Retrospective analysis of clinical features in 134 coronavirus disease 2019 cases

Abstract We aimed to describe the clinical features in coronavirus disease 2019 (COVID-19) cases. We studied 134 critically ill COVID-19 cases from 30 December 2019 to 20 February 2020 in an intensive care unit (ICU) at Wuhan Jinyintan Hospital. Demographics, underlying diseases, therapy strategies and test results were collected and analysed from patients on admission, admission to the ICU and 48 h before death. The non-survivors were older (65.46 (s.d. 9.74) vs. 46.45 (s.d. 11.09)) and were more likely to have underlying diseases. The blood group distribution of the COVID-19 cases differed from that of the Han population in Wuhan, with type A being 43.85%; type B, 26.92%; type AB, 10% and type O, 19.23%. Non-survivors tend to develop more severe lymphopaenia, with higher C-reactive protein, interleukin-6, procalcitonin, D-dimer levels and gradually increased with time. The clinical manifestations were non-specific. Compared with survivors, non-survivors more likely to have organ function injury, and to receive mechanical ventilation, either invasively or noninvasively. Multiple organ failure and secondary bacterial infection in the later period is worthy of attention.

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Some Clinical Features and Supportive Therapies in Covid-19 Patients Died in Hajar Hospital, Tehran, Iran

Complementary Medicine Journal ◽

10.32598/cmja.11.2.1049.2 ◽

2021 ◽

Vol 11 (2) ◽

pp. 154-165

Author(s):

Hamed Maleki ◽

◽

Fatemeh Tabatabaie ◽

Mosayeb Bagherinik ◽

Sosan Azizmohamadi ◽

...

Keyword(s):

Mechanical Ventilation ◽

Clinical Features ◽

Significant Relationship ◽

Clinical Manifestations ◽

Recovery Process ◽

Definitive Treatment ◽

Blood Products ◽

Definite Effect ◽

And Gender ◽

Underlying Diseases

Objective: Due to the spread of Coronavirus Disease 2019 (COVID-19) worldwide and the resulting mortality as well as the lack of definitive treatment for this disease, various non-invasive and invasive drugs and treatments have been used around the world for reducing the effects of this disease or accelerating the treatment process, but the positive and definite effect of none of these methods has been confirmed and they have been effective only in some cases. This study aims to investigate some clinical features and supportive therapies in deceased COVID-19 patients in Iran. Methods: This descriptive-analytical retrospective study was conducted on 100 Covid-19 patients died in Hajar Hospital in Tehran, Iran from February to September 2020. They were divided into two groups of with and without underlying diseases. After coordination and obtaining the necessary permission and informed consent, information was collected from the medical files of samples. Results: Mechanical ventilation, vasoconstrictor injection and blood products had been used as supportive therapies in deceased patients, where ventilation use (n=62, 62%) was significantly higher (P=0.01) compared to vasoconstrictor injection (n=28, 28%) and blood products (n=13, 13%). Most of deceased patients had an underlying diseases (79%). Hypertension, diabetes and heart problems were the most common underlying diseases. The disease severity, clinical manifestations, and mortality rate of deceased patients with cardiovascular diseases, diabetes and hypertension were significantly different compared to those with other underlying diseases (P= 0.01). The age and gender of deceased patients had no significant relationship with the use of any supportive therapies (P≥0.01), but had a significant relationship with the underlying diseases (P≤0.01). Conclusion: The treatment methods that are the definite needs of the patient and have more favorable effects on the recovery process have a high value in the treatment of COVID-19 patients. These patients need to use supportive therapies for purposeful and effective treatment. Mechanical ventilation is more important than injecting vasoconstrictors or using blood products.

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Predicting Mechanical Ventilation For More Than 7 Days In The Emergency Department

10.21203/rs.3.rs-404559/v2 ◽

2021 ◽

Author(s):

Jin Hui Paik ◽

Jung-Soo Kim ◽

Man-Jong Lee ◽

Mi Hwa Park ◽

Areum Durey ◽

...

Keyword(s):

Emergency Department ◽

Mechanical Ventilation ◽

Underlying Disease ◽

Test Results ◽

C Reactive Protein ◽

Reactive Protein ◽

Factors Influencing ◽

Laboratory Test Results ◽

The Mean ◽

Underlying Diseases

Abstract Background: The duration of mechanical ventilation (MV) required by patients admitted to the emergency department (ED) is difficult to predict. We investigated the duration of MV in ED-admitted patients, as well as their clinical progress.Methods: We investigated the duration of MV in adult patients (aged ≥18 years) who were attached to ventilators in our ED between January and December 2017. The patients were divided into two groups; MV <7 days and MV ≥7 days. The patients’ demographic characteristics, diagnoses, clinical features, and underlying diseases were compared between two groups.Results: The study comprised 282 patients including 142 in the MV <7 days group and 140 in the MV ≥7 days group. The MV ≥7 days group had more patients diagnosed with metabolic disorder, pneumonia, neurological disease, sepsis, and multiple trauma, and also had a greater proportion of patients with dementia or stroke as the underlying disease. The mean C-reactive protein level in the MV ≥7 days group was 6.4 mg/dL, which was higher than that in the MV <7 days group. The risk factors for requiring ≥7 days of MV were identified as a diagnosis of stroke as well as having the underlying diseases of cancer and stroke or dementia. Among the laboratory test results, pH, HCO3- , and albumin <3.5 g/dL were identified as factors influencing the duration of MV.Conclusions: MV for ≥7 days is predicted to be required for patients admitted for a stroke; those with underlying cancer or stroke; and those with adverse pH, HCO3-, and albumin blood test results.

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Clinical and biochemical indexes of 11 COVID-19 patients and the genome sequence analysis of the tested SARS-CoV-2

10.21203/rs.3.rs-32414/v2 ◽

2020 ◽

Author(s):

Zhikang Yu ◽

Heming Wu ◽

Qingyan Huang ◽

Xuemin Guo ◽

Zhixiong Zhong

Keyword(s):

Test Results ◽

Global Public Health ◽

C Reactive Protein ◽

Genome Sequences ◽

Multiple Sequence ◽

Reactive Protein ◽

Erythrocyte Sedimentation ◽

Laboratory Test Results ◽

Underlying Diseases ◽

Genetic Form

Abstract BackgroundAt present, SARS-CoV-2 epidemic in the world rapidly spread. It is a serious global public health emergency.MethodsHere we described the clinical characteristics of 11 SARS-CoV-2 infected patients hospitalized in the Meizhou People's Hospital. And viral genome sequences of SARS-CoV-2 from these patients were analyzed.ResultsOf the 11 patients, six cases developed fever, nine cases developed cough, and two cases developed headache and chills. Four patients (36.4%) had underlying diseases. Pneumonia is the most common complication. The laboratory test results showed that there was no adult patients with increased LYM/LYM%. Most patients had normal total protein (TP) and albumin (ALB), but only two patients had decreased. Most patients had increased or normal levels of erythrocyte sedimentation rate (ESR), C reactive protein (CRP), activated partial thromboplastin time (APTT), fibrinogen (FIB), creatine kinase isoenzymes (CK-MB), and lactate dehydrogenase (LDH). Neutrophil (NEU) (r=0.664, P=0.026), CK-MB (r=0.655, P=0.029), blood urea nitrogen (BUN) (r=0.682, P=0.021) and SARS-CoV-2 virus cycle threshold (Ct) value were significantly correlated. Multiple sequence alignment (MSA) shows that we identified two different SNPs at positions 8781 and 28144, and have a completely linked genetic form of 8781C-28144T and 8781T-28144C.ConclusionsThe reports of these 11 cases in our hospital will provide useful information for the diagnosis, treatment and drug development of SARS-CoV-2.

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Predicting Mechanical Ventilation for More Than 7 Days in the Emergency Department

10.21203/rs.3.rs-404559/v1 ◽

2021 ◽

Author(s):

Jin Hui Paik ◽

Jung-Soo Kim ◽

Man-Jong Lee ◽

Mi Hwa Park ◽

Areum Durey ◽

...

Keyword(s):

Emergency Department ◽

Mechanical Ventilation ◽

Underlying Disease ◽

Test Results ◽

C Reactive Protein ◽

Reactive Protein ◽

Factors Influencing ◽

Laboratory Test Results ◽

The Mean ◽

Underlying Diseases

Abstract Background The duration of mechanical ventilation (MV) required by patients admitted to the emergency department (ED) is difficult to predict. We investigated the duration of MV in ED-admitted patients, as well as their clinical progress.Methods We investigated the duration of MV in adult patients (aged ≥18 years) who were attached to ventilators in our ED between January and December 2017. The patients were divided into two groups; MV <7 days and MV ≥7 days. The patients’ demographic characteristics, diagnoses, clinical features, and underlying diseases were compared between two groups.Results The study comprised 282 patients including 142 in the MV <7 days group and 140 in the MV ≥7 days group. The MV ≥7 days group had more patients diagnosed with metabolic disorder, pneumonia, neurological disease, sepsis, and multiple trauma, and also had a greater proportion of patients with dementia or stroke as the underlying disease. The mean C-reactive protein level in the MV ≥7 days group was 6.4 mg/dL, which was higher than that in the MV <7 days group. The risk factors for requiring ≥7 days of MV were identified as a diagnosis of stroke as well as having the underlying diseases of cancer and stroke or dementia. Among the laboratory test results, pH, HCO3- , and albumin <3.5 g/dL were identified as factors influencing the duration of MV.Conclusion MV for ≥7 days is predicted to be required for patients admitted for a stroke; those with underlying cancer or stroke; and those with adverse pH, HCO3-, and albumin blood test results.

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Analyses of the clinical features and contributing factors in 13 fatal cases of Coronavirus Disease 2019

10.21203/rs.3.rs-21072/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Haichao Liu ◽

Zhenhong Hu ◽

Chongzheng Mao ◽

Ruijuan Xu ◽

Fangqi Zhang ◽

...

Keyword(s):

T Lymphocyte ◽

Clinical Manifestations ◽

Critical Group ◽

Inflammatory Factors ◽

Test Results ◽

Contributing Factors ◽

Laboratory Test Results ◽

Severe Group ◽

Cellular Immune ◽

Underlying Diseases

Abstract Objective To investigate the clinical features of and contributing factors in 13 fatal cases of Coronavirus Disease 2019 (COVID-19).Methods The clinical data of 13 patients who died of COVID-19 in Central Theater General hospital, China, between January 4, 2020, and February 24, 2020, were analyzed retrospectively. The data reviewed included clinical manifestations, laboratory test results and radiographic features. The cellular immune function and the expression of inflammatory factors in deceased patients at different stages of the disease were analyzed, and the clinical data and laboratory test results between the deceased group and the moderate group (20 patients), severe group (20 patients) and the critical group (10 patients) were compared.Results Of those who died, the patients consisted of 10 men and 3 women. The average age of those who died was (74±19) years, and 10 patients were over 70 years old (76.9%), which was significantly higher than the ages of patients in the moderate group, severe group and critical group. There were no significant differences in sex ratio and clinical manifestations among the 4 groups. For the patients who died, 9presented with underlying diseases,6 of whom had more than 2 diseases, which was significantly higher than the number of underlying disease in the other groups. On admission, the chest computed tomography (CT) for 8 patients (61.5%) mainly showed multiple patchy ground-glass opacities. When the disease progressed, the ground-glass opacities rapidly developed into diffuse lesions in both lungs. The lymphocyte and CD3 + ,CD4 + , and CD8 + T lymphocyte counts in the peripheral blood of 13 patients were significantly lower than normal levels and decreased more substantially during the disease course based on the levels when admitted (P<0.01). Additionally, the IL-6, D-dimer, C-reactive protein (CRP), lactic acid levels gradually increased, and most peaked before death. There were statistically significant differences in IL-6 expression, lymphocyte count and T lymphocyte subset count between the deceased group and the moderate group, severe group and critical group (P<0.01). However, there were no statistically significant differences in serum CRP lactic acid levels among the 4 groups (P>0.05).The cause of death for most patients was acute respiratory distress syndrome (ARDS) with type I respiratory failure. Three patients eventually developed multiorgan deficiency syndrome (MODS).Conclusion The risk factors of death for COVID-19 patients included older men, more underlying diseases, poor cellular immune function and overexpression of inflammatory factors. The main cause of death in patients with COVID-19 was ARDS, which led to respiratory failure and MODS.

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POSSIBILITIES FOR VERIFICATION OF NEONATAL SEPSIS

Clinical anatomy and operative surgery ◽

10.24061/1727-0847.17.3.2018.11 ◽

2018 ◽

Vol 17 (3) ◽

pp. 69-77

Author(s):

L. O. Bezrukov ◽

O. V. Vlasova ◽

L. V. Kolyubakina ◽

H. V. Nikorych

Keyword(s):

Premature Infants ◽

Neonatal Sepsis ◽

Clinical Manifestations ◽

Multiple Organ ◽

Klebsiella Pneumonia ◽

Antibiotic Resistant ◽

Reactive Protein ◽

Infectious Risk ◽

High Level

The conducted research and own observations demonstrated the current possibilities for verification of neonatal sepsis in newborns. In both clinical cases, neonatal sepsis has developed in premature infants born from mothers having infectious risk factors in their anamnesis. The peculiarities of clinical manifestations were a rapid increase in the phenomena of multiple organ failure with the damage of a number of organs and systems, thrombocytopenia and leukocytosis, high level of C-reactive protein, and presepsin rate. In the epidemiological respect the associations of microorganisms prevailed among the pathogens, in particular, antibiotic resistant strains of Klebsiella pneumonia in combination with Ac. Baumannii and St. Epedermidis took the leading place among them. It has been shown that the determination of the presepsin rate in biological media is perspective for the early and reliable verification of neonatal sepsis, especially among premature infants.

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Clinical characteristics of inpatients with Coronavirus disease 2019 and acute ischemic stroke: from epidemiology to outcomes

Current Neurovascular Research ◽

10.2174/1567202617999201110200410 ◽

2020 ◽

Vol 17 ◽

Author(s):

Shiling Chen ◽

Chao Pan ◽

Ping Zhang ◽

Yingxin Tang ◽

Zhouping Tang

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Neurological Complication ◽

Pathophysiological Mechanism ◽

C Reactive Protein ◽

Vessel Occlusion ◽

Reactive Protein ◽

Detailed Search ◽

Underlying Diseases ◽

Worse Prognosis

Abstract:: Acute Ischemic Stroke (AIS) is currently the most frequently reported neurological complication of Coronavirus disease 2019 (COVID-19). This article will elaborate on the clinical features of inpatients with COVID-19 and AIS and the pathophysiological mechanism of AIS under the background of COVID-19. Through a detailed search of relevant studies, we found that the incidence of AIS among COVID-19 patients varied from 0.9% to 4.6%, and AIS has been observed in many people without underlying diseases and cardiovascular risk factors as well as young people. The National Institute of Health Stroke Scale (NIHSS) score of COVID-19 patients with AIS was higher than historical AIS patients, and the proportion of large vessel occlusion (LVO) was about 64.2%. COVID-19 patients with AIS have commonly high levels of D-D dimer, fibrinogen, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), suggesting systemic hyperinflammatory and hypercoagulable state. The pooled mortality of COVID-19 patients with AIS was 38% and the mortality of LVO patients is higher (45.9%). Compared with COVID-19-negative AIS patients in the same period in 2020 and 2019, COVID- 19 patients with AIS had a worse prognosis.

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Hepatoid adenocarcinoma of the lung: An analysis of the Surveillance, Epidemiology, and End Results (SEER) database

Open Medicine ◽

10.1515/med-2021-0215 ◽

2021 ◽

Vol 16 (1) ◽

pp. 169-174

Author(s):

Lei Lei ◽

Liu Yang ◽

Yang-yang Xu ◽

Hua-fei Chen ◽

Ping Zhan ◽

...

Keyword(s):

Prognostic Factors ◽

Clinical Features ◽

Survival Benefit ◽

Stage Iv ◽

Primary Lesion ◽

Hepatoid Adenocarcinoma ◽

Seer Database ◽

Primary Tumor Size ◽

Adenocarcinoma Of The Lung ◽

To Receive

Abstract Hepatoid adenocarcinoma of the lung (HAL) is a rare malignant tumor that is defined as a primary alpha-fetoprotein (AFP)-producing lung carcinoma. We aimed to identify prognostic factors associated with the survival of patients with HAL using data from the Surveillance, Epidemiology, and End Results (SEER) database. We collected data from patients diagnosed with HAL, adenocarcinoma (ADC), and squamous cell carcinoma (SCC) of the lung between 1975 and 2016 from the SEER database. The clinical features of patients with ADC and SCC of the lung were also analyzed. The clinical features of HALs were compared to ADCs and SCCs. A chi-square test was used to calculate the correlations between categorical variables, and a t test or Mann–Whitney U test was used for continuous variables. The Kaplan–Meier method and Cox regression analysis were used to identify the prognostic factors for the overall survival (OS) of HALs. Two-tailed p values < 0.05 were considered statistically significant. Sixty-five patients with HAL, 2,84,379 patients with ADC, and 1,86,494 with SCC were identified from the SEER database. Fewer males, advanced stages, and more chemotherapy-treated HALs were found. Compared to patients with SCC, patients with HAL were less likely to be male, more likely to be in an advanced stage, and more likely to receive chemotherapy (p < 0.05). The American Joint Committee on Cancer staging was the only prognostic factor for OS in patients with HAL, and stage IV was significantly different from other stages (hazard ratio = 0.045, 95% confidence interval: 0.005–0.398, p = 0.005). Males with HAL were more likely to receive radiotherapy compared to females with HAL (61.8 vs 31.5%, p = 0.034). Younger patients with HAL were more likely to receive chemotherapy (59.4 + 10.2 years vs 69 + 11.3 years, p = 0.001). The primary tumor size of HAL was associated with the location of the primary lesion (p = 0.012). No conventional antitumor therapies, including surgery, chemotherapy, and radiotherapy, were shown to have a significant survival benefit in patients with HAL (p > 0.05). This study showed that stage IV was the only prognostic factor for OS in HALs compared to other clinicopathologic factors. Conventional antitumor therapies failed to show survival benefit; thus, a more effective method by which to treat HAL is needed. Interestingly, the clinical features and the location of the primary lesion were shown to be associated with primary tumor size and treatment in patients with HAL, which have not been reported before.

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Pediatric COVID-19 and the Factors That May Mitigate Its Clinical Course

Journal of Child Science ◽

10.1055/s-0040-1717077 ◽

2020 ◽

Vol 10 (01) ◽

pp. e137-e140

Author(s):

Mosaad Abdel-Aziz ◽

Nada M. Abdel-Aziz ◽

Dina M. Abdel-Aziz ◽

Noha Azab

Keyword(s):

Clinical Features ◽

Clinical Symptoms ◽

Clinical Course ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Angiotensin Converting Enzyme 2 ◽

Compulsory Vaccination ◽

Specific Factors ◽

Novel Coronavirus ◽

Radiographic Data

AbstractThe clinical manifestations of novel coronavirus disease 2019 (COVID-19) vary from mild flu-like symptoms to severe fatal pneumonia. However, children with COVID-19 may be asymptomatic or may have mild clinical symptoms. The aim of this study was to investigate clinical features of pediatric COVID-19 and to search for the factors that may mitigate the disease course. We reviewed the literature to realize the clinical features, laboratory, and radiographic data that may be diagnostic for COVID-19 among children. Also, we studied the factors that may affect the clinical course of the disease. Fever, dry cough, and fatigue are the main symptoms of pediatric COVID-19, sometimes flu-like symptoms and/or gastrointestinal symptoms may be present. Although some infected children may be asymptomatic, a recent unusual hyperinflammatory reaction with overlapping features of Kawasaki's disease and toxic shock syndrome in pediatric COVID-19 has been occasionally reported. Severe acute respiratory syndrome-coronvirus-2 (SARS-CoV-2) nucleic acid testing is the corner-stone method for the diagnosis of COVID-19. Lymphocyte count and other inflammatory markers are not essentially diagnostic; however, chest computed tomography is highly specific. Factors that may mitigate the severity of pediatric COVID-19 are home confinement with limited children activity, trained immunity caused by compulsory vaccination, the response of the angiotensin-converting enzyme 2 receptors in children is not the same as in adults, and that children are less likely to have comorbidities. As infected children may be asymptomatic or may have only mild respiratory and/or gastrointestinal symptoms that might be missed, all children for families who have a member diagnosed with COVID-19 should be investigated.

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Clinical features and predictors of severity in COVID-19 patients with critical illness in Singapore

Scientific Reports ◽

10.1038/s41598-021-81377-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ser Hon Puah ◽

◽

Barnaby Edward Young ◽

Po Ying Chia ◽

Vui Kian Ho ◽

...

Keyword(s):

Mechanical Ventilation ◽

Clinical Features ◽

Operating Characteristic ◽

Characteristic Curve ◽

Case Series ◽

Plateau Pressure ◽

Apache Ii Score ◽

Multivariable Logistic Regression Model ◽

Reactive Protein ◽

Ventilatory Management

AbstractWe aim to describe a case series of critically and non-critically ill COVID-19 patients in Singapore. This was a multicentered prospective study with clinical and laboratory details. Details for fifty uncomplicated COVID-19 patients and ten who required mechanical ventilation were collected. We compared clinical features between the groups, assessed predictors of intubation, and described ventilatory management in ICU patients. Ventilated patients were significantly older, reported more dyspnea, had elevated C-reactive protein and lactate dehydrogenase. A multivariable logistic regression model identified respiratory rate (aOR 2.83, 95% CI 1.24–6.47) and neutrophil count (aOR 2.39, 95% CI 1.34–4.26) on admission as independent predictors of intubation with area under receiver operating characteristic curve of 0.928 (95% CI 0.828–0.979). Median APACHE II score was 19 (IQR 17–22) and PaO2/FiO2 ratio before intubation was 104 (IQR 89–129). Median peak FiO2 was 0.75 (IQR 0.6–1.0), positive end-expiratory pressure 12 (IQR 10–14) and plateau pressure 22 (IQR 18–26) in the first 24 h of ventilation. Median duration of ventilation was 6.5 days (IQR 5.5–13). There were no fatalities. Most COVID-19 patients in Singapore who required mechanical ventilation because of ARDS were extubated with no mortality.

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