Identifying critically ill patients at risk of death from coronavirus disease

BACKGROUND:A pandemic of coronavirus disease(COVID-19)has been declared by the World Health Organization(WHO)and caring for critically ill patients is expected to be at the core of battling this disease.However,little is known regarding an early detection of patients at high risk of fatality.METHODS:This retrospective cohort study recruited consecutive adult patients admitted between February 8 and February 29,2020,to the three intensive care units(ICUs)in a designated hospital for treating COVID-19 in Wuhan.The detailed clinical information and laboratory results for each patient were obtained.The primary outcome was in-hospital mortality.Potential predictors were analyzed for possible association with outcomes,and the predictive performance of indicators was assessed from the receiver operating characteristic(ROC)curve.RESULTS:A total of 121 critically ill patients were included in the study,and 28.9%(35/121)of them died in the hospital.The non-survivors were older and more likely to develop acute organ dysfunction,and had higher Sequential Organ Failure Assessment(SOFA)and quick SOFA(qSOFA)scores.Among the laboratory variables on admission,we identifi ed 12 useful biomarkers for the prediction of in-hospital mortality,as suggested by area under the curve(AUC)above 0.80.The AUCs for three markers neutrophilto-lymphocyte ratio(NLR),thyroid hormones free triiodothyronine(FT3),and ferritin were 0.857,0.863,and 0.827,respectively.The combination of two easily accessed variables NLR and ferritin had comparable AUC with SOFA score for the prediction of in-hospital mortality(0.901 vs.0.955,P=0.085).CONCLUSIONS:Acute organ dysfunction combined with older age is associated with fatal outcomes in COVID-19 patients.Circulating biomarkers could be used as powerful predictors for the in-hospital mortality.

Progressive liver injury and increased mortality risk in COVID-19 patients:A retrospective cohort study in China

BACKGROUND Liver injury is common and also can be fatal,particularly in severe or critical patients with coronavirus disease 2019(COVID-19).AIM To conduct an in-depth investigation into the risk factors for liver injury and into the effective measures to prevent subsequent mortality risk.METHODS A retrospective cohort study was performed on 440 consecutive patients with relatively severe COVID-19 between January 28 and March 9,2020 at Tongji Hospital,Wuhan,China.Data on clinical features,laboratory parameters,medications,and prognosis were collected.RESULTS COVID-19-associated liver injury more frequently occurred in patients aged≥65 years,female patients,or those with other comorbidities,decreased lymphocyte count,or elevated D-dimer or serum ferritin(P<0.05).The disease severity of COVID-19 was an independent risk factor for liver injury(severe patients:Odds ratio[OR]=2.86,95%confidence interval[CI]:1.78-4.59;critical patients:OR=13.44,95%CI:7.21-25.97).The elevated levels of on-admission aspartate aminotransferase and total bilirubin indicated an increased mortality risk(P<0.001).Using intravenous nutrition or antibiotics increased the risk of COVID-19-associated liver injury.Hepatoprotective drugs tended to be of assistance to treat the liver injury and improve the prognosis of patients with COVID-19-associated liver injury.CONCLUSION More intensive monitoring of aspartate aminotransferase or total bilirubin is recommended for COVID-19 patients,especially patients aged≥65 years,female patients,or those with other comorbidities.Drug hepatotoxicity of antibiotics and intravenous nutrition should be alert for COVID-19 patients.

Angiotensin converting enzymes inhibitors or angiotensin receptor blockers should be continued in COVID-19 patients with hypertension

BACKGROUND Recent studies have revealed that sustained ingestion of angiotensin converting enzymes inhibitors or angiotensin receptor blockers(ACEIs/ARBs)had no harmful effects on coronavirus disease 2019(COVID-19)patients complicated with hypertension.AIM To investigate the impact on COVID-19 patients complicated with hypertension who discontinued using ACEIs/ARBs.METHODS All COVID-19 patients complicated with hypertension admitted to our isolated unit were consecutively recruited in this study.Some patients switched from ACEIs/ARBs to calcium channel blocker(CCBs)after admission,while others continued using non-ACEIs/ARBs.We compared characteristics and clinical outcomes between these two groups of patients.RESULTS A total of 53 patients were enrolled,27 patients switched from ACEIs/ARBs to CCBs while 26 patients continued with non-ACEIs/ARBs.After controlling potential confounding factors using the Cox proportional hazards model,hospital stay was longer in patients who discontinued ACEIs/ARBs,with a hazard ratio of 0.424(95%confidence interval:0.187-0.962;P=0.040),upon discharge than patients using other anti-hypertensive drugs.A sub-group analysis showed that the effect of discontinuing use of ACEIs/ARBs was stronger in moderate cases[hazard ratio=0.224(95%confidence interval:0.005-0.998;P=0.0497)].CONCLUSION Patients in the discontinued ACEIs/ARBs group had longer hospital stays.Our findings suggest that COVID-19 patients complicated with hypertension should continue to use ACEIs/ARBs.

Chronic Active Hepatitis B with COVID-19 in Pregnancy: A Case Report

Currently,infection with coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),during pregnancy is a problem worthy of attention,especially in patients with underlying diseases.In this case report,we present a case of chronic active hepatitis B with COVID-19 in pregnancy.A 31-year-old woman at 29 weeks of gestation who had a history of chronic hepatitis B virus infection discontinued antiviral treatment,was admitted to the hospital with chronic active hepatitis B,and tested positive for SARS-CoV-2 infection.In this case,we applied liver protective and antiviral agents,and low-dose dexamethasone therapy to successfully treat the critically ill pregnant woman suffering from chronic active hepatitis B combined with COVID-19.