Predictors of severe and critical COVID-19:A systematic review

BACKGROUND Coronavirus disease 2019(COVID-19)has emerged as a public health crisis that was declared as a global pandemic by the World Health Organization.Although most cases have no or mild symptoms,around 10%of patients develop severe or critical illness that necessitates hospitalization and intensive care unit admission.AIM To assess the literature for the predictive factors that can identify patients having severe/critical COVID-19 disease.METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analysescompliant systematic search of the literature was conducted.Electronic databases including PubMed/MEDLINE,Scopus,and Cochrane Library were queried.The main outcome measures were the predictors of severe/critical COVID-19 and mortality.RESULTS Five studies including 583 patients of a median age of 50.5 years were reviewed.Patients were 346(59.4%)male and 237(40.6%)female.Of 583 hospitalized patients,242(41.5%)had critical illness.Acute respiratory distress disease occurred in 291 patients,accounting for 46.7%of total complications.Onehundred(17.1%)mortalities were recorded.The most commonly reported predictors of severe COVID-19 were older age,medical comorbidities,lymphopenia,elevated C-reactive protein,increased D-dimer,and increased neutrophil ratio.Findings on computed tomography(CT)scanning predictive of severe disease were bronchial wall thickening,CT score>7,linear opacities,consolidation,right upper lobe affection,and crazy paving pattern.CONCLUSION Several demographic,clinical,laboratory,and radiologic factors can help predict severe and critical COVID-19 along with the potential need for mechanical ventilation.Factors that were more commonly reported were older age,medical comorbidities,lymphopenia,increased neutrophil ratio,elevated C-reactive protein,and increased D-dimer.

Multidisciplinary,three-dimensional and individualized comprehensive treatment for severe/critical COVID-19

Severe/critical cases account for 18e20% of all novel coronavirus disease 2019(COVID-19)patients,but their mortality rate can be up to 61.5%.Furthermore,all deceased patients were severe/critical cases.The main reasons for the high mortality of severe/critical patients are advanced age(>60 years old)and combined underlying diseases.Elderly patients with comorbidities show decreased organ function and low compensation for damage such as hypoxia and inflammation,which accelerates disease progression.The lung is the main target organ attacked by severe acute respiratory syndrome coronavirus 2(SARSCoV-2)while immune organs,liver,blood vessels and other organs are damaged to varying degrees.Liver volume is increased,and mild active inflammation and focal necrosis are observed in the portal area.Virus particles have also been detected in liver cells.Therefore,multidisciplinary teams(MDTs)and individualized treatment plans,accurate prediction of disease progression and timely interventions are vital to effectively reduce mortality.Specifically,a“multidisciplinary three-dimensional management,individualized comprehensive plan”should be implemented.The treatment plan complies with three principles,namely,multidisciplinary management of patients,individualized diagnosis and treatment plans,and timely monitoring and intervention of disease.MDT members are mainly physicians from critical medicine,infection and respiratory disciplines,but also include cardiovascular,kidney,endocrine,digestion,nerve,nutrition,rehabilitation,psychology and specialty care.According to a patient's specific disease condition,an individualized diagnosis and treatment plan is formulated(one plan for one patient).While selecting individualized antiviral,anti-inflammatory and immunomodulatory treatment,we also strengthen nutritional support,psychological intervention,comprehensive rehabilitation and timely and full-course intervention to develop overall and special nursing plans.In response to the rapid progression of severe/critical patients,MDT members need to establish a three-dimensional management model with close observation and timely evaluation.The MDT should make rounds of the quarantine wards both morning and night,and of critical patient wards nightly,to implement“round-theclock rounds management”,to accurately predict disease progression,perform the quick intervention and prevent rapid deterioration of the patient.Our MDT has cumulatively treated 77 severe/critical COVID-19 cases,including 62(80.5%)severe cases and 15(19.5%)critical cases,with an average age of 63.8 years.Fifty-three(68.8%)cases presented with more than one underlying disease and 65(84.4%)severe cases recovered from COVID-19.The average hospital stay of severe/critical cases was 22 days,and the mortality rate was 2.6%,both of which were significantly lower than the 30e40 days and 49.0e61.5%,respectively,reported in the literature.Therefore,a multidisciplinary,three-dimensional and individualized comprehensive treatment plan can effectively reduce the mortality rate of severe/critical COVID-19 and improve the cure rate.

Identification of Monocytes Associated with Severe COVID-19 in the PBMCs of Severely Infected Patients Through Single-Cell Transcriptome Sequencing

Understanding the immunological characteristics of monocytes-including the characteristics associated with fibrosis-in severe coronavirus disease 2019(COVID-19)is crucial for understanding the pathogenic mechanism of the disease and preventing disease severity.In this study,we performed single-cell transcriptomic sequencing of peripheral blood samples collected from six healthy controls and 14 COVID-19samples including severe,moderate,and convalescent samples from three severely/critically ill and four moderately ill patients.We found that the monocytes were strongly remodeled in the severely/critically ill patients with COVID-19,with an increased proportion of monocytes and seriously reduced diversity.In addition,we discovered two novel severe-disease-specific monocyte subsets:Mono 0 and Mono 5.These subsets expressed amphiregulin(AREG),epiregulin(EREG),and cytokine interleukin-18(IL-18)gene,exhibited an enriched erythroblastic leukemia viral oncogene homolog(ErbB)signaling pathway,and appeared to exhibit pro-fibrogenic and pro-inflammation characteristics.We also found metabolic changes in Mono 0 and Mono 5,including increased glycolysis/gluconeogenesis and an increased hypoxia inducible factor-1(HIF-1)signaling pathway.Notably,one pre-severe sample displayed a monocyte atlas similar to that of the severe/critical samples.In conclusion,our study discovered two novel severedisease-specific monocyte subsets as potential predictors and therapeutic targets for severe COVID-19.Overall,this study provides potential predictors for severe disease and therapeutic targets for COVID-19 and thus provides a resource for further studies on COVID-19.

Analysis of Antibiotic Usage in Critical COVID-19 Patients with Secondary Infections

Background: Infrequent data exist on the frequency of bacterial co-infections and secondary infection among COVID-19-infected patients admitted to intensive care units (ICU). Objective: To describe the quantity and the quality of antimicrobial usage in COVID-19 with secondary infection, multiple drug resistance organisms and the outcome of antimicrobial treatment. Methods: This study applies observational design with a cross sectional approach. All the patients with laboratory-confirmed severe COVID-19 pneumonia who were discharged from the Intensive Care Unit (ICU) Dr. Ramelan Navy Hospital from February 1st to June 30th 2022 included. The quantity of antibiotics usage was assessed by counting the Defined Daily Dose (DDD). Result: During the study period, 126 patients were referred to the ICU for COVID-19 with severe pneumonia. There were 70.6% (89 patients) treated with antibiotics and 29.4% (37 patients) untreated with antibiotics. Quantitative analysis of 89 patients revealed that levofloxacin was the most common antibiotic prescribed with 43 DDD, followed by Meropenem and Cefoperazone-Sulbactam, which were 17.76 DDD and 16.87 DDD, respectively. Meanwhile, qualitative analysis resulted in 81 antibiotics (43.55%) being used appropriately. No indications of the use of antibiotics were found in 53 antibiotics (28.49%). Klebsiella pneumonia was the main pathogen identified in the blood, sputum. While E. Coli was found to be the main pathogen in urine. Conclusion: A high death rate in patients treated with antibiotics compared to patients not treated with antibiotics.

Effects of traditional Chinese medicine on treatment outcomes in severe COVID-19 patients:a single-centre study

As the search for effective treatments for COVID-19 continues,the high mortality rate among critically ill patients in Intensive Care Units(ICU)presents a profound challenge.This study explores the potential benefits of traditional Chinese medicine(TCM)as a supplementary treatment for severe COVID-19.A total of 110 critically ill COVID-19 patients at the Intensive Care Unit(ICU)of Vulcan Hill Hospital between Feb.,2020,and April,2020(Wuhan,China)participated in this observational study.All patients received standard supportive care protocols,with a subset of 81 also receiving TCM as an adjunct treatment.Clinical characteristics during the treatment period and the clinical outcome of each patient were closely monitored and analysed.Our findings indicated that the TCM group exhibited a significantly lower mortality rate compared with the non-TCM group(16 of 81 vs 24 of 29;0.3 vs 2.3 person/month).In the adjusted Cox proportional hazards models,TCM treatment was associated with improved survival odds(P<0.001).Furthermore,the analysis also revealed that TCM treatment could partially mitigate inflammatory responses,as evidenced by the reduced levels of proinflammatory cytokines,and contribute to the recovery of multiple organic functions,thereby potentially increasing the survival rate of critically ill COVID-19 patients.

TCM theoretical analysis and modern pharmacological mechanism of Huashi Baidu decoction in treating severe novel coronavirus pneumonia

The main symptom elements of the severe novel coronavirus pneumonia epidemic virus closed lung syndrome are cold, damp, poisonous, heat, dryness, blood stasis, and deficiency, which mainly involve the lung and spleen, and are closely related to the heart, liver, kidney, and large intestine. Chinese medicine has accumulated rich academic theories and clinical experience in the prevention and treatment of infectious diseases. The treatment of lung syndrome recommends the use of Huashibaidu formula in the treatment of novel coronavirus pneumonia with integrated traditional Chinese and western medicine. The prescription for removing dampness and detoxification is composed of Maxingshigan formula in "Treatise on Febrile Diseases", "Tingli Dazao Xiefei formula" in "An Outline of Jinkui", Xuanbai Chengqi formula in "Diagnosis of Warm Diseases", "Medical Source Moisture" The combination of four prescriptions of Huopu Xialing formula in "On" is made according to the specific requirements. Through the composition of the prescription of Huashibaidu formula and the pharmacological research involving drugs, the mechanism of the novel coronavirus pneumonia severe epidemic closed lung syndrome may be combined with the blocking of cytokine inflammation storm, immune regulation, antispasmodic and asthma, and improvement Related to hemodynamics.

Severe pediatric COVID‑19:a review from the clinical and immunopathophysiological perspectives

Background Coronavirus disease 2019(COVID-19)tends to have mild presentations in children.However,severe and critical cases do arise in the pediatric population with debilitating systemic impacts and can be fatal at times,meriting further attention from clinicians.Meanwhile,the intricate interactions between the pathogen virulence factors and host defense mechanisms are believed to play indispensable roles in severe COVID-19 pathophysiology but remain incompletely understood.Data sources A comprehensive literature review was conducted for pertinent publications by reviewers independently using the PubMed,Embase,and Wanfang databases.Searched keywords included“COVID-19 in children”,“severe pediatric COVID-19”,and“critical illness in children with COVID-19”.Results Risks of developing severe COVID-19 in children escalate with increasing numbers of co-morbidities and an unvaccinated status.Acute respiratory distress stress and necrotizing pneumonia are prominent pulmonary manifestations,while various forms of cardiovascular and neurological involvement may also be seen.Multiple immunological processes are implicated in the host response to COVID-19 including the type I interferon and inflammasome pathways,whose dysregulation in severe and critical diseases translates into adverse clinical manifestations.Multisystem inflammatory syndrome in children(MIS-C),a potentially life-threatening immune-mediated condition chronologically associated with COVID-19 exposure,denotes another scientific and clinical conundrum that exemplifies the complexity of pediatric immunity.Despite the considerable dissimilarities between the pediatric and adult immune systems,clinical trials dedicated to children are lacking and current management recommendations are largely adapted from adult guidelines.Conclusions Severe pediatric COVID-19 can affect multiple organ systems.The dysregulated immune pathways in severe COVID-19 shape the disease course,epitomize the vast functional diversity of the pediatric immune system and highlight the immunophenotypical differences between children and adults.Consequently,further research may be warranted to adequately address them in pediatric-specific clinical practice guidelines.

Massive bleeding in small intestinal mucosa-associated lymphoid tissue lymphoma associated with COVID-19 infection:a case report

The increased risk of mucosa-associated lymphoid tissue(MALT)lymphoma is closely associated with chronic antigenic stimulation,with infection being the most common cause of recurrence.Lesions are usually associated with the gastrointestinal tract,and the involvement of small intestinal is rare.Recent studies have established a close relationship between novel coronavirus 2019(COVID-19)and the occurrence and progression of various diseases.This article presents a rare case of a small intestinal MALT lymphoma.The patient was initially admitted with COVID-19 pneumonia and subsequently developed gastrointestinal bleeding during hospitalization.Medical and endoscopic treatments were ineffective,and an emergency exploratory laparotomy was performed.The affected segment of the small intestine was excised,and a pathological biopsy confirmed the diagnosis of MALT lymphoma.This case underscores the significance of raising clinical awareness of this condition among health care professionals.

Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study

Background An outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was first detected in Wuhan,Hubei,China.People of all ages are susceptible to SARS-CoV-2 infection.No information on severe pediatric patients with COVID-19 has been reported.We aimed to describe the clinical features of severe pediatric patients with COVID-19.Methods We included eight severe or critically ill patients with COVID-19 who were treated at the Intensive Care Unit (ICU),Wuhan Children's Hospital from January 24 to February 24.We collected information including demographic data,symptoms,imaging data,laboratory findings,treatments and clinical outcomes of the patients with severe COVID-19.Results The onset age of the eight patients ranged from 2 months to 15 years;six were boys.The most common symptoms were polypnea (8/8),followed by fever (6/8) and cough (6/8).Chest imaging showed multiple patch-like shadows in seven patients and ground-glass opacity in six.Laboratory findings revealed normal or increased whole blood counts (7/8),increased C-reactive protein,procalcitonin and lactate dehydrogenase (6/8),and abnormal liver function (4/8).Other findings included decreased CD16 + CD56 (4/8) and Th/Ts*(1/8),increased CD3 (2/8),CD4 (4/8) and CD8 (1/8),IL-6 (2/8),IL-10 (5/8) and IFN-γ (2/8).Treatment modalities were focused on symptomatic and respiratory support.Two critically ill patients underwent invasive mechanical ventilation.Up to February 24,2020,three patients remained under treatment in ICU,the other five recovered and were discharged home.Conclusions In this series of severe pediatric patients in Wuhan,polypnea was the most common symptom,followed by fever and cough.Common imaging changes included multiple patch-like shadows and ground-glass opacity;and a cytokine storm was found in these patients,which appeared more serious in critically ill patients.

Frequency of hepatic steatosis and its association with the pneumonia severity score on chest computed tomography in adult COVID-19 patients

BACKGROUND Recent studies of the coronavirus disease 2019(COVID-19)demonstrated that obesity is significantly associated with increased disease severity,clinical outcome,and mortality.The association between hepatic steatosis,which frequently accompanies obesity,and the pneumonia severity score(PSS)evaluated on computed tomography(CT),and the prevalence of steatosis in patients with COVID-19 remains to be elucidated.AIM To assess the frequency of hepatic steatosis in the chest CT of COVID-19 patients and its association with the PSS.METHODS The chest CT images of 485 patients who were admitted to the emergency department with suspected COVID-19 were retrospectively evaluated.The patients were divided into two groups as COVID-19-positive[CT-and reverse transcriptase-polymerase chain reaction(RT-PCR)-positive]and controls(CT-and RT-PCR-negative).The CT images of both groups were evaluated for PSS as the ratio of the volume of involved lung parenchyma to the total lung volume.Hepatic steatosis was defined as a liver attenuation value of≤40 Hounsfield units(HU).RESULTS Of the 485 patients,56.5%(n=274)were defined as the COVID-19-positive group and 43.5%(n=211)as the control group.The average age of the COVID-19-positive group was significantly higher than that of the control group(50.9±10.9 years vs 40.4±12.3 years,P<0.001).The frequency of hepatic steatosis in the positive group was significantly higher compared with the control group(40.9%vs 19.4%,P<0.001).The average hepatic attenuation values were significantly lower in the positive group compared with the control group(45.7±11.4 HU vs 53.9±15.9 HU,P<0.001).Logistic regression analysis showed that after adjusting for age,hypertension,diabetes mellitus,overweight,and obesity there was almost a 2.2 times greater odds of hepatic steatosis in the COVID-19-positive group than in the controls(odds ratio 2.187;95%confidence interval:1.336-3.580,P<0.001).CONCLUSION The prevalence of hepatic steatosis was significantly higher in COVID-19 patients compared with controls after adjustment for age and comorbidities.This finding can be easily assessed on chest CT images.

COVID-19 Patient with Multifocal Pneumonia and Respiratory Difficulty Resolved Quickly: Possible Antiviral and Anti-Inflammatory Benefits of Quercinex (Nebulized Quercetin-NAC) as Adjuvant

Background: SARS-CoV-2 (COVID-19) is a viral pandemic with no current vaccine or effective treatment. Hydroxychloroquine and azithromycin are not without cardiovascular risk or complications, and these treatments can fail to aid in full recovery from COVID-19. As new treatments become approved for the pandemic, an inexpensive, non-toxic, and safe adjunctive therapy is needed. Case Presentation: A 59-year-old male presented with respiratory symptoms. Chest X-ray revealed classic indications of COVID-19 pneumonia. A PCR nasopharyngeal swab test confirmed a COVID-19 infection and hospital doctors prescribed Rocephin, azithromycin, and hydroxychloroquine. The patient was then prescribed Quercinex, a nebulized formula of quercetin-(cyclodextrin) (20 mg/mL) and N-acetylcysteine (100 mg/mL) three times daily for 14 days by physicians at Envita Medical Center for continued COVID-19 respiratory symptoms. Following 30 minutes after each nebulization treatment, the patient experienced immediate deep breathing relief that lasted for multiple hours. Within the following 48 hours after the first treatment, respiratory symptoms continued to diminish and resolve quickly. Finally, post-treatment follow-up chest X-rays revealed no pulmonary fibrosis (scarring) and clear lung fields. Conclusion: The Quercinex formula appeared to greatly alleviate the unresolved respiratory symptoms rapidly. Several mechanisms of the formula, namely antiviral and anti-inflammatory action, with direct administration via nebulizer to the deep lung tissue, could potentially explain the fast and complete recovery. We recommend that the Quercinex formula be considered for further clinical study as an adjuvant or on its own for COVID-19 and possibly other viral pulmonary conditions.

Secondary Bacterial Organizing Pneumonia in a Patient Recovered from COVID-19 Disease: A Case Report

COVID-19 disease is a global pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) that mainly presents with pneumonia, but has variable multi-systemic manifestations. Concomitant bacterial infections associated with the acute stage of COVID-19 disease have been rarely reported in the literature. However, to our knowledge, post viral organizing pneumonia (OP) secondary to bacterial infection after recovery from SARS-CoV2 infection has not been noted before. We report a 27-year-old male patient with Type 1 Diabetes Mellitus who presented with fever post recovery from COVID-19 disease for seven weeks and was found to have OP secondary to Klebsiella pneumoniae. Furthermore, the bronchoalveolar lavage was positive for SARS-CoV2 by RT-PCR despite multiple negative nasopharyngeal RT-PCR. The patient was successfully treated with antibiotics only. Therefore, we conclude that early recognition of OP secondary to bacterial infection in patients with COVID-19 disease and prompt antibiotic treatment could avoid the use of a prolonged course of steroids.

Impact of COVID-19 pandemic on liver,liver diseases,and liver transplantation programs in intensive care units

Emerging worldwide data have been suggesting that coronavirus disease 2019(COVID-19)pandemic consequences are not limited to the respiratory and cardiovascular systems but encompass adverse gastrointestinal manifestations including acute liver injury as well.Severe cases of liver injury associated with higher fatality rates were observed in critically ill patients with COVID-19.Intensive care units(ICU)have been the center of disposition of severe cases of COVID-19.This review discusses the pathogenesis of acute liver injury in ICU patients with COVID-19,and analyzes its prevalence,consequences,possible drug-induced liver injury,and the impact of the pandemic on liver diseases and transplantation programs.

Similarities and Differences of Early Pulmonary CT Features of Pneumonia Caused by SARS-CoV-2, SARS-CoV and MERS-CoV: Comparison Based on a Systemic Review

Objective To compare the similarities and differences of early CT manifestations of three types of viral pneumonia induced by SARS-CoV-2(COVID-19),SARS-CoV(SARS)and MERS-CoV(MERS)using a systemic review.Methods Electronic database were searched to identify all original articles and case reports presenting chest CT features for adult patients with COVID-19,SARS and MERS pneumonia respectively.Quality of literature and completeness of presented data were evaluated by consensus reached by three radiologists.Vote-counting method was employed to include cases of each group.Data of patients’manifestations in early chest CT including lesion patterns,distribution of lesions and specific imaging signs for the three groups were extracted and recorded.Data were compared and analyzed using SPSS 22.0.Results A total of 24 studies were included,composing of 10 studies of COVID-19,5 studies of MERS and 9 studies of SARS.The included CT exams were 147,40,and 122 respectively.For the early CT features of the 3 pneumonias,the basic lesion pattern with respect to"mixed ground glass opacity(GGO)and consolidation,GGO mainly,or consolidation mainly"was similar among the 3 groups(χ^2=7.966,P>0.05).There were no significant differences on the lesion distribution(χ^2=13.053,P>0.05)and predominate involvement of the subpleural area of bilateral lower lobes(χ^2=4.809,P>0.05)among the 3 groups.The lesions appeared more focal in COVID-19 pneumonia at early phase(χ^2=23.509,P<0.05).The proportions of crazy-paving pattern(χ^2=23.037,P<0.001),organizing pneumonia pattern(P<0.05)and pleural effusions(P<0.001)in COVID-19 pneumonia were significantly lower than the other two.Although rarely shown in the early CT findings of all three viral pneumonias,the fibrotic changes were more frequent in SARS than COVID-19 and MERS(χ^2=6.275,P<0.05).For other imaging signs,only the MERS pneumonia demonstrated tree-in-buds,cavitation,and its incidence rate of interlobular or intralobular septal thickening presented significantly increased as compared to the other two pneumonia(χ^2=22.412,P<0.05).No pneumothorax,pneumomediastinum and lymphadenopathy was present for each group.Conclusions Imaging findings on early stage of these three coronavirus pneumonias showed similar basic lesion patterns,including GGO and consolidation,bilateral distribution,and predominant involvement of the subpleural area and the lower lobes.Early signs of COVID-19 pneumonia showed less severity of inflammation.Early fibrotic changes appeared in SARS only.MERS had more severe inflammatory changes including cavitation and pleural effusion.The differences may indicate the specific pathophysiological processes for each coronavirus pneumonia.

重型及危重型新型冠状病毒肺炎诊疗方案

为规范重型及危重型新型冠状病毒肺炎(COVID-19)的临床诊疗,提高救治成功率,降低病死率,该文在国家卫生健康委员会发布的《新型冠状病毒肺炎诊疗方案(试行第六版)》及国家卫生健康委员会《新型冠状病毒感染的肺炎重型及危重型诊疗方案(试行第一版)》的基础上,结合作者前期医疗救治工作实践经验制订重症及危重症新型冠状病毒肺炎患者诊疗方案,内容包括重症及危重症患者诊断标准、临床预警指标、诊疗流程及护理方案等,供同行参考。

重型、危重型新型冠状病毒肺炎的治疗进展

近期新型冠状病毒肺炎在全国乃至全球200多个国家、地区快速蔓延,人群普遍易感,患患者数迅速增加。重型,尤其是危重型患者死亡率居高不下。截至目前,仍无针对新型冠状病毒感染的特效药物,人们对其认识尚处于初期阶段。如何提高重型,尤其是危重型患者的救治成功率是降低新型冠状病毒肺炎(COVID-19)患者死亡率的关键。本文通过对重型、危重型COVID-19治疗方法的研究进展进行综述,旨在为重型、危重型COVID-19的临床诊治提供参考。

D-二聚体检查对重型及危重型新冠肺炎伴下肢静脉血栓患者死亡风险的评估

目的对重型及危重型新型冠状病毒(以下简称新冠)肺炎患者行双下肢静脉超声检查,应用D-二聚体检查评估重型及危重型新冠肺炎伴下肢静脉血栓栓塞患者的死亡风险。方法32例重型及危重型新冠肺炎患者均行双下肢静脉超声检查和D-二聚体检查,分析其血栓发生情况、D-二聚体异常情况及患者死亡情况。绘制受试者工作特征(ROC)曲线分析D-二聚体预测下肢静脉血栓患者死亡的价值,计算曲线下面积。结果32例患者中,超声检出21例下肢静脉急性血栓(65.6%),其中12例死亡(57.1%)。D-二聚体检查每人平均检测6次,28例6次检查结果均升高,异常率87.5%。以D-二聚体标准差11.310μg/ml为截断值,其预测重型及危重型新冠肺炎伴下肢静脉血栓患者死亡风险的敏感性、特异性分别为91.7%和66.7%,曲线下面积0.759(95%CI:0.524~0.995,P<0.05)。结论当重型及危重型新冠肺炎下肢静脉血栓患者出现D-二聚体明显升高且异常波动时,提示其存在死亡风险,临床治疗时应密切关注D-二聚体波动情况,及早进行双下肢静脉血栓筛查。

Major Depressive Disorder as a Post COVID Infection Sequela

COVID-19 has taken the world by storm, producing a multitude of concerning sequela in all genders and age groups. One surprising finding is the onset of depression post COVID recovery in patients with no past medical history of psychiatric illness. The following case report discusses a 52-year-old female with a past medical history of pneumonia secondary to COVID-19 in April 2021, who presented with recurrent falls and a syncopal episode. On review of systems, it was discovered that the patient has new onset depression since recovering from COVID related pneumonia. Patient has yet to follow up with an outpatient psychiatrist.

Organ function support in patients with coronavirus disease 2019:Tongji experience

Coronavirus disease 2019(COVID-19)is a highly contagious disease and a serious threat to human health.COVID-19 can cause multiple organ dysfunction,such as respiratory and circulatory failure,liver and kidney injury,disseminated intravascular coagulation,and thromboembolism,and even death.The World Health Organization reports that the mortality rate of severe-type COVID-19 is over 50%.Currently,the number of severe cases worldwide has increased rapidly,but the experience in the treatment of infected patients is still limited.Given the lack of specific antiviral drugs,multi-organ function support treatment is important for patients with COVID-19.To improve the cure rate and reduce the mortality of patients with severe-and critical-type COVID-19,this paper summarizes the experience of organ function support in patients with severe-and criticaltype COVID-19 in Optical Valley Branch of Tongji Hospital,Wuhan,China.This paper systematically summarizes the procedures of functional support therapies for multiple organs and systems,including respiratory,circulatory,renal,hepatic,and hematological systems,among patients with severe-and critical-type COVID-19.This paper provides a clinical reference and a new strategy for the optimal treatment of COVID-19 worldwide.

Diagnosis and treatment of novel coronavirus pneumonia based on the theory of traditional Chinese medicine

Since the outbreak of novel coronavirus pneumonia(coronavirus disease 2019,COVID-19),it has rapidly spread to 187 countries,causing serious harm to the health of people and a huge social burden.However,currently,drugs specifically approved for clinical use are not available,except for vaccines against COVID-19 that are being evaluated.Traditional Chinese medicine(TCM)is capable of performing syndrome differentiation and treatment according to the clinical manifestations of patients,and has a better ability of epidemic prevention and control.The authors comprehensively analyzed the etiology and pathogenesis of COVID-19 based on the theory of TCM,and discussed its syndrome differentiation,treatment and prevention measures so as to provide strategies and reference for the prevention and treatment with TCM.