Clinical characteristics and in-hospital mortality of COVID-19 adult patients in Saudi Arabia

Objectives:To provide a detailed study of demographic, baseline comorbidities, clinical features, and outcome for Coronavirus disease 2019 (COVID-19) patients.Methods:A record-based case-series study conducted from March 23 to June 15, 2020 in King Saud Medical City, Riyadh, Saudi Arabia. Demographic data, clinical presentation, laboratory investigations, complications, and in-hospital outcome of COVID-19 patients collected with analysis of the clinical characteristics for survivors and deceased.Results:A total of 768 patients were included. The mean age was 46.36±13.7 years and 76.7% were men. Approximately 96.3% reported more than one comorbidity; diabetes mellitus was the most frequent (46.4%). Fever (84.5%), cough (82.3%), and shortness of breath (79.8%) were the main presenting symptoms. During the follow-up, pneumonia reported in 68.6%, acute respiratory distress syndrome in 32.7%, septic shock in 20.7%, respiratory failure in 20.3%, and acute kidney injury in 19.3%. Approximately 45.8% of enrolled patients required intensive care unit admission. Lung disease (odd ratio [OR]=3.862 with 95% confident interval [CI] (2.455-6.074), obesity (OR=3.732, CI=2.511-5.546), smoking (OR=2.991, CI=2.072-4.317), chronic kidney disease (OR=2.296. CI=1.497-3.521), and diabetes mellitus (OR=2.291, CI=1.714-3.063) are predictors of ICU admission. Fatality ratio was 89/2084 (4.27%). Men were more prevalent in dead group.Conclusion:Coronavirus disease 2019 places a huge burden on healthcare facilities, particularly in patients with comorbidity. Coronavirus disease 2019 patients who are obese and smokers with history of diabetes mellitus have a high risk of death.     

Risk factors for hospital admission among COVID-19 patients with diabetes: A study from Saudi Arabia

Objectives:To elucidate the risk factors for hospital admission among COVID-19 patients with type 2 diabetes mellitus (T2DM).Methods:This retrospective study was conducted at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia between May 2020 and July 2020. Out of 7,260 COVID-19 patients, 920 were identified as T2DM. After the exclusion process, 806 patients with T2DM were included in this analysis. Patients’ data were extracted from electronic medical records. A logistic regression model was performed to estimate the risk factors of hospital admission.Results:Of the total of 806 COVID-19 patients with T2DM, 48% were admitted in the hospital, 52% were placed under home isolation. Older age between 70-79 years (OR [odd ratio] 2.56; p=0.017), ≥80 years (OR 6.48; p=0.001) were significantly more likely to be hospitalized compared to <40 years. Similarly, patients with higher HbA1c level of ≥9% compared to <7%; (OR 1.58; p=0.047); patients with comorbidities such as, hypertension (OR 1.43; p=0.048), cardiovascular disease (OR 1.56; p=0.033), cerebrovascular disease (OR 2.38; p=0.016), chronic pulmonary disease (OR 1.51; p=0.018), malignancy (OR 2.45; p=0.025), chronic kidney disease (CKD) IIIa, IIIb, IV (OR 2.37; p=0.008), CKD V (OR 5.07; p=0.007) were significantly more likely to be hospitalized. Likewise, insulin-treated (OR 1.46; p=0.03) were more likely to require hospital admission compared to non-insulin treated patients.Conclusion:Among COVID-19 patients with diabetes, higher age, high HbA1c level, and presence of other comorbidities were found to be significant risk factors for the hospital admission.     

重症COVID-19预测模型的建立和评价

目的 建立重症新型冠状病毒性肺炎(COVID-19)的预测模型,并对模型进行评价.方法 回顾性分析2020年1月1日至3月10日于江汉大学附属湖北省第三人民医院确诊的314例COVID-19患者入院时的基线资料,按住院后是否进展为重症COVID-19分为重症组(76例)和非重症组(238例),将两组患者间差异显著的指标纳入logistic回归分析得出重症COVID-19的独立危险因素,将所有独立危险因素的回归系数代入方程,建立一个新的联合预测因子(L)模型,以预测重症COVID-19的发生风险.结果 logistic回归分析结果显示,年龄增大(OR=1.138,95％CI:1.080～1.199)、身体质量指数增高(OR=2.346,95％CI:1.509～3.646)、白细胞计数降低(OR=0.519,95％CI:0.357～0.754)、血浆白蛋白水平降低(OR=0.692,95％CI:0.588～0.815)、C反应蛋白水平升高(OR=1.029,95％CI:1.007～1.050)、D-二聚体水平升高(OR=1.278,95％CI:1.089～1.499)是患者发生重症COVID-19的独立危险因素.将这6个独立危险因素拟合为一个新变量,即为联合预测因子L,L的受试者工作特征(ROC)曲线下面积(AUC)为0.985(95％CI:0.974～0.996),截断点为12.90,敏感度为93.4％,特异度为95.0％.结论 联合预测因子在各变量中对于重症COVID-19发生的预测价值最高,这对重症患者的早期识别有一定的临床指导意义.     

Association of Overlapped and Un-overlapped Comorbidities with COVID-19 Severity and Treatment Outcomes: A Retrospective Cohort Study from Nine Provinces in China

ObjectiveSeveral COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear.MethodsA retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients’ medical records. Multivariable logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) of the associations between comorbidities (cardiometabolic or non-cardiometabolic diseases), clinical severity, and treatment outcomes of COVID-19.ResultsOverall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30–6.32), type 2 diabetes (T2DM) (3.57, 2.32–5.49), cardiovascular disease (CVD) (3.78, 1.81–7.89), fatty liver disease (7.53, 1.96–28.96), hyperlipidemia (2.15, 1.26–3.67), other lung diseases (6.00, 3.01–11.96), and electrolyte imbalance (10.40, 3.00–26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89–12.75), CVD (8.47, 6.03–11.89), and electrolyte imbalance (19.44, 11.47–32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25–9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46–29.64) within two weeks.ConclusionBesides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.     

发热门诊治疗新冠肺炎患者康复时间影响因素分析

目的 了解新型冠状病毒肺炎(COVID-19)患者临床特征、实验室指标变化和治疗康复情况,分析影响患者康复时间的因素。方法 采用回顾性方法将2020年1月10日—2月10日在武汉市肺科医院发热门诊治疗的308例COVID-19患者纳入研究范围,分析其临床特征、实验室检测和治疗康复情况,并采用Logistic回归分析影响康复时间的因素。结果 308例新冠肺炎患者康复时间中位数（M）是35（26.00,44.75） d,48.05%的新冠肺炎患者治疗康复时间超过35 d。临床症状以发热（84.74%）和干咳（58.77%）为主,病灶范围≤2肺叶110例（35.71%）, 范围>2肺叶198例（64.29%）;核酸阳性177例（57.47%）,核酸阴性131例（42.53%）;基础疾病以高血压（12.99%）和糖尿病（6.82%）为主,实验室检查结果显示主要为白细胞正常或减少,可见淋巴细胞计数减少、C反应蛋白增高、乳酸脱氢酶增高等;单因素分析结果显示：年龄（P=0.003）、病灶部位（P=0.028）、病灶范围（P=0.035）、基础疾病包括高血压（P=0.003）、糖尿病（P=0.012）、慢性阻塞性肺炎（COPD）（P=0.045）和病情分型（P=0.013）与康复时间是否延长有关;多因素Logistic回归分析结果显示,高血压（OR=2.632,95%CI: 1.237~5.602）、糖尿病（OR=2.620,95%CI: 1.599~4.683）、慢阻肺（OR=5.632,95%CI: 2.372~23.906）和病情重型（OR=2.145,95%CI: 1.021~4.503）等因素可能与新冠患者康复时间延长有关。结论 新冠肺炎患者康复时间可能与病灶范围、基础疾病（高血压、糖尿病和COPD）、病情严重程度存在密切关联,在临床诊治和护理中应加以考虑。     

新冠肺炎疫情下上海市主动心理咨询者焦虑状况及其影响因素

目的 评估新冠肺炎疫情对上海市主动心理咨询者焦虑状况的影响.方法 2020年2月4日—3月11日,通过上海市线上心理咨询服务平台,收集在此期间所有咨询者的相关人口学信息、对新冠肺炎疫情的认知和关注度、对疫情消失的态度及焦虑状况,并采用多元Logistic回归分析新冠肺炎疫情对状态焦虑及特质焦虑的影响.结果 704名咨询...     

Clinical and epidemiological characteristics of COVID-19 mortality in Saudi Arabia

Objectives:To analyze the clinical and epidemiological characteristics for 224 of in-hospital coronavirus disease 2019 (COVID-19) mortality cases. This study’s clinical implications provide insight into the significant death indicators among COVID-19 patients and the outbreak burden on the healthcare system in the Kingdom of Saudi Arabia (KSA).Methods:A multi-center retrospective cross-sectional study conducted among all COVID-19 mortality cases admitted to 15 Armed Forces hospitals across KSA, from March to July 2020. Demographic data, clinical presentations, laboratory investigations, and complications of COVID-19 mortality cases were collected and analyzed.Results:The mean age was 69.66±14.68 years, and 142 (63.4%) of the cases were male. Overall, 30% of the COVID-19 mortalities occurred in the first 24 hours of hospital admission, while 50% occurred on day 10. The most prevalent comorbidities were diabetes mellitus (DM, 73.7%), followed by hypertension (HTN, 69.6%). Logistic regression for risk factors in all mortality cases revealed that direct mortality cases from COVID-19 were more likely to develop acute respiratory distress syndrome (odds ratio [OR]: 1.75, confidence intervel [CI: 0.89-3.43]; p=0.102) and acute kidney injury (OR: 1.01, CI: [0.54-1.90]; p=0.960).Conclusion:Aging, male gender and the high prevalence of the underlying diseases such as, DM and HTN were a significant death indicators among COVID-19 mortality cases in KSA. Increases in serum ferritin, procalcitonin, C-reactive protein (CRP), and D-dimer levels can be used as indicators of disease progression.     

Prevalence of COVID-19 antibodies among operating room and critical care staff at a tertiary teaching hospital: A cross-sectional study

Objectives:To identify the prevalence of COVID-19 antibodies among operating room and critical care staff.Methods:In this cross-sectional study, we recruited 319 Healthcare workers employed in the operation theater and intensive care unit of King Abdulaziz University Hospital (KAUH), a tertiary teaching hospital in Jeddah, Saudi Arabia between August 9, 2020 and November 2, 2020. All participants completed a 20-item questionnaire on demographic data and COVID-19 risk factors and provided blood samples. Antibody testing was performed using an in-house enzyme immunoassay and microneutralization test.Results:Of the 319 participants, 39 had detectable COVID-19 antibodies. Five of them had never experienced any symptoms suggestive of COVID-19, and only 19 were previously diagnosed with COVID-19. The odds of developing COVID-19 or having corresponding antibodies increased if participants experienced COVID-19 symptoms (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.2-7.5) or reported contact with an infected family member (OR, 5.3; 95% CI, 2.5-11.2). Disease acquisition was not associated with employment in the ICU and involvement in the intubation of or close contact with COVID-19 patients. Of the 19 previously diagnosed participants, 6 did not possess any detectable COVID-19 antibodies.Conclusions:Healthcare workers may have undiagnosed COVID-19, and those previously infected may not have long-lasting immunity. Therefore, hospitals must continue to uphold strict infection control during the COVID-19 pandemic.     

Psychological impact of home isolation on children aged 6-14 years during the COVID-19 pandemic in Tabuk,Saudi Arabia 2020

Objectives:To evaluate the impact of home isolation on feelings and behaviors of children aged 6-14 years during COVID-19 pandemic in Tabuk, Saudi Arabia.Methods:A cross-sectional study was conducted between June and August 2020 in Tabuk, Saudi Arabia. A snowball sampling was applied, parents with children aged 6-14 years participated in this survey (N=361). questionnaires were distributed electronically.Results:Four out of ten children reported severe psychological impact on feelings (41.3%), while a majority of the children demonstrated mild psychological impact on behavior (74.8%). Age was associated with risk of psychological impact on behavior (OR: 7.24, 95% CI: 1.35-16.18). Being male was associated with risk of psychological impact on feelings (OR: 2.38, 95% CI: 0.67-6.43), and behavior (OR: 3.50, 95% CI: 0.42-6.00). Living in a small house or without an outside play area was associated with risk of psychological impact on feelings and behaviors.Conclusion:This study revealed that children experienced mild-to-severe psychological impact on behaviors and feelings during home isolation during COVID-19 pandemic. Priority should be given to boys, older age, children of low-income families, living in small houses and those without outside play areas.     

Serum neutrophil gelatinase-associated lipocalin concentrations are significantly associated with the severity of COVID-19 in pregnant patients

Objectives:To evaluate serum neutrophil gelatinase-associated lipocalin (NGAL) concentrations of pregnant women complicated with coronavirus disease 2019 (COVID-19) and investigate its diagnostic value for the severity of COVID-19.Methods:Of the 46 pregnant women with COVID-19 included in the study, we further classified these women into 2 subgroups: the non-severe COVID-19 group (n=25) and the severe COVID-19 group (n=21).Results:Neutrophil gelatinase-associated lipocalin plasma concentrations were significantly higher in pregnant women complicated with severe COVID-19 (90 [53.1-207.7] ng/ml) compared to those from pregnant women with non-severe COVID-19 (51.8 [39.6-70.3] ng/ml) and healthy pregnant women (44.3 [32.2-54.1] ng/ml, p<0.001). Also, at a cutoff value of 72 ng/ml, NGAL predicted severe COVID-19 with a sensitivity rate of 57% and a specificity rate of 84%. Serum NGAL level (adjusted hazard ratio [aHR]=1.020, 95% confidence interval [CI]= [1.006-1.035], p=0.007), and D-dimer level (aHR=2.371, 95% CI= [1.085-5.181], p=0.030) were the variables that were revealed to be significantly associated with the disease severity.Conclusion:We demonstrated that NGAL was highly associated with COVID-19 severity. We consider that NGAL might be a useful biomarker to diagnose the disease severity in patients with COVID-19.     

COVID-19疫情下订单定向全科医学生参与情况及其对职业认同感的影响

目的：通过调查分析COVID-19疫情下订单定向全科医学生参与抗疫情况及疫情对其职业认同感的影响,为针对性开展提升订单定向全科医学生职业认同感的教育提供支持依据。方法：根据文献、指南制定调查问卷,内容包含受访者基本信息、获取COVID-19疫情信息情况、参与抗疫情况、疫情对自我职业认同感影响四个方面。对温州医科大学、吉林医药学院及云南中医药大学订单定向全科医学生进行问卷调查。采用多因素logistic回归分析探讨此次疫情对订单定向全科医学生职业认同感的影响。结果：共回收有效问卷3 321份。受访者中,男1 347人,占40.6%;女1 974人,占59.4%。共产党员198人,占6.0%;非共产党员3 123人,占94.0%。低年级2 129人,占64.1%;高年级1 192人,占35.9%。70.6%的学生关注COVID-19知识时间大于30 min/d;72.4%的学生主动学习COVID-19知识;92.4%的学生阅读过国家发布的COVID-19指南。59.0%的学生有意愿主动报名参与一线抗疫,23.6%的学生参与了本次抗疫。87.7%的学生认为此次疫情对自我职业认同感产生了积极的影响。通过多因素logistic回归分析,发现就读年级（OR=1.653,95%CI=1.314～2.080,P＜0.001）、COVID-19知识关注时间（OR=0.633,95%CI=0.500～0.803,P＜0.001）、COVID-19知识学习方式（OR=1.750,95%CI=1.380～2.220,P＜0.001）、阅读国家发布的COVID-19指南情况（OR=2.264,95%CI=1.630～3.144,P＜0.001）、参与一线抗疫意愿（OR=7.334,95%CI=5.529～9.729,P＜0.001）、此次抗疫参与情况（OR=1.543,95%CI=1.101～2.12,P=0.012）是影响疫情下自我职业认同感变化的独立因素。结论：在疫情下,多数订单定向全科医学生能积极学习COVID-19知识,参与防疫抗疫,职业认同感较强。增加重大事件关注时间、主动学习相关知识特别是学习权威专业知识、提高重大公卫事件参与意愿和实践,能促进订单定向全科医学生自我职业认同感,高年级学生更需要进行这方面的引导。     

抗击新型冠状病毒肺炎护士的焦虑状况及其影响因素

目的 了解抗击新型冠状病毒肺炎（新冠肺炎）护士的焦虑状况及其相关影响因素,为改善临床一线护士的焦虑提供指导。方法 选取2020年1月24日—2020年2月25日河北省第六人民医院抗击新冠肺炎的196名临床一线护士。采用焦虑自评量表（SAS）对临床一线护士的焦虑状况进行调查,应用单因素及多元逐步Logistic回归分析影响临床一线护士焦虑的危险因素。应用受试者工作特征（ROC）曲线下面积判断该模型对临床一线护士焦虑的预测能力。结果 临床一线护士196人中,82人有焦虑,构成比为41.8%（82/196）。单因素分析显示,容易疲劳、参加过突发公共卫生事件、性格类型、告知家人在一线、独生子女、恐慌及睡眠质量与临床一线护士焦虑有关（P<0.05）。多元逐步Logistic回归分析显示,容易疲劳[OR（95%CI）=1.952（1.204~4.216）]、性格内向[OR（95%CI）=1.846（1.115~3.938）]、恐慌[OR（95%CI）=2.428（1.537~6.620）]及睡眠质量差[OR（95%CI）=2.713（1.715~7.258）]是影响临床一线护士焦虑的独立危险因素（P<0.05）,而参加过突发公共卫生事件[OR（95%CI）=0.628（0.316~0.964）]及告知家人在一线[OR（95%CI）=0.593（0.248~0.917）]是临床一线护士焦虑的保护因素（P<0.05）。该模型 ROC 曲线下面积为0.928（95%CI：0.868~0.984,P<0.05）。结论 部分抗击新冠肺炎临床一线护士存在焦虑,其影响因素较多,应采取心理疏导和人文关怀等措施进行干预,以改善护士的焦虑状况。     

Risk factor for 31-day unplanned readmission to hospital in patients with pulmonary tuberculosis in China

Objectives:To evaluate risk factors associated with 31-day unplanned readmission(s) for pulmonary tuberculosis (TB) in China.Methods:This retrospective study enrolled patients (age, >14 years) with pulmonary TB who experienced 31-day unplanned readmissions to a specialized hospital for TB between January 2018 and December 2019. For each confirmed readmission, 2 control subjects were randomly selected from among patients with pulmonary TB but did not experience an unplanned readmission within 31 days.Results:A total of 402 pulmonary TB patients (5.9%) experienced unplanned readmission within 31 days after discharge. In univariate analysis, readmission was associated with gender, age, insurance coverage, residing in a rural area, active smoking, chronic obstructive pulmonary disease (COPD), drug-induced hepatitis, and leaving hospital against medical advice. The final logistic regression model revealed that higher risks for unplanned readmissions were associated with male gender (odds ratio [OR] 1.44, [95% confidence interval (CI) : 1.06-1.95]), age >65 years (OR 2.94, 95%CI: 2.03-4.27), rural residence (OR 8.86, 95%CI: 6.61-11.87), active smoking (OR 2.15, 95% CI 1.37-3.40), COPD (OR 2.77, 95%CI: 1.59-4.81), and leaving hospital against physician advice (OR 4.11, 95%CI: 1.43-11.83). The median time to 31-day unplanned readmission was 24 days. Major reasons for unplanned readmission included fever, exacerbation of dyspnea, and hemoptysis.Conclusion:Unplanned readmission for pulmonary TB within 31 days of discharge was higher among older males residing in rural areas, active smokers, and those leaving hospital against medical advice.     

不同先天性心脏病类型的环境危险因素分析

目的：探索不同类型先天性心脏病（congenital heart defects, CHD）的环境危险因素,为深入研究CHD表型的危险因素提供方向,为预防CHD积累证据。方法：使用广东省CHD监测网2004年至2012年登记的来自于17个地市、34家医疗机构的3 038例CHD活产儿及其1∶1对照儿数据,先后采用单因素分析、多因素条件Logistic回归,分析6类CHD的环境危险因素。结果：左向右分流类CHD的危险因素包括低出生体重（OR=2.63,95%CI：2.04~3.39）或巨大儿（OR=2.21,95%CI：1.47~3.32）,早产（OR=1.95,95%CI:1.53~2.49）,多胎（OR=1.99,95%CI： 1.22~3.26）,产母教育程度低、产母为工厂工人（OR=1.62,95%CI:1.32~1.98）,产次≥2（OR=1.38,95%CI:1.13~1.69）,有异常生育史（OR=2.29,95%CI： 1.75~3.01）,孕早期3个月曾有发烧（OR=2.38,95%CI： 1.26~4.48）,病毒感染（OR=1.80,95%CI： 1.29~2.51）,使用药物（OR=1.73,95%CI： 1.11~2.69）,被动吸烟（OR=1.69,95%CI： 1.26~2.29）,接触化学制剂（OR=8.71,95%CI： 2.33~32.58）,居住装修6个月内的居室（OR=2.56,95%CI： 1.60~4.09）或居室距主要马路<50 m（OR=1.40,95%CI： 1.14~1.72）,父亲为工厂工人（OR=1.46,95%CI： 1.23~1.73）。肺动脉流出道梗阻类CHD的危险因素包括活产儿低出生体重（OR=5.98,95%CI： 2.88~12.44）或巨大儿（OR=6.56,95%CI： 1.19~36.26）,产母教育程度低、产次≥2（OR=2.08,95%CI： 1.03~4.22）,孕早期病毒感染（OR=4.30,95%CI： 1.27~13.45）。左心室流出道梗阻类CHD危险因素为父亲为工厂工人（OR=6.01,95%CI： 1.05~34.59）。大动脉转位（transposition of the great arteries, TGA）的危险因素包括活产儿低出生体重（OR=12.93,95%CI： 1.14~146.26）,产母教育程度低、职业为工厂工人（OR=3.69,95%CI： 1.53~8.91）。合并心内分流型CHD的危险因素包括产次=2（OR=3.45,95%CI： 1.42~8.38）。其他类CHD的危险因素包括巨大儿（OR=4.87,95%CI： 1.19~19.94）、产母既往有异常生育史（OR=2.96,95%CI： 1.14~7.68）、孕早期3个月有病毒感染（OR=4.92,95%CI： 1.56~15.47）、用药（OR=4.90,95%CI： 1.22~19.77）、被动吸烟（OR=10.31,95%CI: 1.25~85.05）。结论：不同CHD类的危险因素存在差异,深入研究CHD的相关环境危险因素及其影响机制需有针对性,预防CHD需特别注意避免影响多类CHD或临床治疗效果较差CHD类的环境危险因素暴露,并加强已暴露人群的产前检查。     

中性粒细胞/淋巴细胞比值可作为重型COVID-19的预警信号

目的 探寻重型新型冠状病毒肺炎（COVID-19）的预警信号。方法 回顾性分析湖北中西医结合医院呼吸四病区及一病区收治的63例COVID-19患者的临床资料,按照诊断标准分为普通型组（32例）和重型组（31例）。比较两组患者在一般资料、基础疾病、临床表现及实验室检查指标的差异,采用相关和回归分析糖尿病、中性粒细胞/淋巴细胞比值（NLR）、血清淀粉样蛋白A （SSA）、C反应蛋白（CRP）、血清白蛋白（ALB）与重型COVID-19的相关性,结合受试者工作特征曲线（ROC曲线）分析NLR的曲线下面积（AUC）,评估其在COVID-19的预测效能。结果 两组患者在糖尿病、NLR、SSA、CRP、ALB具有显著性差异（P< 0.05）;糖尿病、NLR、SSA、CRP与重型COVID-19存在正性相关（P<0.05）;ALB与重型COVID-19存在负性相关（P<0.05）;通过多因素Logistic回归分析显示：NLR为重型COVID-19的独立危险因素（OR=1.264,95%CI：1.046~1.526,P=0.015）;应用ROC曲线计算AUC为0.831（95%CI：0.730~0.932）,相对应的NLR最佳界值为4.795,敏感度为0.839,特异性为0.750。结论 NLR可以作为重型COVID-19的预警信号,能为早期识别重型COVID-19提供客观依据。     

成人COVID-19重症及危重症患者的临床特征分析

目的 探讨新型冠状病毒肺炎（COVID-19）重症及危重症患者的临床特征。方法 对2020年1月~2020年3月湖北省洪湖市人民医院75例COVID-19重症及危重症患者临床资料进行回顾性分析。结果 75例患者重型43例,危重型32例,男性41例 （54.67）,女性34例（45.33%）,年龄58.1±15.9岁,49.3%患者有基础疾病史,主要临床表现为发热（78.67%）和咳嗽（70.67%）等。与重型患者比较,危重型患者在年龄>60岁患者比例、入院时WBC计数、hsCRP、PCT、凝血酶原时间、D二聚体、ALT、CRE、LDH、cTnI、NT-proBNP等均较重症组明显升高,有显著性统计学差异（P<0.05）。单因素logistic 回归分析结果显示,年龄>60 岁、WBC计数升高、hs-CRP升高、凝血酶原时间延长、D二聚体升高、NT-proBNP升高、cTnI升高是 COVID-19 危重型的相关因素 （P均<0.05）。进一步多因素logistic回归分析结果显示,年龄>60岁（OR=8.165,95%CI 1.483,45.576,P=0.017）,凝血酶原时间延长（OR=7.516,95%CI 2.568,21.998,P=0.006）和NT-proBNP 升高（OR=6.194,95%CI 1.305,29.404,P=0.022）是 COVID-19 危重型的独立相关因素。结论 年龄大于60岁、凝血酶原时间延长和NT-proBNP升高是COVID-19危重症患者的重要临床特征,可能为危重症患者的早期预警因素。     

新型冠状病毒肺炎患者死亡的危险因素分析及预测评分系统构建

背景　新型冠状病毒肺炎（COVID-19）已全球流行,如何有效治疗、降低病死率尚处于摸索阶段。寻找死亡危险因素将有利于优化COVID-19治疗策略。目的　探讨COVID-19患者死亡的危险因素并构建预测评分系统。方法　选取2020-01-01至02-29在武汉大学中南医院住院的COVID-19患者270例,收集患者基线资料,包括一般资料、入院症状、合并症、入院生命体征、实验室检查。根据临床结局即治愈出院和死亡分为痊愈组和死亡组。采用多因素Logistic回归分析探讨COVID-19患者死亡的危险因素,基于此构建COVID-19患者死亡预测评分系统。结果　最终245例患者纳入研究,其中治愈出院212例（痊愈组）,死亡33例（死亡组）。多因素Logistic回归分析结果显示,年龄≥65岁〔OR=7.177,95%CI（1.715,30.038）,P<0.05〕、氧饱和度（SpO2）≤93%〔OR=15.456,95%CI（3.343,71.450）,P<0.05〕、血尿素氮（BUN）≥7 mmol/L〔OR=7.115,95%CI（1.550,32.652）,P<0.05〕、血降钙素原（PCT）≥0.1 μg/L〔OR=23.895,95%CI（4.209,135.639）,P<0.05〕是COVID-19患者死亡的独立危险因素。ASBP（A：年龄,S：SpO2,B：BUN,P：PCT）评分系统对COVID-19患者死亡预测价值的ROC曲线下面积（AUC）95%CI为0.967（0.931,0.987）,CURB-65评分系统对COVID-19患者死亡预测价值的AUC 95%CI为0.885（0.831,0.926）。两种评分系统AUC比较,差异有统计学意义（Z=2.816,P<0.01）。选择约登指数最大者作为预测截断值,即ASBP评分系统为5分、CURB-65评分系统2分,相应的灵敏度分别为0.871、0.903,特异度分别为0.957、0.735。结论　年龄≥65岁、SpO2≤93%、BUN≥7 mmol/L和PCT≥0.1 μg/L是COVID-19死亡的独立危险因素,以此构建的ASBP评分系统可用于COVID-19死亡预警。     

普拉格雷和氯吡格雷对冠心病患者疗效和安全性的Meta分析

目的比较普拉格雷(prasugrel)与氯吡格雷(clopidogrel)治疗冠心病的疗效和安全性。方法计算机检索Pub Med、Medline、Cochrane Central Register of Controlled Trials、CNKI全文数据库,收集2006年1月~2014年6月公开发表的有关普拉格雷和氯吡格雷疗效比较的随机对照试验(RCT),手检已获文献的参考文献、会议摘要及相关网站。对文献质量进行严格评价后,对符合要求的RCTs进行资料提取并采用Rev Man5.0软件进行Meta分析。结果共纳入5项RCTs,Meta分析显示,普拉格雷组与氯吡格雷组之间全因病死率(OR=0.94,95%CI:0.86~1.16,P=0.32)、心肌梗死(MI)发生率(OR=0.82,95%CI:0.68~1.00,P=0.05)、脑卒中发生率(OR=0.96,95%CI:0.75~1.22,P=0.72)均无统计学意义;普拉格雷组主要不良心脏事件(MACE)发生率(OR=0.45,95%CI:0.34~0.59,P=0.000)、支架内血栓发生率(OR=0.79,95%CI:0.63~0.98,P=0.04)均低于氯吡格雷组,但大出血发生率(OR=1.26,95%CI:1.03~1.55,P=0.02)高于氯吡格雷组。结论在冠心病双重抗血小板治疗中,第2代P2Y12二磷酸腺苷受体拮抗剂普拉格雷能更显著降低MACE发生率、支架内血栓发生率,在全因病死率、MI发生率、脑卒中发生率与氯吡格雷相似,但能增加大出血的风险。     

第19天微小残留病检测在儿童急性淋巴细胞白血病中的预后意义及危险因素分析

目的 探讨使用中国抗癌协会儿童肿瘤协作组（CCCG）急性淋巴细胞白血病（ALL）2015方案治疗的患儿中，第19天微小残留病（D19 MRD）≥1%作为评价早期治疗反应对预后的意义及其风险因素。方法 回顾性分析2015年1月1日至2018年12月31日在本中心使用该方案治疗的ALL患儿病历资料共243例。以诱导化疗D19 MRD≥1%为节点，分为早期治疗反应良好 （D19 MRD<1%）组和早期治疗反应不良（D19 MRD≥1%）组。比较两组生存时间的差异并分析D19 MRD≥1%的风险因素。结果 D19 MRD<1%组3年总生存率（OS）优于D19 MRD≥1%组（100% vs 90.2%，P=0.004）。D19 MRD<1%组3年无事件生存 率（EFS）优于D19 MRD≥1%组（97.6% vs 71.6%，P<0.001）。单因素分析表明纵膈侵犯，T-细胞免疫分型、TEL/AML1（ETV6/RUNX1）融合基因及第5天外周血存在幼稚细胞的风险系数（OR）及95%置信区间（CI）分别是4.47（0.275~72.968，P=0.034）、 5.250（1.950~14.133，P=0.02）、0.330（0.112~0.970，P=0.036）及4.407（1.782~10.895，P=0.01）。初治危险度（P<0.001），初治白细胞计数分等级间（P=0.018）及其数量（P=0.027），第5天幼稚细胞数量（P<0.001）在两组间均有差异。多因素分析表明初治危险度为中高危，第5天外周血存在幼稚细胞是D19 MRD≥1%的独立风险因素，其OR及其95%CI分别是2.889（1.193~6.996，P=0.019）、4.477（1.692~11.843，P=0.003）。结论 D19 MRD≥1%是影响预后的因素；纵膈侵犯、T细胞免疫分型及第5天外周血存在幼稚细胞是风险因素，而TEL/AML1融合基因是保护因素；中高危及第5天外周血存在幼稚细胞为独立风险因素。