Analysis of Clinical Characteristics of Patients with Critical COVID-19

Abstract Background: According to the data from the joint investigative team of the WHO and China, the fatality rate in Wuhan is 5.8%and 0.7% in the rest of China. Most of the patients who have died have had chronic diseases or advanced age, and patients with critical COVID-19 have the highest death rate. Patients with critical COVID-19 are the main focus of research on treatment. However, there are few reports on critical COVID-19 patients in China and worldwide. It will help other researchers and clinicians around the world for similar cases.Purpose: Coronavirus disease 2019 (COVID-19) is highly infectious and has a high fatality rate.This paper summarizes and analyses the clinical characteristics of patients with critical COVID-19 to improve clinicians' understanding of this disease. Methods: We selected 16 patients with critical COVID-19 who were treated in the ICU of a grade A hospital in Wuhan from February to March 2020. Then, we collected the clinical data and analysed their general conditions, clinical symptoms, blood tests, CT scans and treatments. Results: Patients with critical COVID-19 had comorbidities (87.5%), and the main symptoms were low or moderate fever (75%), cough and expectoration (68.75%), and multiple lesions in both lungs (100%). 2. Patients with critical COVID-19 were divided into the non-surviving and surviving groups, and the interleukin-6 (IL-6) level and CD4/CD8 ratio were significantly different (P<0.05). 3. On chest CT, multiple patchy lesions were observed in both lungs, mainly as patchy infected lesions, partial consolidation, ground-glass opacities, and interstitial changes. 4. There were 10 patients (62.5%) who survived and 6 (37.5%) who died. Conclusion: Critical COVID-19 is mainly characterized by low or moderate fever, cough and sputum and often occurs in people with chronic disease.Chest CT showed multiple patchy ground-glass opacities and consolidation. For critically ill patients, it is important to monitor interleukin-6 (IL-6) and CD4/CD8 ratio. Early treatment involves thymalfasin, immunoglobulin and other immune-enhancing treatments, and a large dose of ulinastatin can reduce plasma levels of inflammatory factors.

Download Full-text

The diagnostic value of chest X-ray in coronavirus disease 2019: A comparative study of X-ray and CT

Science Progress ◽

10.1177/00368504211016204 ◽

2021 ◽

Vol 104 (3) ◽

pp. 003685042110162

Author(s):

Fengxia Zeng ◽

Yong Cai ◽

Yi Guo ◽

Weiguo Chen ◽

Min Lin ◽

...

Keyword(s):

Clinical Symptoms ◽

Diagnostic Value ◽

Rapid Identification ◽

Chest Ct ◽

Ct Scans ◽

Ground Glass ◽

X Ray ◽

Chest X Ray ◽

Laboratory Examinations ◽

Sensitivity Specificity

As the coronavirus disease 2019 (COVID-19) epidemic spreads around the world, the demand for imaging examinations increases accordingly. The value of conventional chest radiography (CCR) remains unclear. In this study, we aimed to investigate the diagnostic value of CCR in the detection of COVID-19 through a comparative analysis of CCR and CT. This study included 49 patients with 52 CT images and chest radiographs of pathogen-confirmed COVID-19 cases and COVID-19-suspected cases that were found to be negative (non-COVID-19). The performance of CCR in detecting COVID-19 was compared to CT imaging. The major signatures that allowed for differentiation between COVID-19 and non-COVID-19 cases were also evaluated. Approximately 75% (39/52) of images had positive findings on the chest x-ray examinations, while 80.7% (42/52) had positive chest CT scans. The COVID-19 group accounted for 88.4% (23/26) of positive chest X-ray examinations and 96.1% (25/26) of positive chest CT scans. The sensitivity, specificity, and accuracy of CCR for abnormal shadows were 88%, 80%, and 87%, respectively, for all patients. For the COVID-19 group, the accuracy of CCR was 92%. The primary signature on CCR was flocculent shadows in both groups. The shadows were primarily in the bi-pulmonary, which was significantly different from non-COVID-19 patients ( p = 0.008). The major CT finding of COVID-19 patients was ground-glass opacities in both lungs, while in non-COVID-19 patients, consolidations combined with ground-glass opacities were more common in one lung than both lungs ( p = 0.0001). CCR showed excellent performance in detecting abnormal shadows in patients with confirmed COVID-19. However, it has limited value in differentiating COVID-19 patients from non-COVID-19 patients. Through the typical epidemiological history, laboratory examinations, and clinical symptoms, combined with the distributive characteristics of shadows, CCR may be useful to identify patients with possible COVID-19. This will allow for the rapid identification and quarantine of patients.

Download Full-text

Chest CT changes in COVID-19 patients with hypertension comorbidities

10.21203/rs.3.rs-30394/v1 ◽

2020 ◽

Author(s):

Wei Li ◽

Wenjun Yu ◽

Jianwei Liao ◽

Yijie Fang ◽

Lin Yao ◽

...

Keyword(s):

Global Health ◽

Clinical Features ◽

Clinical Data ◽

Clinical Characteristics ◽

Ground Glass Opacity ◽

Chest Ct ◽

Ground Glass ◽

Rt Pcr ◽

Relationship Of ◽

Pcr Test

Abstract AIMTo summarize the chest CT and clinical features of COVID-19 pneumonia patients with hypertension comorbidities.METHODSThe initial chest CT imaging and clinical data of 15 confirmed COVID-19 patients with hypertension comorbidities treated in our hospital were analyzed retrospectively from January 1, 2019 to February 14, 2020. The chest CT images and clinical data were reviewed and their relationship of the disease was analyzed.RESULTSTotally 15 COVID-19 patients diagnosed with hypertension comorbidities were included. In terms of clinical characteristics, 14/15 (93.3%) of patients had characteristics of clustering onset, and the positive rates of the first RT-PCR test and the initial CT were 80% and 93% respectively. The most frequent CT abnormality observed was ground glass opacity (GGO) (13/15, 86.7%), including patchy/ punctate GGO and large/multiple GGO. Most of the lesions were multiple, and 60% of them involved 4-5 lobes. Most patients present with bilateral CT onset (12,80.0%), and most present with subpleural distribution (10,66.7%). The average CT score is 13.7, and 40% of the patients exceeded 20 points.CONCLUSIONThe common chest CT findings in COVID-19 patients with hypertension comorbidities are GGO, most of which at present with bilateral CT onset and subpleural distribution. CT is indispensable in the diagnosis and evaluation of this global health emergency.

Download Full-text

COVID-19 Epidemic: Clinical Characteristics of Patients in Pediatric Isolation Ward

Clinical Pediatrics ◽

10.1177/0009922820941228 ◽

2020 ◽

Vol 59 (12) ◽

pp. 1069-1073 ◽

Cited By ~ 1

Author(s):

Jian Zhu ◽

Yabin Wu

Keyword(s):

Clinical Characteristics ◽

Clinical Symptoms ◽

Chest Ct ◽

General Ward ◽

Sinus Arrhythmia ◽

Creatine Kinase Isoenzyme ◽

Abnormal Chest ◽

History Of ◽

Comprehensive Judgment ◽

Isolation Ward

In order to accurately admit children with COVID-19 to an isolation ward, our study retrospectively analyzed the clinical characteristics of children in isolation wards during the COVID-19 epidemic. It was found that 55 cases (83.3%) had fever and 48 cases (72.7%) coughed in the isolated area, 31 cases (47%) had a history of exposure, 26 cases (39.4%) had a decrease in lymphocytes (LYM), more than half had an increase in lactate dehydrogenase and creatine kinase isoenzyme, 14 cases (21.2%) had positive SARS-CoV-2 nucleic acid, 58 cases (87.9%) had abnormal chest computed tomography (CT), and 11 cases (16.7%) had sinus arrhythmia. Therefore, for some suspected children with COVID-19, we can make a comprehensive judgment through clinical symptoms, epidemiological history, LYM number, myocardial enzyme spectrum, chest CT, and electrocardiogram; put these children in an isolation ward for treatment; and then transfer them to a general ward for treatment after excluding COVID-19.

Download Full-text

The Spectrum of Chest CT-Scans in the Hospitalized Patients with the Coronavirus Disease

Journal of Kermanshah University of Medical Sciences ◽

10.5812/jkums.111407 ◽

2020 ◽

Vol In Press (In Press) ◽

Author(s):

Maria Shirvani ◽

Alireza Janbakhsh ◽

Feizollah Mansouri ◽

Babak Sayad ◽

Siavash Vaziri ◽

...

Keyword(s):

Ct Scan ◽

Clinical Symptoms ◽

Large Family ◽

Chest Ct ◽

Hospitalized Patients ◽

Ct Scans ◽

Ground Glass ◽

Sample Population ◽

Ground Glass Opacification ◽

Chest Ct Scan

Background: Coronaviruses are a large family of RNA viruses, which range from the common cold virus to the causative agent of more severe diseases. Coronavirus was declared a pandemic in December 2019 in Wuhan, China. Iran has been an endemic zone for the spread of the coronavirus since the outset of this global epidemic and has remained among the countries largely affected by high rates of the disease. Objectives: The present study aimed to investigate the range of the chest computed tomography (CT) scan findings among the hospitalized patients with COVID-19 in Kermanshah, Iran during March-April 2020 to contribute to the accurate diagnosis of the infected patients. Methods: The sample population consisted of 286 hospitalized patients diagnosed with or suspected of the coronavirus disease. Chest CT-scan images and clinical data were reviewed, and their correlation was analyzed. Results: In total, 176 patients (61.53%) were male, and 110 (38.47%) were female. The mean age of the patients was 56 years. Polymerase chain reaction (PCR) results showed that 35.31% of the cases had coronavirus, while the results were negative in 64.69% of the cases. In addition, the CT-scan findings indicated 77.27% abnormal and 22.73% normal chest CT-scans. Among the patients, 75.87% recovered completely, and 18.53% died. The major CT abnormalities were diffuse ground-glass opacification (35.66%), peripheral ground-glass opacification (bilateral; 21.33%), and a combination of diffuse and peripheral ground-glass lesions (18.88%). The consolidation lesion of one lobe was detected in 16 patients, and the consolidation lesion of more than one lobe was observed in 40 patients. Conclusions: According to the results, the most common chest CT-scan findings in COVID-19 include diffuse ground-glass opacification, peripheral ground-glass opacification (bilateral), central ground-glass opacification (bilateral), a combination of diffuse and peripheral ground-glass opacification, a combination of central and peripheral ground-glass opacification, the consolidation lesion of one lobe, and the consolidation lesion of more than one lobe. Furthermore, significant correlations were observed between the CT-scans and the main clinical symptoms, while no significant correlations were denoted between the chest CT-scan and PCR results.

Download Full-text

A retrospective study of the clinical characteristics of COVID-19 infection in 26 children

10.1101/2020.03.08.20029710 ◽

2020 ◽

Cited By ~ 10

Author(s):

Anjue Tang ◽

Wenhui Xu ◽

Min Shen ◽

Peifen Chen ◽

Guobao Li ◽

...

Keyword(s):

Clinical Characteristics ◽

Pediatric Patients ◽

Clinical Symptoms ◽

Good Prognosis ◽

Chest Ct ◽

Alanine Transaminase ◽

Laboratory Results ◽

Pulmonary Infiltration ◽

Novel Coronavirus ◽

Chest Ct Scan

ABSTRACTBackgroundThe outbreak of novel coronavirus pneumonia in China began in December 2019. Studies on novel coronavirus disease (COVID-19) were less based on pediatric patients. This study aimed to reveal the clinical characteristics of COVID-19 in children.MethodThis study retrospectively analyzed the clinical symptoms, laboratory results, chest CT, and treatment of children with laboratory-confirmed COVID-19(ie, with samples that were positive for 2019 novel coronavirus[2019-nCoV]) who were admitted to Shenzhen Center of National Infectious Disease Clinical Medical Research from January 16 to February 8, 2020.ResultNine patients had no obvious clinical symptom. 11 patients developed fever. Other symptoms, including cough(in eleven of seventeen patients), rhinorrhea(in two), diarrhea(in two), vomiting(in two), were also observed. A small minority of patients had lymphocytopenia. Alanine transaminase or transaminase increased in three cases. According to chest CT scan, 11 patients showed unilateral pneumonia, 8 patients had no pulmonary infiltration. No serious complications such as acute respiratory syndrome and acute lung injury occurred in all patients.ConclusionThe clinical characteristics of 2019-nCoV infection in children were different from adult. The overall condition of children were mild and have a good prognosis.MainpointCOVID-19 is a kind of new infectious disease.The clinical characteristics of 2019-nCoV infection in children may different from adult. Myocardium likely less affected by 2019-nCoV in children.

Download Full-text

Clinical Characteristics Analysis of the “Re-positive” Discharged COVID-19 Pneumonia Patients in Wuhan, China

10.21203/rs.3.rs-28667/v1 ◽

2020 ◽

Author(s):

Shengyang He ◽

Wenwu Sun ◽

Kefu Zhou ◽

Mengyun Hu ◽

Chun Liu ◽

...

Keyword(s):

Ct Scan ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Chest Ct ◽

Apache Ii ◽

Laboratory Results ◽

Characteristics Analysis ◽

Positive Rate ◽

Chest Ct Scan ◽

Demographic Features

Abstract Background: To analyze the clinical characteristics of the re-positive discharged COVID-19 patients and find markers to distinguish them.Methods：The demographic features, clinical symptoms, laboratory results, comorbidities, co-infections, treatments, illness severities and chest CT scan results of 267 patients were collected during 1st January and 15th February 2020. COVID-19 was diagnosed by RT-PCR. The subsequent clinical symptoms and nucleic acid test results was obtained during the 14 days post-hospitalization quarantine.Results: 30 out of 267 COVID-19 patients were detected re-positive during the post-hospitalization quarantine. Re-positive patients couldn’t be distinguished by demographic features, clinical symptoms, laboratory results, comorbidities, co-infections, treatments, chest CT scan results or subsequent clinical symptoms. However, the re-positive rate were found illness severity correlated, along with APACHE II and CURB-65.Conclusion: Common clinical characteristics arn’t able to distinguish re-positive patients. However, severe and critical cases with high APACHE II and CURB-65 scores are more likely to turn re-positive after discharge.Authors Shengyang He, Wenwu Sun, Kefu Zhou contributed equally to this work.

Download Full-text

Marine Envenomation

SN Comprehensive Clinical Medicine ◽

10.1007/s42399-020-00490-y ◽

2020 ◽

Vol 2 (11) ◽

pp. 2288-2292

Author(s):

Toru Hifumi ◽

Yoshimune Fukuchi ◽

Norio Otani

Keyword(s):

Global Warming ◽

Clinical Practice ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Marine Organisms ◽

Human Interaction ◽

Definitive Treatment ◽

Comprehensive Review ◽

Box Jellyfish ◽

The World

AbstractWith global warming and an increasing frequency of human interaction with venomous marine organisms, physicians are likely to encounter more cases of marine envenomation in clinical practice in Japan and around the world. Few review articles regarding the clinical characteristics of marine envenomation have been published and there has been no comprehensive review of available antivenoms, which are the definitive treatment. We discuss the epidemiology, venom activity, clinical symptoms, diagnosis, and treatment of marine envenomation by the Okinawan box jellyfish, stonefish, Portuguese man-of-war, geography cone, and blue-ringed octopus. A comprehensive review of available antivenom treatments is also presented.

Download Full-text

REPORT CASE STUDY AND REVEIW LITERATURE: A BENIGN MYOEPITHELIOMA OF THE LUNG

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.1.19 ◽

2017 ◽

pp. 115-118

Author(s):

Thanh Tuan Phan ◽

The Quan Ngo

Keyword(s):

S100 Protein ◽

Chest Ct ◽

Lung Nodules ◽

Ct Scanner ◽

Normal Range ◽

Blood Tests ◽

Pulmonary Tumor ◽

Spindle Cells ◽

The World

Introduction: Benign myoepithelioma is extremely rare tumor in the lung, there are little cases having been reported in the literature in all over the world, and no report in Vietnam. Case report: A 33-years woman have fever and dry cough from 6 months before entering the hospital, she were treated at home, her fever was gone but the coughing isnot stop, and increasing dyspnea and chest pain. The blood tests is almost in the normal range. Chest CT-scanner showed the tumor in the central bronchial tubes, endoscopy was defined the tumor made the obstruction for the caliber of the left bronchial and designated to remove it by bronchialendoscopy. Histologically, there was mixed of spindle cells, plasmocytoid cells, epithelial cell and clear cells. No mitotic activity or necrosis was seen. Immuhistochemically, the tumor cells positive for EMA, VIII factor, vimentine, and S100 protein. They were negatives for cytokeratine, desmin, CD31, CD34 and GFAP. The diagnosis was benign myoepithelioma of the lung. The patient recovered well after surgery. Conclusion: Benign myoepithelioma is a rare pulmonary tumor, used to differentiate when diagnosing for single lung nodules. This tumor usually distinct from pleomorphic adenoma. Key words: Benign myoepithelioma, lung, lung nodules

Download Full-text

Clinical characteristics of “re-positive” discharged COVID-19 pneumonia patients in Wuhan, China

Scientific Reports ◽

10.1038/s41598-020-74284-6 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Shengyang He ◽

Kefu Zhou ◽

Mengyun Hu ◽

Chun Liu ◽

Lihua Xie ◽

...

Keyword(s):

Ct Scan ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Chest Ct ◽

Disease Classification ◽

Apache Ii ◽

Laboratory Results ◽

Positive Rate ◽

Chest Ct Scan ◽

Demographic Features

Abstract To analyze the clinical characteristics of re-positive discharged COVID-19 patients and find distinguishing markers. The demographic features, clinical symptoms, laboratory results, comorbidities, co-infections, treatments, illness severities and chest CT scan results of 267 patients were collected from 1st January to 15th February 2020. COVID-19 was diagnosed by RT-PCR. Clinical symptoms and nucleic acid test results were collected during the 14 days post-hospitalization quarantine. 30 out of 267 COVID-19 patients were detected re-positive during the post-hospitalization quarantine. Re-positive patients could not be distinguished by demographic features, clinical symptoms, laboratory results, comorbidities, co-infections, treatments, chest CT scan results or subsequent clinical symptoms. However, re-positive rate was found to be correlated to illness severity, according the Acute Physiology and Chronic Health Evaluation II (APACHE II) severity-of-disease classification system, and the confusion, urea, respiratory rate and blood pressure (CURB-65) score. Common clinical characteristics were not able to distinguish re-positive patients. However, severe and critical cases classified high according APACHE II and CURB-65 scores, were more likely to become re-positive after discharge.

Download Full-text

Differences in Clinical Features and Laboratory Results between Adults and Children with SARS-CoV-2 Infection

BioMed Research International ◽

10.1155/2020/6342598 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Xiaoli Li ◽

Yan Rong ◽

Peiyan Zhang ◽

Junli Wang ◽

Liping Qie ◽

...

Keyword(s):

Aspartate Aminotransferase ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Clinical Information ◽

Chest Ct ◽

Asymptomatic Children ◽

Increased Risk ◽

History Of ◽

Adults And Children ◽

Exposure History

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children accounts for a small proportion of all infections and is usually mild or asymptomatic. There are few studies on the clinical characteristics of SARS-CoV-2 infection in children, and the causes of the low prevalence in children remain unclear. Herein, we compared the epidemiological and clinical characteristics of SARS-CoV-2 infection between adults and children. Fifty-two patients with Coronavirus Disease 2019 (COVID-19) were retrospectively analyzed, including 38 adults and 14 children. Their clinical information such as epidemiological exposure history, laboratory indicators, chest computed tomography (CT) performance, and number of SARS-CoV-2 positive days were analyzed and compared. In children, 5 (35.71%) had mild COVID-19 and 9 (64.29%) had common type, while, in adults, 9 (23.68%) cases were mild, and 29 (76.32%) were common COVID-19. Among them, family clustering infection accounted for 50% (7/14) of child cases and 23.68% (9/36) of adult cases. Epidemiological exposure history, clinical classification, clinical symptoms, chest CT manifestations, and number of SARS-CoV-2-positive days were not significantly different between children and adults. However, the percentage of neutrophils in adults was significantly higher than that in children ( P < 0.05 ). The percentage and absolute value of lymphocytes, platelet counts, aspartate aminotransferase, and aspartate aminotransferase/alanine aminotransferase in adults were lower than those in children ( P < 0.05 ). Conclusively, children infected with SARS-CoV-2 show the characteristics of family clustering, and the proportion of mild and asymptomatic infections is higher. For families with a history of epidemiological exposure, routine SARS-CoV-2 nucleic acid testing and chest CT examination should be performed in asymptomatic children to determine whether they are infected. Unlike adults, although the reduction of lymphocytes and platelets in children is not common, it is necessary to be alert to the increased risk of liver damage in children.

Download Full-text