Risk factors associated with the need for oxygen therapy in patients with COVID-19

Respiratory failure is the major cause of death in patients with coronavirus disease (COVID-19). Data on factors affecting the need for oxygen therapy in early-stage COVID-19 are limited. This study aimed to evaluate the factors associated with the need for oxygen therapy in patients with COVID-19.This is a retrospective study of consecutive COVID-19 patients who were hospitalized between February 27 and June 28, 2020, in South Korea. Logistic regression analyses were performed to identify the factors associated with the need for oxygen therapy.Of the 265 patients included in the study, 26 (9.8%) received oxygen therapy, and 7 of these patients (29.2%) were transferred to a step-up facility, and 3 (11.5%) died. The median age of all patients was 46 years (IQR, 30–60 years), and the median modified early warning score at admission was 1 (IQR, 1–2). In a multivariate logistic regression analysis, being a current smoker (odds ratio [OR] 7.641, 95% confidence interval [CI] 1.686–34.630, P = .008), heart rate (OR 1.053, 95% CI 1.010–1.097, P = .014), aspartate aminotransferase values (OR 1.049, 95% CI 1.008–1.092, P = .020), blood urea nitrogen levels (OR 1.171, 95% CI 1.073–1.278, P < .001), and chest radiographic findings (OR 3.173, 95% CI 1.870–5.382, P < .001) were associated with oxygen therapy.In patients with less severe COVID-19, the need for oxygen therapy is affected by smoking and elevated values of aspartate aminotransferase and blood urea nitrogen. Further research is warranted on the risk factors for deterioration in COVID-19 to efficiently allocate medical resources.     

Clinical characteristics of a case series of children with coronavirus disease 2019

We reported the clinical characteristics of a case series of 10 patients with coronavirus disease 2019 (COVID‐19) aged from 1 year to 18 years. Seven patients had contact with confirmed COVID‐19 family members before onset. Fever (4 [40.0%]) and cough (3 [30.0%]) were the most common symptoms. No patient showed leucopenia and lymphopenia on admission. Pneumonia was observed in chest CT images in 5 (50.0%) patients. Five (50.0%) patients received antiviral treatment. No patient had severe complications or developed a severe illness in our study. Our study indicated that COVID‐19 children present less severe symptoms and have better outcomes.     

Pulmonary thromboembolism in coronavirus disease 2019 patients undergoing thromboprophylaxis

We aimed to investigate the prevalence of pulmonary thromboembolism (PTE) and its association with clinical variables in a cohort of hospitalized coronavirus disease 2019 (COVID-19) patients receiving low-molecular-weight heparin (LMWH) at prophylactic dosage.In this retrospective observational study we included COVID-19 patients receiving prophylactic LMWH from admission but still referred for lower-limbs venous Doppler ultrasound (LL-US) and computed tomography pulmonary angiography (CTPA) for clinical PTE suspicion. A dedicated radiologist reviewed CTPA images to assess PTE presence/extension.From March 1 to April 30, 2020, 45 patients were included (34 men, median age 67 years, interquartile range [IQR] 60–76). Twenty-seven (60%) had PTE signs at CTPA, 17/27 (63%) with bilateral involvement, none with main branch PTE. In 33/45 patients (73%) patients LL-US was performed before CTPA, with 3 patients having superficial vein thrombosis (9%, none with CTPA-confirmed PTE) and 1 patient having deep vein thrombosis (3%, with CTPA-confirmed PTE). Thirty-three patients (73%) had at least one comorbidity, mainly hypertension (23/45, 51%) and cardiovascular disease (15/45, 33%). Before CTPA, 5 patients had high D-dimer (11.21 μg/mL, IQR 9.10–13.02), 19 high fibrinogen (550 mg/dL, IQR 476–590), 26 high interleukin-6 (79 pg/mL, IQR 31–282), and 11 high C-reactive protein (9.60 mg/dL, IQR 6.75–10.65), C-reactive protein being the only laboratory parameter significantly differing between patients with and without PTE (P = .002)High PTE incidence (60%) in COVID-19 hospitalized patients under prophylactic LMWH could substantiate further tailoring of anticoagulation therapy.     

Safety of coronavirus disease 2019 vaccines in 213 adult patients with sickle cell disease

Given the lack of information about safety of the COVID-19 vaccines for sickle cell disease (SCD) patients, we sought to determine whether COVID-19 vaccine was associated with subsequent hospital admission for vaso-occlusive events (VOEs). We included 402 patients with SCD, including 88 regularly transfused. As of July 31, 2021, 213 (53.0%) of them had received a least one dose of COVID vaccine (Pfizer 93.0%). We showed similar risk of hospital admission for a VOE among vaccinated patients (whether transfused or not) and among a control group of non-vaccinated patients matched for age, sex and genotype.     

新型冠状病毒肺炎合并肝脏损伤的预防及诊疗方案

新型冠状病毒肺炎(世界卫生组织命名为2019-冠状病毒病,coronavirus disease 2019,COVID-19)是一种新发的主要经呼吸道传播的急性病毒性疾病,其主要特点是传播快、人群普遍易感,临床主要表现为发热、干咳和乏力,少部分患者有全身肌肉酸痛,重症患者多在发病1周后出现急性呼吸困难和(或)低氧血症,其病死率为1%~3%[1-3]。临床实践和有关文献报道显示,部分患者可有不同程度的肝脏生化学异常。为帮助临床医生积极预防、及时诊断和有效治疗本病相关肝损伤,受中国医师协会消化医师分会和中华医学会肝病学分会委托,邀请国内有关专家,特别是在一线参加COVID-19诊断和治疗的肝病和传染病防治专家,总结分析现有文献资料并结合自己的临床实践,编写了《新型冠状病毒肺炎合并肝脏损伤的预防及诊疗方案》。     

Corrected QT interval in hospitalized patients with coronavirus disease 2019: Focus on drugs therapy

Corrected QT (QTc) interval prolongation has been associated with poor patient prognosis. In this study, we assessed the effects of different drugs and cardiac injury on QTc interval prolongation in patients with coronavirus disease 2019 (COVID-19).The study cohort consisted of 395 confirmed COVID-19 cases from the Wuhan Union Hospital West Campus. All hospitalized patients were treated with chloroquine/hydroxychloroquine (CQ/HCQ), lopinavir/ritonavir (LPV/r), quinolones, interferon, Arbidol, or Qingfei Paidu decoction (QPD) and received at least 1 electrocardiogram after drug administration.Fifty one (12.9%) patients exhibited QTc prolongation (QTc ≥ 470 ms). QTc interval prolongation was associated with COVID-19 severity and mortality (both P < .001). Administration of CQ/HCQ (odds ratio [OR], 2.759; 95% confidence interval [CI], 1.318–5.775; P = .007), LPV/r (OR, 2.342; 95% CI, 1.152–4.760; P = .019), and quinolones (OR, 2.268; 95% CI, 1.171–4.392; P = .015) increased the risk of QTc prolongation. In contrast, the administration of Arbidol, interferon, or QPD did not increase the risk of QTc prolongation. Notably, patients treated with QPD had a shorter QTc duration than those without QPD treatment (412.10 [384.39–433.77] vs 420.86 [388.19–459.58]; P = .042). The QTc interval was positively correlated with the levels of cardiac biomarkers (creatine kinase-MB fraction [rho = 0.14, P = .016], high-sensitivity troponin I [rho = .22, P < .001], and B-type natriuretic peptide [rho = 0.27, P < .001]).In conclusion, QTc prolongation was associated with COVID-19 severity and mortality. The risk of QTc prolongation was higher in patients receiving CQ/HCQ, LPV/r, and quinolones. QPD had less significant effects on QTc prolongation than other antiviral agents.     

新型冠状病毒肺炎疫情流行期间老年患者的焦虑抑郁状态及其影响因素

目的调查新型冠状病毒肺炎(COVID-19)疫情流行期间老年患者心理状况,并分析其影响因素。方法选择四川省绵阳市中医医院建立的老年病患者信息管理群中的86例患者为研究对象,采用电话、微信、QQ等方法对患者进行基本资料调查,并采用焦虑自评量表(SAS)和抑郁自评量表(SDS)对患者的焦虑及抑郁状态评估。采用SPSS 18.0软件对数据进行统计分析。多重线性回归法分析疫情期间影响老年病患者产生抑郁与焦虑的相关因素。结果COVID-19疫情流行期间86例老年病患者焦虑评分为31.25~82.21(54.88±11.84)分,其中轻度焦虑20例(23.53%),中度焦虑53例(62.35%),重度焦虑12例(14.12%)。86例老年患者抑郁评分为26.25~86.42(52.20±13.36)分,其中轻度抑郁44例(64.71%),中度抑郁18例(26.47%),重度抑郁6例(8.82%)。多重线性回归分析显示,对疫情担忧、COVID-19疫情对生活的严重影响、慢性病遵医嘱用药情况差对老年患者焦虑影响较大(P<0.05);居住地、身边有人感染COVID-19则对老年患者抑郁影响较大(P<0.05)。结论COVID-19疫情流行期间老年病患者明显存在焦虑抑郁心理情绪,可针对疫情使其产生的担忧、对其生活的影响以及自身慢性病遵医嘱用药情况采取针对性干预措施,以减轻心理精神障碍。     

踝臂脉搏波速度及糖化血红蛋白与冠心病危险因素的关系

目的 探讨踝臂脉搏波速度(baPWV)、糖化血红蛋白(HbA1c)与冠心病(CHD)危险因素的关系.方法 选择CHD患者87例,其中无糖尿病46例(A组),合并糖尿病41例(B组),另选健康体检者80例作为对照组.收集3组的年龄、腰围、收缩压(SBP)、舒张压(DBP)、脉压差(PP)、血脂、空腹血糖(FPG)及HbA1c检测指标,并检测其baPWV,分析CHD的相关危险因素.结果 3组间年龄、腰围、血压、PP、HbA1c、LDL-C、baPWV比较,P＜0.01或＜ 0.05;A、B组腰围、FPG、HbA1c、TG、TC、LDL-C、baPWV比较,P＜0.01或＜0.05.Logistic回归分析显示,高龄、baPWV、DBP、PP、TC、LDL-C、HbA1c是CHD的危险因素,其危险程度从高到低依次为高龄、baPWV、DBP、PP、HbA1c、LDL-C、FPG(P ＜0.01或＜0.05).A组baPWV与年龄、SBP、DBP、PP、TC、LDL-C、HbA1c呈正相关,B组baPWV与年龄、SBP、DBP、PP、TC、LDL-C、HbA1c、FPG呈正相关,C组baPWV与年龄、SBP、PP呈正相关,P＜0.01或＜0.05.结论 baPWV与CHD的主要危险因素HbA1c有相关性,baPWV、HbA1c对CHD发病有预测价值.     

新型冠状病毒肺炎防疫期老年人口腔健康管理

新型冠状病毒肺炎传染性强,疫情发展迅速,已被世界卫生组织认定为突发公共卫生事件。老年人群感染易发重症和死亡,应高度重视防护。老年人口腔疾病发病率高,疫情期老年人心理应激状态易加重口腔病症。口腔门诊诊疗中,医患近距离接触,操作中产生大量气溶胶,为避免发生交叉感染,保障防疫工作,目前口腔治疗仅做急症处理。本文依据老年人心理状态及口腔特点,分析了口腔健康对防疫的重要意义,提出老年人新型冠状病毒肺炎疫期口腔疾病的治疗要点和预防措施,为特殊时期老年人口腔诊疗提出建议。     

新型冠状病毒肺炎疫情给建设和运营老年病专科医院带来的新挑战

2020年初的新型冠状病毒肺炎(COVID-19)传染性强、感染人数多,老年患者救治难度大、死亡比例高。疫情的发生,给国内正在运营和新建的老年病专科医院提出了新挑战和新要求。笔者对照国家和各省卫生管理部门正在执行的老年病专科医院建设标准和评审标准,结合三级综合医院和三级专科医院建设、管理、运营的实践,着眼于应对未知烈性呼吸道传播疾病的提前预防,分别从感染防控要求、建筑设计改进、人员学科配置调整、老年医学和医院建筑学交叉融合、医疗集团建设及运营管理优化等方面进行了探讨,提出了改进的初步构想,以期对老年病医院更好地服务患者有所帮助。     

免疫衰老影响老年人重型新型冠状病毒肺炎发病机制的研究进展

免疫衰老是免疫系统随年龄增长而发生最为显著的改变。免疫衰老与感染性疾病、自身免疫性疾病和恶性肿瘤等存在密切关系,且导致老年人在感染SARS冠状病毒（SARS-CoV-2）后,容易进展成为重型新型冠状病毒肺炎（COVID-19）。免疫衰老通过先天性免疫系统和适应性免疫系统,改变免疫细胞数量、表型及功能,造成免疫系统功能障碍和炎症反应失衡,增加老年患者的死亡风险和预后不良事件。通过分析免疫衰老与重型新型冠状病毒肺炎之间的关系,有助于发现老年重型COVID-19的有效治疗方法,改善老年患者的生存及预后。     

A cross-sectional follow up study to estimate seroprevalence of coronavirus disease 2019 in Kobe,Japan

We conducted a study to estimate the seroprevalence of coronavirus disease 2019 (COVID-19) in Kobe, Japan with positive immunoglobulin G (IgG) rate of 3.3% (95% confidence interval [CI] 2.3%–4.6%) in April 2020. Because there were large concerns about the spread of COVID-19 among citizens thereafter, we conduct a follow-up cross-sectional study to estimate the seroprevalence, and we also added a validation study using a different assay.We conducted cross-sectional serologic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody using 1000 samples from patients at outpatient settings who visited the clinic from May 26 to June 7, 2020, stratified by the decade of age and sex. We used both Kurabo and Abbott serology assays to identify IgG against SARS-CoV-2.There were 18 and 2 positive IgG among 1000 serum samples using Kurabo and Abbott serology assays, respectively (1.8%, 95% CI 1.1%–2.8%, and 0.2%, 95% CI 0.02%–0.7% respectively). By applying the latter figure to the census of Kobe City (population: 1,518,870), it is estimated that the number of people with positive IgG is 3038 (95% CI: 304–10,632) while a total of 285 patients were identified by polymerase chain reaction (PCR) testing at the end of the study period. Assuming Abbott assay as the reference, Kurabo assay had calculated sensitivity and specificity of 100% and 98.4% respectively. Age and sex adjusted prevalence of positivity was calculated to be 0.17%.We found a lower seroprevalence than 2 months before in Kobe city although the figures were still higher than those detected by PCR. Kurabo assay showed more false positives than true positives despite reasonable sensitivity and specificity, due to low prevalence in Kobe.     

Impact of the coronavirus disease 2019 outbreak on the transportation of patients requiring emergency care

The first confirmed community transmission of coronavirus disease 2019 in Daegu Metropolitan City, South Korea, occurred on February 18, 2020. In the following 70-day period, approximately 6000 new cases occurred, severely impacting the medical service system. This study investigated the crisis-impact on the local emergency transport system.Emergency medical service activity reports were retrospectively reviewed to determine patient demographics and initial vital signs. Delay in reaching the patient, transporting the patient to the hospital, and returning to the fire station were assessed and categorized based on patients’ initial vital signs. The study period was divided into 4 groups (1/1–2/18, 2/19–3/3, 3/4–3/31, and 4/1–04/30) and intergroup differences were analyzed.When compared to Period 1, the time-difference between the request to attend a scene and arrival at the scene was delayed in Periods 2, 3, and 4 by 4 minute 58 s, 3  minute 24 seconds, and 2 minute 20 seconds, respectively; that between arriving at the scene and at the hospital was delayed by 7  minute 43 seconds, 6 minutes 59 seconds, and 4 minutes 30 seconds, respectively; and that between arriving at the hospital and returning to the fire station was delayed by 29  minute 3 second, 25  minute 55 second, and 18  minute 44 second, respectively. In Period 2, for patients with symptoms of severe illness when compared to patients lacking such symptoms, the time-difference between the request to attend the scene and arrival at a hospital and between arrival at the hospital and returning to the fire station were 6 to 23 minute and 12 to 48 minute longer, respectively. Most of the delays impacted patients with a fever. In terms of condition, the statistical effect size for delay in transport time was from large to small: fever, hypoxia, abnormal respiratory rate, respiratory symptom, and hypotension.Outbreaks of infectious disease cause a paradoxical state in emergency medical transport systems, inducing delays in the transport of severely ill patients. Therefore, maintenance and improvement of the medical service system for both patients with infectious disease and those with other severe illnesses is required.     

基于倾向性评分匹配法的血浆D-二聚体升高与新型冠状病毒肺炎重症化相关性研究

目的 评估血浆D-二聚体(D-dimer,D-D)与新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)重症化的相关性.方法 回顾性分析2020年1月20日—2月8日在阜阳市第二人民医院住院的102例COVID-19患者的临床资料,将患者按血浆D-D是否升高分为D-D不升高组与D-D持...     

对比分析18例重症/危重症新型冠状病毒肺炎心肌损伤患者临床特征

目的回顾性分析伴心肌损伤的重症/危重症新型冠状病毒肺炎(COVID-19)患者临床特征及心肌酶学指标动态变化。方法纳入2020年1月17至3月1日中山大学附属第五医院收治的18例重症/危重症COVID-19患者。依据住院期间心肌酶或肌钙蛋白I检测值,正常范围患者归为非心肌损伤组(n=13),异常升高患者归为心肌损伤组(n=5)。对比分析两组患者入院后的流行病学和临床资料,并分析血常规、肝肾功能、心肌酶、C反应蛋白(CRP)等实验室指标,动态分析肌酸激酶、肌酸激酶同工酶MB、N端脑钠肽前体(NT-proBNP)和肌钙蛋白I变化情况。结果18例重症/危重症患者中,心肌损伤患者占27.8%(5/18)。与非心肌损伤组患者比较,心肌损伤组患者年龄、性别、基础疾病、症状和体征、发病至住院时间、体温、心率、舒张压、住院时间无明显差异,但心肌损伤组患者入院时收缩压明显高于非心肌损伤组(P=0.0171)。两组患者入院时白细胞计数、淋巴细胞计数、单核细胞计数无明显差异;入院时谷丙氨酸氨基转移酶、天冬氨酸氨基转移酶、乳酸脱氢酶、α-羟丁酸脱氢酶、肌酸激酶、肌酸激酶同工酶MB、血肌酐、CRP、N端脑钠肽前体两组患者中也未见明显差异。动态分析发现心肌损伤组重症患者在住院第4~5天左右,肌酸激酶、肌酸激酶同工酶、肌钙蛋白I、N端脑钠肽前体逐渐出现升高,在第9~11天后逐渐恢复正常。结论重症/危重症COVID-19患者收缩压较高可能与容易出现心肌损伤相关,心肌酶谱异常出现在住院的早期,早期发现和干预治疗对心肌损伤患者有益。     

从2019新型冠状病毒病疫情谈新发传染病防控策略

2019年12月湖北省武汉市出现了2019新型冠状病毒病疫情,疫情在很短时间内席卷了中国的34个省级行政单位,中国境外多个国家也有病例报道。2019新型冠状病毒病疫情是由冠状病毒科β冠状病毒属的"SARS-CoV-2"所致,一种以前从未被发现的新型冠状病毒,目前研究显示SARS-CoV-2的传染性较强。本文基于目前我国2019新型冠状病毒病疫情及其防控,对疫情现阶段采取的主要防控措施进行梳理和总结,并基于One Health视角探讨新发传染病防控策略,以期为今后我国有效应对新发传染病提供宝贵的可借鉴经验。     

新型冠状病毒肺炎疫情下长期住院老年患者的管理策略

新型冠状病毒肺炎疫情爆发以来,传播速度快,感染率高。长期住院的老年患者是一部分特殊的群体,如何在疫情期间做好该类人群的管理,对于疫情的控制和保护该类人群顺利度过疫期具有重要意义。本文针对长期住院老年患者在疫情期间的预防和管理策略进行了总结。     

Early prediction model for progression and prognosis of severe patients with coronavirus disease 2019

Coronavirus disease 2019 (COVID-19) has been a rampant worldwide health threat and we aimed to develop a model for early prediction of disease progression.This retrospective study included 124 adult inpatients with COVID-19 who presented with severe illness at admission and had a definite outcome (recovered or progressed to critical illness) during February 2020. Eighty-four patients were used as training cohort and 40 patients as validation cohort. Logistic regression analysis and receiver operating characteristic curve (ROC) analysis were used to develop and evaluate the prognostic prediction model.In the training cohort, the mean age was 63.4 ± 1.5 years, and male patients (48, 57%) were predominant. Forty-three (52%) recovered, and 41 (49%) progressed to critical. Decreased lymphocyte count (LC, odds ratio [OR] = 4.40, P = .026), elevated lactate dehydrogenase levels (LDH, OR = 4.24, P = .030), and high-sensitivity C-reactive protein (hsCRP, OR = 1.01, P = .025) at admission were independently associated with higher odds of deteriorated outcome. Accordingly, we developed a predictive model for disease progression based on the levels of the 3 risk factors (LC, LDH, and hsCRP) with a satisfactory performance in ROC analysis (area under the ROC curve [AUC] = 0.88, P < .001) and the best cut-off value was 0.526 with the sensitivity and specificity of 75.0% and 90.7%, respectively. Then, the model was internally validated by leave-one-out cross-validation with value of AUC 0.85 (P < .001) and externally validated in another validation cohort (26 recovered patients and 14 progressed patients) with AUC 0.84 (P < .001).We identified 3 clinical indicators of risk of progression and developed a severe COVID-19 prognostic prediction model, allowing early identification and intervention of high-risk patients being critically illness.     

新型冠状病毒肺炎疫情下老年骨质疏松患者的管理

骨质疏松是一种与增龄相关的骨骼疾病,其严重后果是骨折,致死和致残率都高,需早期防治和有效合理地管理。2019年12月底我国从湖北省武汉市开始爆发了新型冠状病毒肺炎(COVID-19),目前研究表明老年和有慢性基础疾病的患者预后较差,也是主要的死亡人群。因此,疫情期间做好老年骨质疏松患者的科学防控和管理至关重要。为此本文综述了老年骨质疏松患者的防控及综合治疗措施,以指导临床医师更好地管理患者,从而安全度过疫期。