Clinical characteristics and outcomes of COVID-19 patients with prediabetes

Background and aimsWe aimed to examine the clinical characteristics and outcomes of coronavirus disease 2019 (COVID-19) patients with prediabetes.MethodsThis was a retrospective cohort study of 102 COVID-19 patients admitted to a tertiary care hospital in India between May and October 2020.ResultsMost patients had a poor clinical profile on admission. They had high rates of invasive mechanical ventilation (48%), intensive care unit admission (48%), complications (72.6%), and mortality (32.4%).ConclusionPeople with prediabetes are at high risk for poor outcomes from COVID-19.     

重型新型冠状病毒肺炎患者临床特征及诊治分析

目的 总结重型新型冠状病毒肺炎(COVID-19)患者临床特征及诊治经验。方法 回顾性分析2020 年1 月27 日至2020 年3 月10 日在我院诊治的重症COVID-19 患者资料。结果 5 例重症COVID-19 患者中,男性2例,女性3 例,年龄47~65 岁,3 例合并基础疾病,主要临床表现为发热、咳嗽、咳痰、胸闷、乏力及腹泻等。外周血淋巴细胞绝对值与嗜酸性粒细胞均出现显著降低。胸部CT 表现为外周分布、双肺多发斑片状阴影。5 例重症患者均予抗病毒治疗,康复者血浆治疗1 例,托珠单抗治疗1 例。患者均治愈出院。结论 5 例重症COVID-19 患者以呼吸道症状及消化道症状为主要表现,外周血淋巴细胞及嗜酸性粒细胞显著减少,影像学特点以外周分布的两肺多发斑片状阴影为主,经积极治疗预后良好。     

Clinical characteristics,outcomes and prognosticators in adult patients hospitalized with COVID-19

BackgroundCOVID-19 is a novel disease caused by SARS-CoV-2.MethodsWe conducted a retrospective evaluation of patients admitted with COVID-19 to one site in March 2020. Patients were stratified into 3 groups: survivors who did not receive mechanical ventilation (MV), survivors who received MV, and those who received MV and died during hospitalization.ResultsThere were 140 hospitalizations; 22 deaths (mortality rate 15.7%), 83 (59%) survived and did not receive MV, 35 (25%) received MV and survived; 18 (12.9%) received MV and died. Thee mean age of each group was 57.8, 55.8 and 72.7 years, respectively (P = .0001). Of those who received MV and died, 61% were male (P = .01). More than half the patients (n = 90, 64%) were African American. First measured d-dimer >575.5 ng/mL, procalcitonin > 0.24 ng/mL, lactate dehydrogenase >445.6 units/L, and brain natriuretic peptide (BNP) >104.75 pg/mL had odds ratios of 10.5, 5, 4.5 and 2.9, respectively for MV (P < .05 for all). Peak BNP >167.5 pg/mL had an odds ratio of 6.7 for inpatient mortality when mechanically ventilated (P = .02).ConclusionsAge and gender may impact outcomes in COVID-19. D-dimer, procalcitonin, lactate dehydrogenase and BNP may serve as early indicators of disease trajectory.     

39例新型冠状病毒肺炎患者临床特征分析

目的　分析新型冠状病毒肺炎（coronavirus disease-2019, COVID-19）患者的流行病学特点、临床表现、实验室检查、影像学特征及临床转归等资料,为COVID-19的诊治提供参考。方法　纳入2020年1月21日—2月24日在郴州市第二人民医院经SARS-CoV-2核酸检测阳性的COVID-19患者39例,对其流行病学特征、首发症状、WBC、淋巴细胞计数、降钙素原（procalcitonin, PCT）、IL-6、CRP、CD4+ T淋巴细胞计数、CD8+ T淋巴细胞计数、影像学及临床转归等资料进行分析。结果　39例患者中,2例为轻型,35例为普通型,2例为重型,除去无明确接触史及返乡前就已发病的患者,其余潜伏期为2.0～12.0 d,平均为（7.7±3.3）d,其中32例（82.05%）发病前有武汉旅居史或武汉返乡人员密切接触史,5例（12.82%）发病前有广东旅居史或广东返乡人员密切接触史,2 例（5.12%）无明确可疑接触史;有7起家族聚集性病例,共26例,占发病总例数的66.67%。24例（61.54%）患者早期症状为发热,25例（64.10%）患者早期症状为咳嗽,有少数患者存在咽痛、肌肉酸痛、纳差、咳嗽、腹泻,3例（7.69%）无任何临床表现。WBC下降12 例（30.77%）;淋巴细胞计数下降8例（20.51%）;T淋巴细胞计数下降3例（7.69%）;ALT升高12例（30.77%）;TBIL升高10例（25.64%）;LDH升高21例（53.85%）;CRP升高18例（46.15%）;IL-6升高3例（7.69%）;患者 降钙素原均正常。肺部CT病灶呈双肺多发,以外侧带胸膜下为主,多表现为斑片状、云絮状磨玻璃样改变。6例普通型COVID-19患者出院后随访,肺部病灶完全吸收,吸收时间18.0～31.0 d,平均（26.8±4.5） d。结论　本研究前期纳入的COVID-19患者为输入性病例,后期则以家庭聚集性病例为主;临床表现以发热和咳嗽为常见症状,少数患者症状轻甚至无症状;大部分患者为普通型;胸部CT表现多为斑片状、云絮状磨玻璃样改变;肺部病灶的好转不与核酸转阴完全同步;目前随访的普通型COVID-19患者预后良好。     

Consensus elements for observational research on COVID-19-related long-term outcomes

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its long-term outcomes may be jointly caused by a wide range of clinical, social, and economic characteristics. Studies aiming to identify mechanisms for SARS-CoV-2 morbidity and mortality must measure and account for these characteristics to arrive at unbiased, accurate conclusions. We sought to inform the design, measurement, and analysis of longitudinal studies of long-term outcomes among people infected with SARS-CoV-2. We fielded a survey to an interprofessional group of clinicians and scientists to identify factors associated with SARS-CoV-2 infection and subsequent outcomes. Using an iterative process, we refined the resulting list of factors into a consensus causal diagram relating infection and 12-month mortality. Finally, we operationalized concepts from the causal diagram into minimally sufficient adjustment sets using common medical record data elements. Total 31 investigators identified 49 potential risk factors for and 72 potential consequences of SARS-CoV-2 infection. Risk factors for infection with SARS-CoV-2 were grouped into five domains: demographics, physical health, mental health, personal social, and economic factors, and external social and economic factors. Consequences of coronavirus disease 2019 (COVID-19) were grouped into clinical consequences, social consequences, and economic consequences. Risk factors for SARS-CoV-2 infection were developed into a consensus directed acyclic graph for mortality that included two minimally sufficient adjustment sets. We present a collectively developed and iteratively refined list of data elements for observational research in SARS-CoV-2 infection and disease. By accounting for these elements, studies aimed at identifying causal pathways for long-term outcomes of SARS-CoV-2 infection can be made more informative.     

Electrocardiographic features of patients with COVID-19 pneumonia

Background. The electrocardiographic (ECG) changes which may occur during hospitalization for COVID-19 have not yet been comprehensively assessed.Patients and methods. We examined 50 patients admitted to hospital with proven COVID-19 pneumonia. At entry, all patients underwent a detailed clinical examination, 12-lead ECG, laboratory tests and arterial blood gas test. ECG was also recorded at discharge and in case of worsening clinical conditions.Results. Mean age of patients was 64 years and 72% were men. At baseline, 30% of patients had ST-T abnormalities, and 33% had left ventricular hypertrophy. During hospitalization, 26% of patients developed new ECG abnormalities which included atrial fibrillation, ST-T changes, tachy-brady syndrome, and changes consistent with acute pericarditis. One patient was transferred to intensive care unit for massive pulmonary embolism with right bundle branch block, and another for non-ST segment elevation myocardial infarction. Patients free of ECG changes during hospitalization were more likely to be treated with antiretrovirals (68% vs 15%, p = 0.001) and hydroxychloroquine (89% vs 62%, p = 0.026) versus those who developed ECG abnormalities after admission. Most measurable ECG features at discharge did not show significant changes from baseline (all p>0.05) except for a slightly decrease in Cornell voltages (13±6 vs 11±5 mm; p = 0.0001) and a modest increase in the PR interval. The majority (54%) of patients with ECG abnormalities had 2 prior consecutive negative nasopharyngeal swabs. ECG abnormalities were first detected after an average of about 30 days from symptoms’ onset (range 12–51 days).Conclusions. ECG abnormalities during hospitalization for COVID-19 pneumonia reflect a wide spectrum of cardiovascular complications, exhibit a late onset, do not progress in parallel with pulmonary abnormalities and may occur after negative nasopharyngeal swabs.     

Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients

BackgroundDue to the general susceptibility of new coronaviruses, the clinical characteristics and outcomes of elderly and young patients may be different.ObjectiveTo analyze the clinical characteristics of elderly patients with 2019 new-type coronavirus pneumonia (COVID-19).MethodsThis is a retrospective study of patients with new coronavirus pneumonia (COVID-19) who were hospitalized in Hainan Provincial People's Hospital from January 15, 2020 to February 18, 2020. Compare the clinical characteristics of elderly with Young and Middle-aged patients.ResultsA total of 56 patients were enrolled 18 elderly patients (32.14%), and 38 young and middle-aged patients (67.86%). The most common symptoms in both groups were fever, followed by cough and sputum. Four patients in the elderly group received negative pressure ICU for mechanical ventilation, and five patients in the young and middle-aged group. One patient died in the elderly group (5.56%), and two patients died in the young and middle-aged group (5.26%). The PSI score of the elderly group was higher than that of the young and middle-aged group (P < 0.001). The proportion of patients with PSI grades IV and V was significantly higher in the elderly group than in the young and middle-aged group (P < 0.05). The proportion of multiple lobe involvement in the elderly group was higher than that in the young and middle-aged group (P < 0.001), and there was no difference in single lobe lesions between the two groups. The proportion of lymphocytes in the elderly group was significantly lower than that in the young and middle-aged group (P < 0.001), and the C-reactive protein was significantly higher in the young group (P < 0.001). The Lopinavir and Ritonavir Tablets, Chinese medicine, oxygen therapy, and mechanical ventilation were statistically different in the elderly group and the young and middle-aged group, and the P values were all <0.05.InterpretationThe mortality of elderly patients with COVID-19 is higher than that of young and middle-aged patients, and the proportion of patients with PSI grade IV and V is significantly higher than that of young and middle-aged patients. Elderly patients with COVID-19 are more likely to progress to severe disease.     

Clinical features and outcomes of the patients with anti-glycyl tRNA synthetase syndrome

Clinical Rheumatology - To analyze the clinical features and outcomes of the patients with anti-glycyl tRNA synthetase (anti-EJ) syndrome in a large Chinese cohort. The medical records, imaging,...     

Nutritional determinants and COVID-19 outcomes of older patients with COVID-19: A systematic review

BackgroundMalnutrition among older people is one of the serious public health problem worldwide. Nutritional status and levels of nutrients of older patients with COVID-19 effect on COVID-19 outcomes. The purpose of this systematic review was to identify the prevalence of malnutrition and levels of nutrients associated with outcomes of the older patients with COVID-19.Materials and MethodsA literature search was performed using PubMed, Science direct and Google scholar database using specific keywords related to the aims. All related articles published on COVID-19 during 2020 were retrieved. PRISMA Statement was followed. The quality of the study was assessed using the quality assessment tools of the National Heart, Lung, and Blood Institute of the National Institutes of Health.ResultsOf the 2979 studies found, a total of eight studies were included in this review. Of these studies, three provided data on nutritional status and outcomes of COVID-19 among older patients with COVID-19. The prevalence of malnutrition among older patients with COVID-19 was high and it was associated with negative outcomes including hospital deaths and transfer to intensive care units. Five studies provided data on nutrients and outcomes of COVID-19. Low albumin, vitamin D, magnesium ,vitamin B12, Se status were associated with malnutrition, oxygen therapy and/or intensive care support of the patients, survival of COVID -19.ConclusionsExtra care should be provided to older patients with COVID-19 to minimize the prevalence of malnutrition and negative outcomes of COVID-19.     

严重急性呼吸道综合征并发全身炎症反应综合征时的肝脏损害

探讨严重急性呼吸道综合征(SARS)并发全身炎症反应综合征时肝脏损害的临床特点、可能的原因及机理。选择在我院住院的严重急性呼吸道综合征患者128例。观察其临床表现特点，连续检测血常规、血气分析、肝肾功能和心肌酶谱等实验室指标，测定32例患者血清炎症因子。部分患者行肝脏B型超声和尸检病理学检查。①128例SARS患者中，97例存在除肺脏以外的其他脏器损害，以肝脏损害最常见；②转氨酶、心肌酶和炎症因子升高多见于发病后前2周，并随着病情好转而下降；白蛋白进行性下降提示预后不良；肌酐和尿素氮持续增高主要出现于重型患者的晚期；③肝脏B型超声和病理学检查显示肝脏有非特异性炎症改变。SARS患者容易发生肝脏等实质脏器的损害，是全身炎症反应综合征的一部分，早期控制炎症反应综合征有助于延缓疾病进程，改善预后。     

Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature

Background and aimTo conduct a systematic literature review and analyze the demographic/biochemical parameters and clinical outcomes of COVID-19 patients with diabetic ketoacidosis (DKA) and combined DKA/HHS (hyperglycemic hyperosmolar syndrome).MethodsPubMed, Scopus, Embase, and Google Scholar databases were systematically searched till August 3, 2020 to identify studies reporting COVID-19 patients with DKA and combined DKA/HHS. A total of 19 articles reporting 110 patients met the eligibility criteria.ResultsOf the 110 patients, 91 (83%) patients had isolated DKA while 19 (17%) had DKA/HHS. The majority of the patients were male (63%) and belonged to black ethnicity (36%). The median age at presentation ranged from 45.5 to 59.0 years. Most of the patients (77%) had pre-existing type 2 diabetes mellitus. Only 10% of the patients had newly diagnosed diabetes mellitus. The median blood glucose at presentation ranged from 486.0 to 568.5 mg/dl, being higher in patients with DKA/HHS compared to isolated DKA. The volume of fluid replaced in the first 24 h was higher in patients with DKA/HHS in contrast to patients with DKA alone. The in-hospital mortality rate was 45%, with higher mortality in the DKA/HHS group than in the isolated DKA group (67% vs. 29%). pH was lower in patients who had died compared to those who were discharged.ConclusionDKA in COVID-19 patients portends a poor prognosis with a mortality rate approaching 50%. Differentiating isolated DKA from combined DKA/HHS is essential as the latter represents nearly one-fifth of the DKA cases and tends to have higher mortality than DKA alone.     

Gastrointestinal symptoms in patients hospitalized with COVID-19: Prevalence and outcomes

To characterize outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19) who present with gastrointestinal (GI) symptoms.Clinical outcomes in patients with COVID-19 associated with GI symptoms have been inconsistent in the literature.The study design is a retrospective analysis of patients, age 18 years or older, admitted to the hospital after testing positive for COVID-19. Clinical outcomes included intensive care unit requirements, rates of discharges to home, rates of discharges to outside facilities, and mortality.Seven hundred fifty patients met the inclusion criteria. Three hundred seventy three (49.7%) patients presented with at least one GI symptom and 377 (50.3%) patients presented with solely non-GI symptoms. Patients who presented with at least one GI symptom had significantly lower ICU requirements (17.4% vs 20.2%), higher rates of discharges home (77.2% vs 67.4%), lower rates of discharges to other facilities (16.4% vs 22.8%), and decreased mortality (6.4% vs 9.8%) compared with patients with non-GI symptoms. However, patients who presented with solely GI symptoms had significantly higher ICU requirements (23.8% vs 17.0%), lower rates of discharges home (52.4% vs 78.7%), higher rates of discharges to facilities (28.6% vs 15.6%), and higher mortality (19.0% vs 5.7%) compared with those with mixed GI and non-GI symptoms.Although patients with COVID-19 requiring hospitalization with GI symptoms did better than those without GI symptoms, those with isolated GI symptoms without extra-GI symptoms had worse clinical outcomes. COVID-19 should be considered in patients who present with new onset or worsening diarrhea, nausea, vomiting, and abdominal pain even without pulmonary symptoms.