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Dobrijević D, Andrijević L, Antić J, Rakić G, Pastor K. Hemogram-based decision tree models for discriminating COVID-19 from RSV in infants. J Clin Lab Anal 2023; 37:e24862. [PMID: 36972470 PMCID: PMC10156096 DOI: 10.1002/jcla.24862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 12/29/2022] [Accepted: 03/04/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE Decision trees are efficient and reliable decision-making algorithms, and medicine has reached its peak of interest in these methods during the current pandemic. Herein, we reported several decision tree algorithms for a rapid discrimination between coronavirus disease (COVID-19) and respiratory syncytial virus (RSV) infection in infants. METHODS A cross-sectional study was conducted on 77 infants: 33 infants with novel betacoronavirus (SARS-CoV-2) infection and 44 infants with RSV infection. In total, 23 hemogram-based instances were used to construct the decision tree models via 10-fold cross-validation method. RESULTS The Random forest model showed the highest accuracy (81.8%), while in terms of sensitivity (72.7%), specificity (88.6%), positive predictive value (82.8%), and negative predictive value (81.3%), the optimized forest model was the most superior one. CONCLUSION Random forest and optimized forest models might have significant clinical applications, helping to speed up decision-making when SARS-CoV-2 and RSV are suspected, prior to molecular genome sequencing and/or antigen testing.
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Affiliation(s)
- Dejan Dobrijević
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia
| | | | - Jelena Antić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia
| | - Goran Rakić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia
| | - Kristian Pastor
- Faculty of Technology, Univeristy of Novi Sad, Novi Sad, Serbia
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2
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Parthasarathi A, Padukudru S, Arunachal S, Basavaraj CK, Krishna MT, Ganguly K, Upadhyay S, Anand MP. The Role of Neutrophil-to-Lymphocyte Ratio in Risk Stratification and Prognostication of COVID-19: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 10:vaccines10081233. [PMID: 36016121 PMCID: PMC9415708 DOI: 10.3390/vaccines10081233] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 01/18/2023] Open
Abstract
Several studies have proposed that the neutrophil−lymphocyte ratio (NLR) is one of the various biomarkers that can be useful in assessing COVID-19 disease-related outcomes. Our systematic review analyzes the relationship between on-admission NLR values and COVID-19 severity and mortality. Six different severity criteria were used. A search of the literature in various databases was conducted from 1 January 2020 to 1 May 2021. We calculated the pooled standardized mean difference (SMD) for the collected NLR values. A meta-regression analysis was performed, looking at the length of hospitalization and other probable confounders, such as age, gender, and comorbidities. A total of sixty-four studies were considered, which included a total of 15,683 patients. The meta-analysis showed an SMD of 3.12 (95% CI: 2.64−3.59) in NLR values between severe and non-severe patients. A difference of 3.93 (95% CI: 2.35−5.50) was found between survivors and non-survivors of the disease. Upon summary receiver operating characteristics analysis, NLR showed 80.2% (95% CI: 74.0−85.2%) sensitivity and 75.8% (95% CI: 71.3−79.9%) specificity for the prediction of severity and 78.8% (95% CI: 73.5−83.2%) sensitivity and 73.0% (95% CI: 68.4−77.1%) specificity for mortality, and was not influenced by age, gender, or co-morbid conditions. Conclusion: On admission, NLR predicts both severity and mortality in COVID-19 patients, and an NLR > 6.5 is associated with significantly greater the odds of mortality.
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Affiliation(s)
| | - Sunag Padukudru
- Yenepoya Medical College, Yenepoya University, Mangalore 575018, India;
| | - Sumalata Arunachal
- Department of Respiratory Medicine, JSS Medical College, JSSAHER, Mysore 570015, India; (S.A.); (C.K.B.)
| | - Chetak Kadabasal Basavaraj
- Department of Respiratory Medicine, JSS Medical College, JSSAHER, Mysore 570015, India; (S.A.); (C.K.B.)
| | - Mamidipudi Thirumala Krishna
- University Hospitals Birmingham NHS Foundation Trust, Institute of Immunology Immunotherapy, University of Birmingham, Birmingham B15 2GW, UK;
| | - Koustav Ganguly
- Unit of Integrative Toxicology, Institute of Environmental Medicine (IMM), Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Swapna Upadhyay
- Unit of Integrative Toxicology, Institute of Environmental Medicine (IMM), Karolinska Institutet, 17177 Stockholm, Sweden;
- Correspondence: (S.U.); (M.P.A.)
| | - Mahesh Padukudru Anand
- Department of Respiratory Medicine, JSS Medical College, JSSAHER, Mysore 570015, India; (S.A.); (C.K.B.)
- Correspondence: (S.U.); (M.P.A.)
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3
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Nahari AD, Son MBF, Newburger JW, Reis BY. An integrated framework for identifying clinical-laboratory indicators for novel pandemics: COVID-19 and MIS-C. NPJ Digit Med 2022; 5:9. [PMID: 35058541 PMCID: PMC8776774 DOI: 10.1038/s41746-021-00547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/28/2021] [Indexed: 12/05/2022] Open
Abstract
During the critical early stages of an emerging pandemic, limited availability of pathogen-specific testing can severely inhibit individualized risk screening and pandemic tracking. Standard clinical laboratory tests offer a widely available complementary data source for first-line risk screening and pandemic surveillance. Here, we propose an integrated framework for developing clinical-laboratory indicators for novel pandemics that combines population-level and individual-level analyses. We apply this framework to 7,520,834 clinical laboratory tests recorded over five years and find clinical-lab-test combinations that are strongly associated with SARS-CoV-2 PCR test results and Multisystem Inflammatory Syndrome in Children (MIS-C) diagnoses: Interleukin-related tests (e.g. IL4, IL10) were most strongly associated with SARS-CoV-2 infection and MIS-C, while other more widely available tests (ferritin, D-dimer, fibrinogen, alanine transaminase, and C-reactive protein) also had strong associations. When novel pandemics emerge, this framework can be used to identify specific combinations of clinical laboratory tests for public health tracking and first-line individualized risk screening.
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Affiliation(s)
- Adam D Nahari
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
| | - Mary Beth F Son
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jane W Newburger
- Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Ben Y Reis
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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4
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Sarkar S, Khanna P, Singh AK. The Impact of Neutrophil-Lymphocyte Count Ratio in COVID-19: A Systematic Review and Meta-Analysis. J Intensive Care Med 2021; 37:857-869. [PMID: 34672824 PMCID: PMC9160638 DOI: 10.1177/08850666211045626] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: The neutrophil–lymphocyte count ratio (NLR) has emerged
as a potential prognostic tool for different diseases. In the current
coronavirus disease (COVID-19) pandemic, the NLR may be a useful tool for risk
scarification and the optimal utilization of limited healthcare resources.
However, there is no consensus regarding the optimal value of NLR, and the
association with disease severity and mortality. Thus, this study aims to
systematically analyze the current evidence of the utility of baseline NLR as a
predictive tool for mortality, disease severity in COVID-19 patients.
Methods: A compendious screening of electronic databases up to
June 15, 2021, was done after enlisting the protocol in PROSPERO
(CRD42020202659). Studies evaluating the utility of baseline NLR in COVID-19 are
included for this review as per the PRISMA statement. Results: We
retrieved a total of 13112 and 12986 COVID-19 patients for survivability and
severity over 90 studies. The expired and critically sick patients had elevated
baseline NLR on admission, in comparison to survivors and noncritical patients.
(SMD = 3.82; 95% CI: 2.79-4.85; I2 = 100% and SMD = 1.42; 95% CI:
1.22-1.63; I2 = 95%, respectively). The summary receiver operating
curve analysis for mortality (AUC = 0.87; 95% CI: 0.86-0.87;
I2 = 94.7%), and severity (AUC = 0.82; 95% CI: 0.80-0.84;
I2 = 79.7%) were also suggestive of its significant predictive
value. Conclusions: The elevated NLR on admission in COVID-19
patients is associated with poor outcomes.
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5
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Traversi D, Pulliero A, Izzotti A, Franchitti E, Iacoviello L, Gianfagna F, Gialluisi A, Izzi B, Agodi A, Barchitta M, Calabrò GE, Hoxhaj I, Sassano M, Sbrogiò LG, Del Sole A, Marchiori F, Pitini E, Migliara G, Marzuillo C, De Vito C, Tamburro M, Sammarco ML, Ripabelli G, Villari P, Boccia S. Precision Medicine and Public Health: New Challenges for Effective and Sustainable Health. J Pers Med 2021; 11:135. [PMID: 33669364 PMCID: PMC7920275 DOI: 10.3390/jpm11020135] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 02/06/2023] Open
Abstract
The development of high-throughput omics technologies represents an unmissable opportunity for evidence-based prevention of adverse effects on human health. However, the applicability and access to multi-omics tests are limited. In Italy, this is due to the rapid increase of knowledge and the high levels of skill and economic investment initially necessary. The fields of human genetics and public health have highlighted the relevance of an implementation strategy at a national level in Italy, including integration in sanitary regulations and governance instruments. In this review, the emerging field of public health genomics is discussed, including the polygenic scores approach, epigenetic modulation, nutrigenomics, and microbiomes implications. Moreover, the Italian state of implementation is presented. The omics sciences have important implications for the prevention of both communicable and noncommunicable diseases, especially because they can be used to assess the health status during the whole course of life. An effective population health gain is possible if omics tools are implemented for each person after a preliminary assessment of effectiveness in the medium to long term.
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Affiliation(s)
- Deborah Traversi
- Department of Public Health and Pediatrics, University of Torino, Piazza Polonia 94, 10126 Torino, Italy;
| | - Alessandra Pulliero
- Department of Health Sciences School of Medicine, University of Genoa, 16132 Genova, Italy;
| | - Alberto Izzotti
- Department of Experimental Medicine, University of Genoa, 16132 Genova, Italy;
- IRCCS Ospedale Policlinico San Martino, 161632 Genova, Italy
| | - Elena Franchitti
- Department of Public Health and Pediatrics, University of Torino, Piazza Polonia 94, 10126 Torino, Italy;
| | - Licia Iacoviello
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (L.I.); (F.G.)
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077 Pozzilli, Italy; (A.G.); (B.I.)
| | - Francesco Gianfagna
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (L.I.); (F.G.)
- Mediterranea Cardiocentro, 80122 Napoli, Italy
| | - Alessandro Gialluisi
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077 Pozzilli, Italy; (A.G.); (B.I.)
| | - Benedetta Izzi
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077 Pozzilli, Italy; (A.G.); (B.I.)
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy; (A.A.); (M.B.)
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy; (A.A.); (M.B.)
| | - Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.E.C.); (I.H.); (M.S.); (S.B.)
| | - Ilda Hoxhaj
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.E.C.); (I.H.); (M.S.); (S.B.)
| | - Michele Sassano
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.E.C.); (I.H.); (M.S.); (S.B.)
| | - Luca Gino Sbrogiò
- Dipartimento di Prevenzione, Az. ULSS3 Serenissima, 30174 Venezia, Italy;
| | | | | | - Erica Pitini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (E.P.); (G.M.); (C.M.); (C.D.V.); (P.V.)
| | - Giuseppe Migliara
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (E.P.); (G.M.); (C.M.); (C.D.V.); (P.V.)
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (E.P.); (G.M.); (C.M.); (C.D.V.); (P.V.)
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (E.P.); (G.M.); (C.M.); (C.D.V.); (P.V.)
| | - Manuela Tamburro
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy; (M.T.); (M.L.S.); (G.R.)
| | - Michela Lucia Sammarco
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy; (M.T.); (M.L.S.); (G.R.)
| | - Giancarlo Ripabelli
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy; (M.T.); (M.L.S.); (G.R.)
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (E.P.); (G.M.); (C.M.); (C.D.V.); (P.V.)
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.E.C.); (I.H.); (M.S.); (S.B.)
- Department of Woman and Child Health and Public Health-Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
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6
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Lv Z, Lv S. Clinical characteristics and analysis of risk factors for disease progression of COVID-19: A retrospective Cohort Study. Int J Biol Sci 2021; 17:1-7. [PMID: 33390828 PMCID: PMC7757033 DOI: 10.7150/ijbs.50654] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/04/2020] [Indexed: 01/08/2023] Open
Abstract
Objective: Since December 2019, an outbreak of coronavirus disease 2019 (COVID 19) has been experienced from Wuhan, China to the world. A retrospective cohort study was conducted to summarize the clinical characteristics of patients with COVID-19 and to explore the risk factors affecting the disease duration in Jiangan Fangcang shelter hospital, Wuhan, China. Methods: Clinical characteristics of 409 patients with COVID-19 were retrospectively analyzed. We describe the clinical characteristics and distribution of discharge time or transfer time for each patient. Then we performed univariate and multivariate Cox regression analysis to identify potential risk factors for progression from non-severe to severe COVID-19 or death. Results: The median disease duration of all patients was 23 days (IQR 19-28). The main symptoms of the patient were fever (95.6%), cough (74.3%), tiredness (21.5%), and so on. Comorbidities mainly included hypertension (30.6%) diabetes (17.6%) and heart disease (12.5%). The univariate Cox regression analysis showed that old age, number of symptoms, the combination of hypertension, heart disease and pulmonary disease were associated with the progression of disease. The multivariate Cox regression analysis showed that old age (HR: 7.294; 95% CI: 1.442-36.888; P = 0.016), the combination of hypertension (HR: 2.230; 95% CI: 1.090-4.562; P = 0.028) and heart disease (HR: 2.650; 95% CI: 1.079-6.510; P = 0.034) were independent risk factors for progression of COVID-19. Conclusions: The age of the patient, the combination of hypertension and heart disease were independent risk factors for the progression of COVID-19. Cautions should be raised for patients with these risk factors.
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Affiliation(s)
- Zhengtong Lv
- Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China.,Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, P.R. China
| | - Shubin Lv
- Department of Respiratory Medicine, Tianjin Binhai New Area Dagang Hospital, Tianjin, P.R. China
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7
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Pang R, Zhao J, Gan Z, Hu Z, Xue X, Wu Y, Qiao Q, Zhong A, Xia X, Liao H, Wang Z, Zhang L. Evolution of COVID-19 in patients with autoimmune rheumatic diseases. Aging (Albany NY) 2020; 12:23427-23435. [PMID: 33289698 PMCID: PMC7762508 DOI: 10.18632/aging.202193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/20/2020] [Indexed: 01/08/2023]
Abstract
The characteristics of COVID-19 patients with autoimmune rheumatic diseases (AIRD) have rarely been reported. Patients with AIRD have suppressed immune defense function, which may increase their susceptibility to COVID-19. However, the immunosuppressive agents AIRD patients routinely used may be beneficial for protecting the cytokine storm caused by SARS-CoV-2. In this retrospective study, we included all confirmed cases in Huoshenshan Hospital from February 4 to April 9. Data were extracted from electronic medical records and were analyzed for clinical and laboratory features using SPSS (version 25.0). Of 3059 patients, 21 had the comorbidities with systematic lupus erythematosus (SLE) and/or rheumatoid arthritis (RA), including 5 with SLE, 15 with RA, and 1 with Rhupus. The proportion was 57.1% for severe cases, 61.9% for either severe or critical cases, and 4.8% for critical cases. The main manifestations, ARDS and ICU admission rate, as well as the mortality and length of hospital stay of COVID-19 in AIRD patients were similar to COVID-19 patients in the general population. Our preliminary experience shows that patients with AIRD tend to have a higher risk of SARS-CoV-2 infection, and may be at risk for a severe but less likely critical disease course. Further investigation is needed to understand the immunological features of these diseases.
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Affiliation(s)
- Rongrong Pang
- COVID-19 Research Center, Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, The First School of Clinical Medicine, Southern Medical University, Nanjing 210002, Jiangsu, China
- Department of Laboratory Medicine, Nanjing Red Cross Blood Center, Nanjing 210003, Jiangsu, China
| | - Jun Zhao
- COVID-19 Research Center, Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, The First School of Clinical Medicine, Southern Medical University, Nanjing 210002, Jiangsu, China
- Graduate School, Nanjing Medical University, Nanjing 211166, Jiangsu, China
| | - Zhenhua Gan
- Department of Medical Administration, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
- Joint Expert Group, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
| | - Zhiliang Hu
- Nanjing Infectious Disease Center, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, Jiangsu, China
- School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, China
| | - Xiang Xue
- Department of Biochemistry and Molecular Biology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Yanjun Wu
- Department of Information, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
- Department of Information, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
| | - Qinghua Qiao
- Medical and Technical Support Department, Pingdingshan Medical District, The 989th Hospital, Pingdingshan 467000, Henan, China
- Department of Laboratory Medicine and Blood Transfusion, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
| | - Aifang Zhong
- Department of Laboratory Medicine and Blood Transfusion, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
- Medical Technical Support Division, Changzhou Medical District, The 904th Hospital, Changzhou 213003, Jiangsu, China
| | - Xinyi Xia
- COVID-19 Research Center, Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, The First School of Clinical Medicine, Southern Medical University, Nanjing 210002, Jiangsu, China
- Joint Expert Group, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
- Department of Laboratory Medicine and Blood Transfusion, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
| | - Hui Liao
- Department of Hematology, The Air Force Hospital from Eastern Theater of PLA, Nanjing 210002, Jiangsu, China
| | - Zhihua Wang
- Joint Expert Group, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
- Department of Laboratory Medicine and Blood Transfusion, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
- Department of Laboratory Medicine and Blood Transfusion, The 907th Hospital, Nanping 350702, Fujian, China
| | - Libo Zhang
- COVID-19 Research Center, Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, The First School of Clinical Medicine, Southern Medical University, Nanjing 210002, Jiangsu, China
- Department of Laboratory Medicine, Nanjing Red Cross Blood Center, Nanjing 210003, Jiangsu, China
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8
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Guo T, Shen Q, Zhou Z, Li J, Guo W, He W, Wang Y, Xiang Z, Huang P, Zeng N, Qin Q, Chen P, Luo H, Peng H. Combined Interventions for Severe Novel Coronavirus Disease (COVID-19): Experience from 350 Patients. Infect Drug Resist 2020; 13:3907-3918. [PMID: 33154656 PMCID: PMC7608599 DOI: 10.2147/idr.s279255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/07/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose To summarize the clinical features and effective therapy of severe COVID-19 patients. Patients and Methods In this retrospective, multicenter study, the medical records of COVID-19 patients in Hunan, from January 21, 2020 to February 19, 2020 were reviewed. Results Of the 350 COVID-19 patients, 13.7% were severe cases. On admission, compared with non-severe patients, more severe patients had a neutrophil/lymphocyte ratio > 3 (58.3% vs 33.8%, P=0.001), D-dimer > 1 mg/L (41.7% vs 13.6%, P<0.0001), higher level of CRP (39.1 mg/L, IQR18.1–75.9 vs 13.4 mg/L, IQR5.0–32.8, P<0.0001), and multiple pneumonia on CT (77.1% vs 18.2%, P<0.0001). All severe patients received oxygen support. 95.8% of them received antivirals, and the most frequent therapy was lopinavir and ritonavir plus human interferon-α2b. Moxifloxacin was used in 70.8% severe patients. The total dosage of methylprednisolone sodium succinate was 640 mg (IQR 360–960) in severe patients, and the duration of use was 8.5 days (IQR 6.8–11.3). The total dosage of immunoglobulin was 80 g (IQR, 60–140) in severe patients, and the duration was 8.0 days (IQR, 6.0–11.5). As of March 15, 2020, 95.8% of the severe patients had been discharged and only two deaths occurred. Conclusion The rate of severe cases and mortality of COVID-19 in Hunan are lower than those in Wuhan. In addition to antivirals and oxygen support, timely interventions including corticosteroids, immunoglobulin, and antibiotics, contribute to improving the prognosis of severe COVID-19 patients.
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Affiliation(s)
- Ting Guo
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Qinxue Shen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Zhiguo Zhou
- Department of Respiratory and Critical Care Medicine, The First Hospital of Changsha, Changsha, Hunan, People's Republic of China
| | - Jinhua Li
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Wei Guo
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Wenlong He
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Yunnian Wang
- Department of Respiratory and Critical Care Medicine, The Traditional Chinese Medicine Hospital of Liling, Zhuzhou, Hunan, People's Republic of China
| | - Zhi Xiang
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Huaihua, Huaihua, Hunan, People's Republic of China
| | - Peng Huang
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Zhuzhou, Zhuzhou, Hunan, People's Republic of China
| | - Nanyang Zeng
- Department of Infectious Disease, The Lvkou People's Hospital of Zhuzhou, Zhuzhou, Hunan, People's Republic of China
| | - Qingwu Qin
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Ping Chen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Hong Luo
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Hong Peng
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
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