNA detection results showed that the positive rate in sputum and feces were the highest. Blood gas analysis showed that deterioration of hypoxia with the enlargement of pulmonary exudation area. And alveolar-arterial oxygen difference and oxygenation index were correlated with IgA and IgG. The results of biopsy showed that the epithelium of lung was exfoliated and the mucosa was edematous. In severe COVID-19 patients, the combination of IgA and IgG can predict the progress of pulmonary lesions and is closely related to hypoxemia and both also play an important defense role in invasion and destruction of bronchial and alveolar epithelium by SARS-CoV-2.

Clinical relevance of serum Krebs von den Lungen-6 levels in patients with coronavirus disease 2019.

The clinical relevance of Krebs von den Lungen-6 (KL-6) levels in patients with coronavirus disease 2019 (COVID-19) is unclear. This study aimed to evaluate the correlation between KL-6 levels, laboratory parameters, and clinical outcomes. We enrolled 364 patients with confirmed COVID-19 who were hospitalized within 1 week of symptom onset. Their serum KL-6 level was measured on admission. Demographic data, symptoms, comorbidities, and laboratory parameters were recorded at the time of admission. Days to nucleic acid conversion and days of hospitalization were defined as clinical outcomes for evaluating the clinical relevance of serum KL-6 levels in COVID-19. Patients with elevated KL-6 levels were significantly older; had more reported instances of fever, cough, fatigue, and wheezing; and a longer hospital stays than those with normal KL-6 levels; the difference was statistically significant (p < 0.001). Furthermore, KL-6 levels was associated with the days of hospitalization and various laboratory parameters that influence the severity and prognosis of COVID-19. Elevated KL-6 levels have also been shown to be an independent risk factor for prolonged hospitalization. Our data suggest that serum KL-6 levels on admission can serve as an indicator for assessing the clinical outcomes of COVID-19.

Characteristics of COVID-19 Patients Based on the Results of Nucleic Acid and Specific Antibodies and the Clinical Relevance of Antibody Levels.

Combination of nucleic acid and specific antibody testing is often required in the diagnosis of COVID-19, but whether patients with different nucleic acid and antibody results have different laboratory parameters, severities and clinical outcomes, has not yet been comprehensively investigated. Thus, according to different groups of nucleic acid and antibody results, we aimed to investigate the differences in demographic characteristics, and laboratory parameters among the different groups and predict their clinical outcomes. In our study, nasopharyngeal swab nucleic acids and antibodies were detected by reverse-transcription polymerase chain reaction and chemiluminescence, respectively. Patients with confirmed COVID-19 with different severities, were divided into the PCR+Ab+, PCR+Ab-, and PCR-Ab+ groups. Demographic characteristics, symptoms, comorbidities, laboratory parameters, and clinical outcomes were compared among the three groups. The correlation of antibodies with laboratory parameters and clinical outcomes was also explored, and antibodies were used to predict the timing of nucleic acid conversion. We found that a total of 364 COVID-19 patients were included in the final analysis. Of these, a total of 184, 37, and 143 patients were assigned to the PCR+Ab+, PCR+Ab-, and PCR-Ab+ groups, respectively. Compared to patients in the PCR+Ab- or PCR- Ab+ groups, patients in the PCR+Ab+ group presented worse symptoms, more comorbidities, more laboratory abnormalities, and worse clinical outcomes (P < 0.05). In addition, the levels of IgG, IgM, and IgA were all significantly correlated with the days of hospitalization, days of PCR turning negative, and multiple laboratory parameters (P < 0.05). Meanwhile, combined IgM, IgA, and IgG predicted the days of PCR turning negative within 1 week. The best performance was achieved when the cut-off values of IgM, IgG, and IgA were 3.2, 1.8 and 0.5, respectively, with a sensitivity of 73% and specificity of 82%. In conclusion, COVID-19 patients who were both positive for nucleic acids and antibodies presented with worse clinical features, laboratory abnormalities, and clinical outcomes. The three specific antibodies were positively correlated with clinical outcomes and most laboratory parameters. Furthermore, antibody levels can predict the time of nucleic acid conversion.

The role of serum specific- SARS-CoV-2 antibody in COVID-19 patients.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for coronavirus disease 2019 (COVID-19), has rapidly spread, resulting in considerable casualties and serious economic loss worldwide. Disease severity and related symptoms markedly vary among individuals. A large number of patients present atypical symptoms, which represent a big challenge for early diagnosis and prompt infection source isolation. Currently, COVID-19 diagnosis predominantly depends on nucleic acid tests (NAT) for SARS-CoV-2 in respiratory specimens, but this method presents a high rate of false negative results. Therefore, serum antibody measurement has been rapidly developed as a supplementary method with the aim of improving diagnostic accuracy. Further, serum antibody levels might help to identify the infection stage, asymptomatic carriers, and patients with diverging severities and to monitor convalescent plasma therapy. In the current review, we aim to present comprehensive evidence to clarify the utility of SARS-CoV-2 antibodies in COVID-19 patients as a reference for use in the clinic.

Exploration and correlation analysis of changes in Krebs von den Lungen-6 levels in COVID-19 patients with different types in China.

This study aimed to determine the clinical significance of Krebs von den Lungen-6 (KL-6) in patients with COVID-19, so as to find a marker with high sensitivity, specificity and easy detection to evaluate the lung injury and inflammation of COVID-19. Sixty-three COVID-19 patients and 43 non-COVID-19 patients with similar clinical phenotypes and/or imaging findings were enrolled to test the levels of KL-6 using chemiluminescent immunoassay. In addition, the blood gas, imaging and lymphocyte factors tests were collected from all participants. The data was finally analyzed using multivariate statistical analysis. The results showed KL-6 levels in COVID-19 patients were higher than those in non-COVID-19 patients (P < 0.001). Moreover, the KL-6 levels in severe and critically severe patients were significantly upregulated compared with patients with mild and common type (P < 0.05). Meanwhile, the imaging evaluation showed a significant correlation between KL-6 and pulmonary lesion area (P < 0.05). KL-6 was also found to be significantly correlated with oxygenation index and oxygen partial pressure difference of alveolar artery (PA-aDO2) (Both P < 0.01). In conclusion, KL-6 could be an indicator to evaluate the progression of COVID-19, which is parallel to the level of lung injury and inflammation in patients. Moreover, it can also reflect the pulmonary ventilation function.

Kinetics of SARS-CoV-2 specific IgM and IgG responses in COVID-19 patients.

The emerging COVID-19 caused by SARS-CoV-2 infection poses severe challenges to global public health. Serum antibody testing is becoming one of the critical methods for the diagnosis of COVID-19 patients. We investigated IgM and IgG responses against SARS-CoV-2 nucleocapsid (N) and spike (S) protein after symptom onset in the intensive care unit (ICU) and non-ICU patients. 130 blood samples from 38 COVID-19 patients were collected. The levels of IgM and IgG specific to N and S protein were detected by ELISA. A series of blood samples were collected along the disease course from the same patient, including 11 ICU patients and 27 non-ICU patients for longitudinal analysis. N and S specific IgM and IgG (N-IgM, N-IgG, S-IgM, S-IgG) in non-ICU patients increased after symptom onset. N-IgM and S-IgM in some non-ICU patients reached a peak in the second week, while N-IgG and S-IgG continued to increase in the third week. The combined detection of N and S specific IgM and IgG could identify up to 75% of SARS-CoV-2 infected patients in the first week. S-IgG was significantly higher in non-ICU patients than in ICU patients in the third week. In contrast, N-IgG was significantly higher in ICU patients than in non-ICU patients. The increase of S-IgG positively correlated with the decrease of C-reactive protein (CRP) in non-ICU patients. N and S specific IgM and IgG increased gradually after symptom onset and can be used for detection of SARS-CoV-2 infection. Analysis of the dynamics of S-IgG may help to predict prognosis.

Occupational exposure to SARS-CoV-2 in burns treatment during the COVID-19 epidemic: Specific diagnosis and treatment protocol.

Epidemic prevention and control measures for the new coronavirus disease 2019 (COVID-19) has achieved significant results. As of 8 April 2020, 22,073 infection cases of COVID-19 among healthcare workers from 52 countries had been reported to WHO. COVID-19 has strong infectivity, high transmission speeds, and causes serious infection among healthcare worker. Burns are an acute-care condition, and burn treatment needs to be initiated before COVID-19 infection status can be excluded. The key step to infection prevention is to identify risk points of infection exposure, strengthen the protection against those risk points, and formulate an appropriate diagnosis and treatment protocol. Following an in-depth study of the latest literature on COVID-19 diagnosis and treatment, we reviewed the protocols surrounding hospitalization of patients with extensive burns (area≥50 %) in our hospital from February 2009 to February 2019 and, in accordance with the epidemiological characteristics of COVID-19, developed an algorithm for protection during diagnosis and treatment of burns. Therefore, the aspects of medical protection and the diagnosis and treatment of burns appear to be particularly important during the prevention and control of the COVID-19. This algorithm was followed for 4 patients who received emergency treatment in February 2020 and were hospitalized. All healthcare worker were protected according to the three-tiered protective measures, and there was no nosocomial infection. During the COVID-19 epidemic, the early stages of emergency treatment for patients with extensive burns requiring the establishment of venous access for rehydration, endotracheal intubation or tracheostomy, wound treatment, and surgery are the risk points for exposure to infection. The implementation of effective, appropriate-grade protection and formulation of practical treatment protocols can increase protection of healthcare worke and reduce the risk of COVID-19 infection exposure.