Association of inflammatory markers with the severity of COVID-19

BackgroundThe ongoing worldwide epidemic of Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2), has posed a huge threat to global public health. However, with regard to the effects of inflammatory markers on the severity of COVID-19, studies have reported associations that vary in strength and direction. AimsIn the meta-analysis, we aimed to provide an overview of the association of inflammatory markers with severity of COVID-19. MethodsThe following databases were searched: PubMed, Embase, Cochrane Library, Wanfang database and CNKI (China National Knowledge Infrastructure) database until March 20, 2020. Weighted mean difference (WMD) and 95% confidence intervals (CIs) were pooled using random or fixed-effects models. ResultsA total of 16 studies were included in our analysis comprising of 3962 patients with COVID-19. Random-effects results demonstrated that patients with COVID-19 in non-severe group had lower levels for CRP (WMD = -41.78 mg/l, 95% CI = [-52.43, - 31.13], P < 0.001), PCT (WMD = -0.13 ng/ml, 95% CI = [-0.20, -0.05], P < 0.001), IL- 6 (WMD = -21.32 ng/l, 95% CI = [-28.34, -14.31], P < 0.001), ESR (WMD = - 8.40 mm/h, 95% CI = [-14.32, -2.48], P = 0.005), SAA (WMD = -43.35 g/ml, 95% CI = [-80.85, -5.85], P = 0.020) and serum ferritin (WMD = -398.80 mg/l, 95% CI = [- 625.89, -171.71], P < 0.001), compared with those in severe group. Moreover, survivors had lower level for IL-6 than non-survivors with COVID-19 (WMD = -4.80 ng/ml, 95% CI = [-5.87, -3.73], P < 0.001). These results were consistent through sensitivity analysis and publication bias assessment. ConclusionsThe meta-analysis highlights the association of inflammatory markers with the severity of COVID-19. Measurement of inflammatory markers might help clinicians to monitor and evaluate the severity and prognosis of COVID-19.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection During Pregnancy In China: A Retrospective Cohort Study

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been identified as the cause of the ongoing worldwide epidemic of Coronavirus Disease 2019 (COVID-19) in China and worldwide. However, there were few studies about the effects of SARS-CoV-2 infection on pregnant women. MethodsIn this retrospective cohort study, we enrolled 31 pregnant women and 35 non-pregnant women from Jan 28 to Feb 28, 2020 to evaluate the effects of SARS-CoV-2 infection during pregnancy. Inflammatory indices were used to assess the severity of COVID-19. Evidence of vertical transmission was determined by laboratory confirmation of SARS-CoV-2 in amniotic fluid, placenta, neonatal throat and anal swab and breastmilk samples. FindingsCompared with non-pregnant women, pregnant women had a significantly lower proportion of fever (54{middle dot}8% vs. 87{middle dot}5%, p= 0.006), a shorter average interval from onset to hospitalization (7{middle dot}80 {+/-}7{middle dot}0d vs. 13{middle dot}2 {+/-} 8{middle dot}2d, p= 0.005), and a higher proportion of severe or critical COVID-19 (32{middle dot}3% vs. 11{middle dot}4%, p=0.039). Neutrophil-to-lymphocyte ratio (NLR) and systematic immune-inflammation-based prognostic index (SII) were significantly higher on admission in severe/critical pneumonia group than moderate pneumonia group. We could not detect the presence of SARS-CoV-2 by RT-PCR in amniotic fluid, placenta, neonatal throat and anal swab and breastmilk samples. InterpretationThe clinical symptoms of COVID-19 in pregnant women were insidious and atypical, compared with those in non-pregnant patients. SII and NLR could be a useful marker to evaluate the severity of COVID-19. There was no evidence of vertical transmission during pregnancy with SARS-CoV-2 infection. FundingNational Natural Science Foundation of China and Research Funds for the Central Universities. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSWe searched PubMed, Embase and Web of science for articles published up to March 1st, 2020, using the keywords ("novel coronavirus" OR "2019 novel coronavirus" OR "2019-nCoV" OR COVID-19 OR SARS-CoV-2) AND (pregnancy OR "maternal infection" OR "fetal infection") AND "Cohort studies". We identified no published cohort studies on pregnant women with the 2019 novel coronavirus disease (COVID-19) infection. Added value of this studyFor this retrospective cohort study, we reviewed clinical records, laboratory findings, and chest CT scans from 31 pregnant women and 35 non-pregnant women from Jan 28 to Feb 28, 2020 to evaluate the effects of SARS-CoV-2 infection during pregnancy. Inflammatory indices were used to assess the severity of COVID-19. Evidence of vertical transmission was determined by laboratory confirmation of SARS-CoV-2 in amniotic fluid, placenta, neonatal throat and anal swab and breastmilk samples. Compared with non-pregnant women, pregnant women had a significantly lower proportion of fever (54{middle dot}8% vs. 87{middle dot}5%, p= 0.006), a shorter average interval from onset to hospitalization (7{middle dot}80 {+/-}7{middle dot}0d vs. 13{middle dot}2 {+/-} 8{middle dot}2d, p= 0.005), and a higher proportion of severe or critical COVID-19 (32{middle dot}3% vs. 11{middle dot}4%, p=0.039). Neutrophil-to-lymphocyte ratio (NLR) and systematic immune-inflammation-based prognostic index (SII) were significantly higher on admission in severe/critical pneumonia group than moderate pneumonia group. Amniotic fluid, placenta, neonatal throat and anal swab and breastmilk samples were tested for SARS-CoV-2 by RT-PCR and all results were negative. Implications of all the available evidenceThe clinical symptoms of COVID-19 in pregnant women were insidious and atypical, compared with those in non-pregnant patients. SII and NLR could be a useful marker to evaluate the severity of COVID-19. There was no evidence of vertical transmission during pregnancy with SARS-CoV-2 infection.

An analysis of epidemiological and clinical features of 46 patients with hemorrhagic fever with renal syndrome in Shenzhen City / 中华地方病学杂志

Objective To understand the epidemiological and clinical features of patients with hemorrhagic fever and renal syndrome (HFRS) in Shenzhen,and to accumulate experience in the diagnosis and treatment of HFRS in this area.Methods A retrospective analysis was conducted by collecting the clinical data from 46 patients who were confirmed with HFRS and admitted to the Department of Infectious Diseases of Shenzhen People's Hospital from January 2015 to December 2018.The demographic characteristics,epidemiological,clinical manifestations,examinations,treatments and prognosis,and other characteristics were analyzed.Results All the 46 patients with HFRS were residens in Shenzhen,with a male-to-female ratio of 6.67:1.00 (40:6),aged (40.18 ± 15.63) years old,and 38 patients (82.61％) aged 23-45 years old.There were 41 patients (89.13％) with a history of HFRS epidemiology,and there were mice in their houses or workplaces.The houses of 39 patients (84.78％) were rented,and 34 patients (87.18％) rented their houses in urban villages.There were morbidity throughout the year,and 33 patients (71.74％) were ill from January to June.In clinical classification,44 cases (95.65％) were mild,2 cases (4.35％) were medium,and there were no severe or critical cases.The clinical manifestations were that all patients were hospitalized due to fever mainly with hyperthermia.Thirty-nine patients (84.78％) were presented with systemic aches,headaches,low back pain and eyelid pain,and 28 patients (60.87％) had skin and mucous membrane hyperemia flushing.Clinical stages showed that all patients had pyretogenesis stage and polyuria stage,including pyretogenesis stage [(7.34 ± 6.82) d],polyuria stage [(9.94 ± 5.77) d],only 4.35％ (2/46) patients with hypotension shock stage,all patients did not have oliguric stage.On the next day of admission,the number of white blood cells in 46 patients was (8.17 ± 3.19) × 109/L,and 38 cases (82.61％) in the normal range;platelet was (61.92 ±32.53) × 109/L,and 42 cases (91.30％) were decreased;the procalcitonin was (1.62 ± 0.38) ng/ml,and 41 cases (89.13％) were increased;C-reactive protein was (74.33 ± 30.48) mg/L,and 46 patients (100.00％) were elevated;creatinine was (176.25 ± 55.15) μmol/L,and 19 cases (41.30％) were increased.Abnormal liver function was manifested by increased enzymology,alanine aminotransferase was (137.58 ± 46.76) U/L,and aspartate aminotransferase was (129.82 ± 40.29) U/L.All patients were positive for Hantavirus IgM.B-ultrasound results showed that in 58.70％ (27/46) patients,both kidneys were plump and the parenchymal echo was enhanced.Liver injury occurred in 39 patients (84.78％) and sinus bradycardia in 2 patients (4.35％).All the 46 patients were clinically cured.Conclusion The epidemiological characteristics of patients with HFRS in Shenzhen are typical,the clinical manifestations are mild,and the curative effect and prognosis are good.

Social support and management strategies for chronic disease in patients with systemic lupus erythematosus / 中南大学学报(医学版)

To investigate the social support level and its influencial factors in patients with systemic lupus erythematosus (SLE), and to develop the management strategies for chronic disease.
 Methods: Patients with SLE were investigated by Social Support Rating Scale (SSRS), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), 36-Item Short-Form Health Survey (SF-36) and Visual Analogue Scale (VAS) of fatigue. The demographic and clinical data of SLE patients were recorded. SLE disease activity and damage severity were assessed by SLE Disease Activity Index (SLEDAI) and SLE Damage Index (SDI), respectively. Influencial factors for social support were analyzed.
 Results: A total of 246 patients were included. Social support scores for these patients were 40.76±7.93 and the scores showed no significant difference with the national norm (P>0.05). Patients who were younger than 18, single, unemployed or damaged by disease showed lower level of social support (P<0.05). Compared with the high social support group, patients in the low social support group experienced more severe depression or anxiety, and scored lower on mental component summary scale (vitality, social functioning, emotional role and mental health perception) and physical role of SF-36 (P<0.05).
 Conclusion: Social support levels for patients with SLE are closely related to the quality of life, and influenced by age, marital status, professional condition, and disease damage. Health education for patients and their families should be strengthened in chronic disease management to enhance social support and finally, improve their quality of life.

Clinical feature of 39 patients with acute brucellosis from Shenzhen: results of a retrospective analysis / 中华地方病学杂志

Objective To analyze the clinical features of patients with acute stage brucellosis in Shenzhen,and provide a scientific basis for prevention and control of brucellosis in immigrant city.Methods A retrospective analysis was conducted to collect clinical data of patients with brucellosis admitted to the Department of Infectious Diseases,Shenzhen People's Hospital from May 2013 to May 2018.The patient's epidemiology manifestations,pathogen and laboratory examination results,diagnosis and treatment outcomes and prognosis were analyzed.Results Among the 39 patients with brucellosis,males were predominant,with a male to female ratio of 1.4 ∶ 1.0 (23 ∶ 16),an age of (44.91 ± 17.18) years and 24 cases were non-Guangdong natives.There were 23 cases with epidemiological history,including 14 cases with mutton,sheep viscera and goat milk history;the disease occurred throughout the year,mainly from February to July,a total of 26 cases.The clinical manifestations of the patients were mainly fever,sweating,fatigue,joint and muscle pain,weight loss,and liver or spleen or lymph nodes swelling.The blood culture was identified as 38 cases of Brucella melitensis and 1 case of Brucella suis.All strains were sensitive to common antibiotics in vitro.All cases were diagnosed as acute stage of brucellosis,2 cases with orchitis,1 case with brucellosis meningoencephalitis,3 cases with spondylitis,and 3 cases with misdiagnosis.Thirty-nine patients were cured according to the "Brucellosis Diagnosis and Treatment Guidelines (Trial)" and were followed up for 1 year.Conclusions Patients with brucellosis in Shenzhen are mainly infected with Brucella melitensis;fever,sweating,joint and muscle pain are the main clinical symptoms;the patient's efficacy and prognosis are better after treatment;for the occurrence of occasional misdiagnosis,it is recommended that in immigrant cities,medical staff should strengthen their understanding of brucellosis.

An analysis of epidemiological and clinical features of 46 patients with hemorrhagic fever with renal syndrome in Shenzhen City / 中华地方病学杂志

Objective@#To understand the epidemiological and clinical features of patients with hemorrhagic fever and renal syndrome (HFRS) in Shenzhen, and to accumulate experience in the diagnosis and treatment of HFRS in this area.@*Methods@#A retrospective analysis was conducted by collecting the clinical data from 46 patients who were confirmed with HFRS and admitted to the Department of Infectious Diseases of Shenzhen People's Hospital from January 2015 to December 2018. The demographic characteristics, epidemiological, clinical manifestations, examinations, treatments and prognosis, and other characteristics were analyzed.@*Results@#All the 46 patients with HFRS were residens in Shenzhen, with a male-to-female ratio of 6.67∶1.00(40∶6), aged (40.18 ± 15.63) years old, and 38 patients (82.61%) aged 23-45 years old. There were 41 patients (89.13%) with a history of HFRS epidemiology, and there were mice in their houses or workplaces. The houses of 39 patients (84.78%) were rented, and 34 patients(87.18%) rented their houses in urban villages. There were morbidity throughout the year, and 33 patients (71.74%) were ill from January to June. In clinical classification, 44 cases (95.65%) were mild, 2 cases (4.35%) were medium, and there were no severe or critical cases. The clinical manifestations were that all patients were hospitalized due to fever mainly with hyperthermia. Thirty-nine patients (84.78%) were presented with systemic aches, headaches, low back pain and eyelid pain, and 28 patients (60.87%) had skin and mucous membrane hyperemia flushing. Clinical stages showed that all patients had pyretogenesis stage and polyuria stage, including pyretogenesis stage [(7.34 ± 6.82) d], polyuria stage [(9.94 ± 5.77) d], only 4.35% (2/46) patients with hypotension shock stage, all patients did not have oliguric stage. On the next day of admission, the number of white blood cells in 46 patients was (8.17 ± 3.19) × 109/L, and 38 cases (82.61%) in the normal range; platelet was (61.92 ± 32.53) × 109/L, and 42 cases (91.30%) were decreased; the procalcitonin was (1.62 ± 0.38) ng/ml, and 41 cases (89.13%) were increased; C-reactive protein was (74.33 ± 30.48) mg/L, and 46 patients (100.00%) were elevated; creatinine was (176.25 ± 55.15) μmol/L, and 19 cases (41.30%) were increased. Abnormal liver function was manifested by increased enzymology, alanine aminotransferase was (137.58 ± 46.76) U/L, and aspartate aminotransferase was (129.82 ± 40.29) U/L. All patients were positive for Hantavirus IgM. B-ultrasound results showed that in 58.70% (27/46) patients, both kidneys were plump and the parenchymal echo was enhanced. Liver injury occurred in 39 patients (84.78%) and sinus bradycardia in 2 patients (4.35%). All the 46 patients were clinically cured.@*Conclusion@#The epidemiological characteristics of patients with HFRS in Shenzhen are typical, the clinical manifestations are mild, and the curative effect and prognosis are good.

Associated factors on sleep disorders in systemic lupus erythematosus patients / 中华风湿病学杂志

Objective To investigate the prevalence of sleep disorders and the relevant determinants in a cohort of systemic lupus erythematosus (SLE) patients.Methods One hundred patients with SLE were included in the study.Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI).Depression,anxiety,quality of life,and fatigue were evaluated by patient health questionnaire (PHQ)-9,generalized anxiety disorder (GAD)-7,short form 36 health survey (SF-36),and visual analogue scale (VAS) respectively.The demographic and clinical data were also recorded.SLE disease activity and damage severity were assessed by systemic lupus erythematosus disease activity index (SLEDAI) and systemic lupus erythematosus damage index (SDI) respectively.Mann-Whitnry U test,t test,Logistic regression were used for statistically analysis.Results The prevalence of sleep disorders in SLE patients was 42％.Compared with patients without sleep disorders,the ratio of males and married patients,age,the score of SDI,PHQ-9,GAD-7,and fatigue were higher in SLE patients with sleep disorders,while the score of SF-36 was lower (r＜0.05).Age,SLEDAI,SDI,PHQ-9,GAD-7,and fatigue correlated positively with sleep disorders (The values of r were 0.215,0.230,0.311,0.529,0.455,0.541,P＜0.05).C3 and the score of SF-36 correlated negatively with sleep disorders (The values of r were-0.204,-0.342,-0.490,-0.464,-0.497,-0.590,-0.428,-0.478,-0.398,-0.412,-0.659respectively,P＜0.05).In multi-ple logistic regression analyses,gender (OR=22.22),anxiety (OR =2.895),body pain (OR =0.964),and energy (OR =0.947) were the independent determinants of sleep disorders (R2=0.494,P＜0.01).Conclusion Poor sleep quality is common in SLE patients.Gender,age,disease activity and severity,anxiety,depressed mood,and quality of life contribute significantly to sleep disorders in SLE.

A prevalence survey of adult diabetes mellitus in Liaoning Anshan and its related risk factors / 中国医师进修杂志

Objective To investigate the prevalence and awareness rate of adult diabetes mellitus and the risk factors in Liaoning Anshan. Methods A cross-sectional population survey was performed among residents in Liaoning Anshan and 2 500 subjects participated. Subjects whose fasting plasma glucose ≥ 5.6 mmol/L were confirmed by oral glucose tolerance test (OGTT). Results The standardized prevalence of adult diabetes mellitus over the age of 20 in Liaoning Anshan was 8.2%, and the standardized prevalence of pre-diabetes mellitus was 14.8%. The prevalence of diabetes mellitus increased with age (P<0.05). The awareness rate of diabetes mellitus in Liaoning Anshan was 52.3%(125/239), and the awareness rate of pre-diabetes mellitus was 8.7%(35/402). Logistic regression indicated that age, family history of diabetes, overweight or obesity, waist circumference, hypertriacylglycerolemia was the risk factors (P<0.05), while regular exercise was protective factor (P<0.05). Conclusions The current prevalence of diabetes mellitus and pre-diabetes mellitus in Liaoning Anshan is higher, and the awareness rate is lower.

Association of the serum soluble intercellular adhesion molecule-1 and soluble vascular cell adhesion molecule-1 with metabolic syndrome and its components / 中国糖尿病杂志

Objective To study the association of the serum soluble intercellular adhesion molecule-1(SICAM-1) and soluble vascular cell adhesion molecule-1(SVCAM-1) with metabolic syndrome(MS) and its components. Methods The MS was defined by criteria of the international diabetes federation. The levels of SICAM-1 ,SVCAM-1,plasma glucose,insulin,lipids,uric acid, glycosylated haemoglobin A(1C), and blood viscosity were measured. Results The concentrations of SICAM-1 and SVCAM-1 were significantly higher in subjects with MS and its components than in those without them. The concentrations of SICAM-1 and SVCAM-1 were correlated positively with disorder number of BMI, WHR, SBP, DBP,FPG, 2 hour plasma glucose, triglyceride, uric acid, HbA1c, blood viscosity and HOMA-IR,and negatively with high density lipoprotein cholesterol. Conclusions The concentrations of SICAM-1 and SVCAM-1 rise with the increase of the number of MS components. Endothelial dysfunction might participate in the occurrence and development of MS.

Study about serum levels of high sensitivity C-reactive protein in subjects with varying glucose tolerances and its correlation with insulin resistance / 中国实用内科杂志

Objective To investigate the difference of serum high sensitivity C-reactive protein(hs-CRP)concentrations in subjects with various glucose tolerances,and to analyze the correlation with insulin resistance.Methods A total of 90 subjects,who came from the Medical Examination Center of the First Hospital Affiliated to China Medical University from Oct.2004 to Apr.2005,were divided into five groups according to oral glucose tolerance test(OGTT):normal glucose tolerance(NGT)group;impaired fasting glucose(IFG)group;impaired glucose tolerance(IGT)group;IFG and IGT(IGT/IFG)group;newly diagnosed,complication-free type 2 diabetes(T2DM)group.By using the ELISA methods,the concentration of serum high sensitivity C-reactive protein(hs-CRP)was measured in these subjects,and its correlation with homeostasis model assessment insulin resistance index(HOMA-IR)was andlysed.Results The concentration of hs-CRP was significantly higher in IFG,IFG/IGT,T2DM than in NGT.The concentration of hs-CRP was positively correlated with glucose metabolism index and insulin resistance index.Conclusion Our study demonstrates that inflammation already exists not only in T2DM patients but also in subjects with IFG.Inflammation might participate in the occurance and development of T2DM.

Serum C-reactive protein levels in subjects with impaired fasting glycemia and its clinical significance / 中国实用内科杂志

Objective To investigate the levels of serum C-reactive protein in subjects with impaired fasting glycemia and its significance.Methods From Mar.to Sep.2005,according to oral 75 g glucose tolerance test(OGTT)in the patients in the First Hospital Affiliated to China Medical University,there are 30 subjects with normal glucose tolerance(NGT),28 cases with impaired fasting glycemia(IFG).CRP was detected with ELISA.Results (1)Serum CRP in the subjects with impaired fasting glycemia was significantly higher than those in normal subjects( P