Epidemiological and clinical characteristics of COVID-19 patients in Hengyang,Hunan Province,China

BACKGROUND In December 2019,an ongoing outbreak of coronavirus disease 2019(COVID-19)was first identified in Wuhan,China.The characteristics of COVID-19 patients treated in local hospitals in Wuhan are not fully representative of patients outside Wuhan.Therefore,it is highly essential to analyze the epidemiological and clinical characteristics of COVID-19 in areas outside Wuhan or Hubei Province.To date,a limited number of studies have concentrated on the epidemiological and clinical characteristics of COVID-19 patients with different genders,clinical classification,and with or without basic diseases.AIM To study the epidemiological and clinical characteristics of COVID-19 patients in Hengyang(China)and provide a reliable reference for the prevention and control of COVID-19.METHODS From January 16 to March 2,2020,a total of 48 confirmed cases of COVID-19 were reported in Hengyang,and those cases were included in this study.The diagnostic criteria,clinical classification,and discharge standard related to COVID-19 were in line with the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia(Trial Version 7)released by National Health Commission and National Administration of Traditional Chinese Medicine.The presence of SARS-CoV-2 in pharyngeal swab specimens was detected by quantitative reverse transcription polymerase chain reaction.All the data were imported into the excel worksheet and statistically analyzed by using SPSS 25.0 software.RESULTS A total of 48 cases of COVID-19 were collected,of which 1 was mild,38 were moderate,and 9 were severe.It was unveiled that there were 31(64.6%)male patients and 17(35.4%)female patients,with a female-to-male ratio of 1.82:1.The range of age of patients with COVID-19 was dominantly 30-49 years old[25(52.1%)of 48],followed by those aged over 60 years old[11(22.9%)].Besides,29.2%(14 of 48)of patients had basic diseases,and 57.2%(8 of 14)of patients with basic diseases were aged over 60 years old.The occupations of 48 COVID-19 patients were mainly farmers working in agricultural production[15(31.5%)of 48],rural migrant workers from Hengyang to Wuhan[15(31.5%)],and service workers operating in the service sector[8(16.7%)].The mean latent period was 6.86±3.57 d,and the median was 7[interquartile range(IQR):4-9]d.The mean time from onset of symptoms to the first physician visit was 3.38±2.98(95%CI:2.58-9.18)d,with a median of 2(IQR:1-5)d,and the mean time from hospital admission to confirmed diagnosis was 2.29±2.11(95%CI:1.18-6.42)d,with a median of 2(IQR:1-3)d.The main symptoms were fever[43(89.6%)of 48],cough and expectoration[41(85.4%)],fatigue[22(45.8%)],and chills[22(45.8%)].Other symptoms included poor appetite[13(27.1%)],sore throat[9(18.8%)],dyspnea[9(18.8%)],diarrhea[7(14.6%)],dizziness[5(10.4%)],headache[5(10.4%)],muscle pain[5(10.4%)],nausea and vomiting[4(8.3%)],hemoptysis[4(8.3%)],and runny nose[1(2.1%)].The numbers of peripheral blood leukocytes,lymphocytes,and eosinophils were significantly reduced in the majority of the patients.The levels of C-reactive protein,fibrinogen,blood glucose,lactate dehydrogenase,Ddimer,alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transferase(γ-GT),myoglobin(MB),and creatine kinase(CK)were increased in 64.6%,44.7%,43.2%,37.0%,29.5%,22.9%,20.8%,21.6%,13.6%,and 12.8%of patients,respectively.The incidence of ALT elevation in male patients was remarkably higher than that in females(P<0.01),while the incidences of AST,CK,and blood glucose elevations in severe patients were remarkably higher than those in moderate patients(P<0.05,respectively).Except for the mild patients,chest computed tomography showed characteristic pulmonary lesions.All the patients received antiviral drugs,38(79.2%)accepted traditional Chinese medicine,and 2(4.2%)received treatment of human umbilical-cord mesenchymal stem cells.On March 2,2020,48 patients with COVID-19 were all cured and discharged.CONCLUSION Based on our results,patients with COVID-19 often have multiple organ dysfunction or damage.The incidences of ALT elevation in males,and AST,CK,and blood glucose elevations in severe patients are remarkably higher.

Prognoses of patients with acute-on-chronic hepatitis B liver failure are closely associated with altered SOCS1 mRNA expression and cytokine production following glucocorticoid treatment

Suppressor of cytokine signaling （SOCS） 1 plays a crucial role in the immune response and might contribute to the prognoses of liver failure treated with glucocorticoid. We recruited 47 acute-on-chronic hepatitis B liver failure （ACHBLF） patients receiving glucocorticoid treatment and 30 healthy controls to determine the potential effects of glucocorticoid on the transcriptional level of SOCS1 in peripheral blood mononuclear cells. On the third and twenty-eighth days of glucocorticoid treatment, SOCS1 expression was negatively correlated with model for end-stage liver disease （MELD） score. Interleukin-6 （IL-6） and tumor-necrosis factor-a （＇I＇NF-a） levels were statistically lower, while the SOCS1 transcription level was higher in survivors than non-survivors both in pre- and post-treatment ACHBLF patients. The methylation rate of the SOCS1 promoter in ACHBLF patients was higher than in healthy control patients as determined by methylation-specific polymerase chain reaction. The mRNA level of SOCS1 in methylated promoters was significantly lower than from patients with unmethylated SOCS1 promoters, interferon （IFN）-y-responsive and STATl-dependent gene expression was higher in survivors and was dramatically decreased with rising expression of SOCS1 after glucocorticoid treatment. Mortality rates were significantly higher in methylated patients than for those without methylation at the end of a 90-day follow-up. Furthermore, we found that five in six surviving patients displayed demethylated SOCS1 on the twenty-eighth day after treatment, while that number was 3 in 10 in the non-survivors. These findings suggested that ACHBLF patients without SOCS1 methylation may have a favorable response to corticosteroid treatment.