Prediction for risk of disease progression among hospitalized COVID-19 patients

Objective:The COVID-19 pandemic poses a significant threat to global health.Given the lack of studies on risk factors for COVID-19 progression at present,this study aimed to build a predictive model to predict the progression risk among hospitalized COVID-19 patients.Methods:We extracted data from 1074 mild and moderate COVID-19 patients from Electronic Health Records(EHRs)in a designated Wuhan hospital including demographic characteristics and clinical and laboratory information.Disease progression was defined as progressing to severe critical illness after admission.The LASSO regression was used to select the predicted variables and a logistic regression model was applied to build the predictive model.Nomogram was used to show the results.Results:Seven variables were included in the predictive model:age per 10 years(OR,1.15;95%CI,1.03-1.29),lactate dehydrogenase(OR,1.73;95%CI,1.14-2.62),neutrophil-to-lymphocyte ratio(OR,2.07;95%CI,1.42-3.02),eosinophil count(OR,2.10;95%CI,1.20-3.69),albumin(OR,2.37;95%CI,1.65-3.45),hemoglobin(OR,1.50;95%CI,1.10-2.05),D-dimer(OR,1.63;95%CI,1.19-2.23).The mean area under the receiver operating characteristic curve of the predictive model was 0.72(95%CI,0.69-0.76).Conclusions:This study built a predictive model that could effectively predict the progression risk among hospitalized COVID-19 patients.

新型冠状病毒肺炎患者中医药用药规律分析

目的:描述中医药(traditional Chinese medicine,TCM)用于新型冠状病毒肺炎(COVID-19)患者治疗的临床用药规律。方法:将接受中医药治疗的成年COVID-19患者根据入院时临床分型合并为非严重型组(轻型和普通型)和严重型组(重型和危重型)。通过调查患者的病历和用药记录,描述其中医药使用情况和用药模式。结果:共纳入3872例新冠肺炎患者。总体患者中,口服中成药(CPM)是最常用的中药种类,其次是方剂汤药;联合用药比例高于药物单用(55.0%vs.45.0%),方剂汤药联用口服CPM为最常见的联用模式(39.1%,1514/3872)。两组不同入院病情患者中,严重型组患者口服、注射、外用CPM使用较非重症组多见,非严重型组以方剂汤药、非药物中医药治疗较严重型组多见;两组患者均以多药联用为主,均以方剂汤药联用口服CPM最常见。将严重型患者按预后及结局分为三组,注射CPM在病情不断进展最终死亡患者组中使用比例较高(35.0%,36/103);两组最终出院患者最常见的两种用药模式分别为汤剂联用口服CPM和单用口服CPM,最终死亡患者中则为口服CPM及其与注射CPM联用;三组患者在中医药使用比例及用药模式上存在显著差异。结论:本研究发现的COVID-19患者常用的中医药治疗措施及用药模式有待进一步探索,以期为COVID-19治疗提供更完整的参考。

Landscape of DILI-related adverse drug reaction in China Mainland

Drug-induced liver injury(DILI)is a type of bizarre adverse drug reaction(ADR)damaging liver(L-ADR)which may lead to substantial hospitalizations and mortality.Due to the general low incidence,detection of L-ADR remains an unsolved public health challenge.Therefore,we used the data of 6.673 million of ADR reports from January 1st,2012 to December 31st,2016 in China National ADR Monitoring System to establish a new database of L-ADR reports for future investigation.Results showed that totally 114,357 ADR reports were retrieved by keywords searching of liver-related injuries from the original heterogeneous system.By cleaning and standardizing the data fields by the dictionary of synonyms and English translation,we resulted 94,593 ADR records reported to liver injury and then created a new database ready for computer mining.The reporting status of L-ADR showed a persistent 1.62-fold change over the past five years.The national population-adjusted reporting numbers of L-ADR manifested an upward trend with age increasing and more evident in men.The annual reporting rate of L-ADR in age group over 80 years old strikingly exceeded the annual DILI incidence rate in general population,despite known underreporting situation in spontaneous ADR reporting system.The percentage of herbal and traditional medicines(H/TM)L-ADR reports in the whole number was 4.5%,while 80.60%of the H/TM reports were new findings.There was great geographical disparity of reported agents,i.e.more cardiovascular and antineoplastic agents were reported in higher socio-demographic index(SDI)regions and more antimicrobials,especially antitubercular agents,were reported in lower SDI regions.In conclusion,this study presented a large-scale,unbiased,unified,and computer-minable L-ADR database for further investigation.Age-,sex-and SDI-related risks of L-ADR incidence warrant to emphasize the precise pharmacovigilance policies within China or other regions in the world.