Clinical characteristics and outcomes of patients with severe acute respiratory infections (SARI): results from the Egyptian surveillance study 2010–2014
clinical, Outcomes, Viral, SARI, Egypt, Surveillance
Abstract Background Respiratory viral and atypical bacterial infections data in Egyptian patients are sparse. This study describes the clinical features and outcomes of patients with severe acute respiratory infections (SARI) in hospitalized patients in Egypt. Methods SARI surveillance was implemented at Cairo University Hospital (CUH) during the period 2010–2014. All hospitalized patients meeting the WHO case definition for SARI were enrolled. Nasopharyngeal/oropharyngeal (NP/OP) swabs were collected and samples were tested using RT-PCR for influenza A, B, respiratory syncytial virus (RSV), human metapneumovirus (hMPV), parainfluenza virus (PIV 1,2,3,4), adenovirus, bocavirus, coronavirus, enterovirus, rhinovirus, and atypical bacteria. Data were analyzed to calculate positivity rates for viral pathogens and determine which pathogens related to severe outcomes or resulted in death. Results Overall, 1,075/3,207 (33.5%) cases had a viral etiology, with a mean age of 5.74 (±13.87) years. The highest rates were reported for RSV (485 cases, 45.2%), PIV (125, 11.6%), and adenovirus (105, 9.8%). Children had a higher viral rate (981, 91.2%) compared to 94 (8.8%) cases in adults. Patients with identified viruses had significantly lower rates for ICU admission, hospital stay, mechanical ventilation, and overall mortality than those without identified viruses. No infections were independently associated with severe outcomes. Conclusions Viral pathogens were encountered in one-third of hospitalized adult and pediatric Egyptian patients with SARI, while atypical bacteria had a minor role. Highest rates of viral infections were reported for RSV, PIV, and adenovirus. Viral infections had neither negative impacts on clinical features nor outcomes of patients with SARI in our locality.
Ashraf Hatem, Sherif Mohamed, Usama E Abuelhassan, Eman A. M. Ismael, Magda S Rizk, Amany El-kholy, Mohamed El-Harras
Clinical characteristics and outcomes of patients with severe covid-19 with diabetes
Objective This study explores the clinical characteristics of patients with diabetes with severe covid-19, and the association of diabetes with survival duration in patients with severe covid-19.Research design and methods In this single-center, retrospective, observational study, the clinical and laboratory characteristics of 193 patients with severe covid-19 were collected. 48 patients with severe covid-19 had diabetes, and 145 patients (ie, the controls) did not have diabetes. A severe case was defined as including at least one of the following criteria: (1) Respiratory rate >30/min. (2) Oxygen saturation ≤93%. (3) PaO2/FiO2≤300 mm Hg. (4) Patients, either with shock or respiratory failure, requiring mechanical ventilation, or combined with other organ failure, requiring admission to intensive care unit (ICU).Results Of 193 patients with severe covid-19, 48 (24.9%) had diabetes. Compared with patients with severe covid-19 without diabetes, patients with diabetes were older, susceptible to receiving mechanical ventilation and admission to ICU, and had higher mortality. In addition, patients with severe covid-19 with diabetes had higher levels of leukocyte count, neutrophil count, high-sensitivity C reaction protein, procalcitonin, ferritin, interleukin (IL) 2 receptor, IL-6, IL-8, tumor necrosis factor α, D-dimer, fibrinogen, lactic dehydrogenase and N-terminal pro-brain natriuretic peptide. Among patients with severe covid-19 with diabetes, more non-survivors were men (30 (76.9%) vs 9 (23.1%)). Non-survivors had severe inflammatory response, and cardiac, hepatic, renal and coagulation impairment. Finally, the Kaplan-Meier survival curve showed a trend towards poorer survival in patients with severe covid-19 with diabetes than patients without diabetes. The HR was 1.53 (95% CI 1.02 to 2.30; p=0.041) after adjustment for age, sex, hypertension, cardiovascular disease and cerebrovascular disease by Cox regression. The median survival durations from hospital admission in patients with severe covid-19 with and without diabetes were 10 days and 18 days, respectively.Conclusion The mortality rate in patients with severe covid-19 with diabetes is considerable. Diabetes may lead to an increase in the risk of death.
Huihui Ren, Kun Dong, Yongli Yan, Fen Wang, Shujun Zhang, Xiaoli Shi, Xuefeng Yu
Diseases of the endocrine glands. Clinical endocrinology
Clinical Characteristics and Predictors of Mortality in Patients with COVID-19 Infection Outside Intensive Care
mortality, ICU, covid-19, Lymphopenia, Frailty, Renal dysfunction
Saadiq M Moledina,* Alexander A Maini,* Alice Gargan, William Harland, Heloise Jenney, Georgina Phillips, Kate Thomas, Devkishan Chauhan, Michael Fertleman From the Cutrale Perioperative & Ageing Group, St Mary’s Hospital, Imperial College London, London, UK*These authors contributed equally to this workCorrespondence: Saadiq M MoledinaSt Mary’s Hospital, Imperial College London, Praed Street, Paddington, London W2 1NY, UKTel +44 02033126666Email smoledina1@doctors.org.ukBackground/Introduction: The coronavirus disease 2019 (COVID-19) pandemic has affected all aspects of inpatient hospital medicine with patients admitted from level 1 (general medical wards) to level 3 (intensive care). Often, there are subtle physiological differences in these cohorts of patients. In particular, in intensive care, patients tend to be younger and have increased disease severity. Data, to date, has combined outcomes from medical and intensive care cohorts, or looked exclusively at intensive care. We looked solely at the level 1 (medical) cohort to identify their clinical characteristics and predictors of outcome.Patients and Methods: This was a retrospective study of adult patients admitted to a central London teaching hospital with a diagnosis of COVID-19 from 23rd March to 7th April 2020 identified from the hospital electronic database. Any patients who required level 2 or 3 care were excluded.Results: A total of 229 patients were included for analysis. Increased age and frailty scores were associated with increased 30-day mortality. Reduced renal function and elevated troponin blood levels are also associated with poor outcome. Baseline observations showed that increased oxygen requirement was predictive for mortality. A trend of increased mortality with lower diastolic blood pressure was noted. Lymphopenia was not shown to be related to mortality.Conclusion: Urea and creatinine are the best predictors of mortality in the level 1 cohort. Unlike previous intensive care data, lymphopenia is not predictive of mortality. We suggest that these factors be considered when prognosticating and for resource allocation for the treatment and escalation of care for patients with COVID-19 infection.Keywords: COVID-19, mortality, frailty, ICU, renal dysfunction, lymphopenia
Moledina SM, Maini AA, Gargan A, Harland W, Jenney H, Phillips G, Thomas K, Chauhan D, Fertleman M
Clinical Characteristics and Reasons for Differences in Duration From Symptom Onset to Release From Quarantine Among Patients With COVID-19 in Liaocheng, China
quarantine, clinical characteristic, granulocyte count, Epidemiologic characteristic, COVID-19 patients
Objective: This study aimed to identify additional characteristics and features of coronavirus disease (COVID-19) by assessing the clinical courses among COVID-19 patients in a region outside Hubei province.Methods: We analyzed retrospective data regarding general characteristics, epidemiologic history, underlying chronic diseases, clinical symptoms and complications, chest computed tomography findings, biochemical monitoring, disease severity, treatments, and outcomes among 37 adult patients with COVID-19. According to the duration from symptom onset to release from quarantine, the patients were divided into the ≤20 and >20-day groups, and the similarities and differences between them were compared.Results: Among the 37 patients, five had mild disease, 30 had moderate disease, one had severe disease, and one was critically ill. All of the patients were released from quarantine, and no mortality was observed. The average duration from symptom onset to release from quarantine was 20.2 ± 6.6 days. The average duration from symptom onset to hospitalization was 4.1 ± 3.7 days, and the patients were hospitalized for an average of 16.1 ± 6.2 days. The average age was 44.3 ± 1.67 years, and 78.4% of cases were caused by exposure to a patient with confirmed disease or the workplace of a patient with confirmed disease. The main symptoms were cough (67.6%), fever (62.2%), shortness of breath (32.4%), fatigue (24.3%), sore throat (21.6%), vomiting, and diarrhea (21.6%). White blood cell count was decreased in 27.0% of patients, and lymphocyte count was decreased in 62.2% of the patients, among whom 43.5% patients had counts of ≤0.6 × 109/L. On admission, 86.5% of patients showed pneumonia in chest CT scans, including some asymptomatic patients, while 68.8% of patients showed bilateral infiltration. In the >20-day group, the average age was 49.9 ± 1.38 years, and the average duration from symptom onset to hospitalization was 5.5 ± 3.9 days. Compared with the ≤20-day group, patients in the >20-day group were older and the duration was longer (P < 0.05). All of the seven asymptomatic patients belonged to the ≤20-day group. When the 37 patients were released from quarantine, the white blood cell count of 16.2% of the patients was <4.0 × 109/L, the lymphocyte count of 59.5% of the patients was <1.1 × 109/L, and the absolute counts of white blood cells and lymphocytes were 5.02 ± 1.34 × 109/L and 1.03 ± 0.34 × 109/L, respectively, compared with those recorded on admission (P > 0.05).Conclusion: The majority of COVID-19 cases in the study area were mild and moderate, with good clinical outcomes. There were some special characteristics in the clinical course. The reasons for differences in the duration from symptom onset to release from quarantine were complex. There was no significant change in the number of granulocytes at the time of release from quarantine compared to that at the time of admission.
Min Wu, Juan Chen, Jian HAN, Hui Tian, Kang Ning, Wenming Zhang, Tie-Jun Wu, Yunxia Wang, Guiji eZhou, Suochen Tian, Zhenqin Chang, Xiuli Zou, Tingfang Xiao, Junmin Xing
Clinical characteristics and risk factors for coronavirus disease 2019 (COVID-19) among patients under investigation in Thailand
To manage coronavirus disease 2019 (COVID-19), a national health authority has implemented a case definition of patients under investigation (PUIs) to guide clinicians’ diagnoses. We aimed to determine characteristics among all PUIs and those with and without COVID-19. We retrospectively reviewed clinical characteristics and risk factors for laboratory-confirmed COVID-19 cases among PUIs at a tertiary care center in Bangkok, Thailand, between March 23 and April 7, 2020. Reverse transcription-polymerase chain reaction for SARS-CoV-2 RNA was performed. There were 405 evaluable PUIs; 157 (38.8%) were men, with a mean age ± SD of 36.2 ± 12.6 years. The majority (68.9%) reported no comorbidities. There were 53 (13.1%) confirmed COVID-19 cases. The most common symptoms among those were cough (73.6%), fever (58.5%), sore throat (39.6%), and muscle pain (37.4%). Among these patients, diagnoses were upper respiratory tract infection (69.8%), viral syndrome (15.1%), pneumonia (11.3%), and asymptomatic infection (3.8%). Multivariate analysis identified close contact with an index case (OR, 3.49; 95%CI, 1.49–8.15; P = 0.004), visiting high-risk places (OR, 1.92; 95%CI, 1.03–3.56; P = 0.039), productive cough (OR, 2.03; 95%CI, 1.05–3.92; P = 0.034), and no medical coverage (OR, 3.91; 95%CI, 1.35–11.32; P = 0.012) as independent risk factors for COVID-19 among the PUIs. The majority had favorable outcomes, though one (1.9%) died from severe pneumonia. COVID-19 was identified in 13% of PUIs defined per a national health authority’s case definition. History of contact with a COVID-19 patient, visiting a high-risk place, having no medical coverage, and productive cough may identify individuals at risk of COVID-19 in Thailand.
Jackrapong Bruminhent, Nattanon Ruangsubvilai, Jeff Nabhindhakara, Atiporn Ingsathit, Sasisopin Kiertiburanakul, Muhammad Adrish
Clinical characteristics and risk factors of patients with severe COVID-19 in Jiangsu province, China: a retrospective multicentre cohort study
covid-19, pneumonia, severe, SARS-CoV-2, severity, Critically ill
Abstract Background Coronavirus Disease-2019 (COVID-19) pandemic has become a major health event that endangers people health throughout China and the world. Understanding the factors associated with COVID-19 disease severity could support the early identification of patients with high risk for disease progression, inform prevention and control activities, and potentially reduce mortality. This study aims to describe the characteristics of patients with COVID-19 and factors associated with severe or critically ill presentation in Jiangsu province, China. Methods Multicentre retrospective cohort study of all individuals with confirmed Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infections diagnosed at 24 COVID-19-designated hospitals in Jiangsu province between the 10th January and 15th March 2020. Demographic, clinical, laboratory, and radiological data were collected at hospital admission and data on disease severity were collected during follow-up. Patients were categorised as asymptomatic/mild/moderate, and severe/critically ill according to the worst level of COVID-19 recorded during hospitalisation. Results A total of 625 patients, 64 (10.2%) were severe/critically ill and 561 (89.8%) were asymptomatic/mild/moderate. All patients were discharged and no patients died. Patients with severe/critically ill COVID-19 were more likely to be older, to be single onset (i.e. not belong to a cluster of cases in a family/community, etc.), to have a medical history of hypertension and diabetes; had higher temperature, faster respiratory rates, lower peripheral capillary oxygen saturation (SpO2), and higher computer tomography (CT) image quadrant scores and pulmonary opacity percentage; had increased C-reactive protein, fibrinogen, and D-dimer on admission; and had lower white blood cells, lymphocyte, and platelet counts and albumin on admission than asymptomatic/mild/moderate cases. Multivariable regression showed that odds of being a severe/critically ill case were associated with age (year) (OR 1.06, 95%CI 1.03–1.09), lymphocyte count (109/L) (OR 0.25, 95%CI 0.08–0.74), and pulmonary opacity in CT (per 5%) on admission (OR 1.31, 95%CI 1.15–1.51). Conclusions Severe or critically ill patients with COVID-19 is about one-tenths of patients in Jiangsu. Age, lymphocyte count, and pulmonary opacity in CT on admission were associated with risk of severe or critically ill COVID-19.
Duolao Wang, Songqiao Liu, Huanyuan Luo, Yuancheng Wang, Luis E. Cuevas, Shenghong Ju, Yi Yang
Clinical Characteristics of 5 COVID-19 Cases With Non-respiratory Symptoms as the First Manifestation in Children
pediatrics, clinical characteristics, Nonrespiratory symptoms, first manifestation, novel coronavirus disease 2019
An outbreak of the novel coronavirus disease 2019 (COVID-19) occurred in Wuhan, China, in December 2019, which then rapidly spread to more than 80 countries. However, detailed information on the characteristics of COVID-19 in children is still scarce. Five patients with non-respiratory symptoms as the first manifestation were hospitalized from the emergency department, and were later confirmed to have COVID-19, between 23 January and 20 February 2020, at the Wuhan Children's Hospital. SARS-CoV-2 nucleic acid detection was positive for all the patients. Four of the patients were male and one was female, and their ages ranged from 2-months to 5.6 years. All lived in Wuhan. One patient had a clear history of exposure to SARS-CoV-2, one had a suspected history of exposure, while the others had no exposure history. For three of the five patients, the primary onset disease required an emergency operation or treatment, and included intussusception, acute suppurative appendicitis perforation with local peritonitis, and traumatic subdural hemorrhage with convulsion, while for the other two it was acute gastroenteritis (including one patient with hydronephrosis and a stone in his left kidney). During the course of the disease, four of the five patients had a fever, whereas one case had no fever or cough. Two patients had leukopenia, and one also had lymphopenia. In the two cases of severe COVID-19, the levels of CRP, PCT, serum ferritin, IL-6, and IL-10 were significantly increased, whereas the numbers of CD3+, CD4+, CD8+ T lymphocytes, and CD16 + CD56 natural killer cells were decreased. We also found impaired liver, kidney, and myocardial functions; the presence of hypoproteinemia, hyponatremia, and hypocalcemia; and, in one case, abnormal coagulation function. Except for one patient who had a rotavirus infection, all patients tested negative for common pathogens, including the influenza virus, parainfluenza virus, respiratory syncytial virus, adenovirus, enterovirus, mycoplasma, Chlamydia, and Legionella. Chest CT images of all the patients showed patches or ground-glass opacities in the lung periphery or near the pleura, even large consolidations. This case series is the first report to describe the clinical features of COVID-19 with non-respiratory symptoms as the first manifestation in children.
Yan Chen, Wenbin Li, Songbo Li, Xiao-Fang Cai, Zhihui Rong, Yaoling Ma
Clinical characteristics of 82 cases of death from COVID-19.
A recently developed pneumonia caused by SARS-CoV-2 bursting in Wuhan, China, has quickly spread across the world. We report the clinical characteristics of 82 cases of death from COVID-19 in a single center. Clinical data on 82 death cases laboratory-confirmed as SARS-CoV-2 infection were obtained from a Wuhan local hospital's electronic medical records according to previously designed standardized data collection forms. All patients were local residents of Wuhan, and a large proportion of them were diagnosed with severe illness when admitted. Due to the overwhelming of our system, a total of 14 patients (17.1%) were treated in the ICU, 83% of deaths never received Critical Care Support, only 40% had mechanical ventilation support despite 100% needing oxygen and the leading cause of death being pulmonary. Most of the patients who died were male (65.9%). More than half of the patients who died were older than 60 years (80.5%), and the median age was 72.5 years. The bulk of the patients who died had comorbidities (76.8%), including hypertension (56.1%), heart disease (20.7%), diabetes (18.3%), cerebrovascular disease (12.2%), and cancer (7.3%). Respiratory failure remained the leading cause of death (69.5%), followed by sepsis/MOF (28.0%), cardiac failure (14.6%), hemorrhage (6.1%), and renal failure (3.7%). Furthermore, respiratory, cardiac, hemorrhagic, hepatic, and renal damage were found in 100%, 89%, 80.5%, 78.0%, and 31.7% of patients, respectively. On admission, lymphopenia (89.2%), neutrophilia (74.3%), and thrombocytopenia (24.3%) were usually observed. Most patients had a high neutrophil-to-lymphocyte ratio of >5 (94.5%), high systemic immune-inflammation index of >500 (89.2%), and increased C-reactive protein (100%), lactate dehydrogenase (93.2%), and D-dimer (97.1%) levels. A high level of IL-6 (>10 pg/ml) was observed in all detected patients. The median time from initial symptoms to death was 15 days (IQR 11-20), and a significant association between aspartate aminotransferase (p = 0.002), alanine aminotransferase (p = 0.037) and time from initial symptoms to death was remarkably observed. Older males with comorbidities are more likely to develop severe disease and even die from SARS-CoV-2 infection. Respiratory failure is the main cause of COVID-19, but the virus itself and cytokine release syndrome-mediated damage to other organs, including cardiac, renal, hepatic, and hemorrhagic damage, should be taken seriously as well.
Bicheng Zhang, Xiaoyang Zhou, Yanru Qiu, Yuxiao Song, Fan Feng, Jia Feng, Qibin Song, Qingzhu Jia, Jun Wang
Clinical characteristics of 9 cancer patients with SARS-CoV-2 infection
cancer, Outcomes, clinical characteristics, SARS-CoV-2
Abstract In December 2019, a cluster of pneumonia cases was caused by the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China. Cancer patients are a special group, the immunity of them will be suppressed because of various anti-tumor treatments, and the risk of infection will be greatly increased, so we will report clinical features of 9 cancer patients with SARS-CoV-2 infection. 5 (56%) patients were ordinary type, 3 (33%) were severe type, and 1 (11%) was critical type. A total of 8 patients received combined therapy of traditional Chinese medicines and western medicines. From the clinical outcomes of these 8 patients, western combined therapy of traditional Chinese medicine was indeed an effective treatment method. D-dimmer rise, infection index rise, and chest CT(computed tomography) progression may be clinical warning indicators for severe patients, in our study, more 50% of patients had elevated levels of these indicators, but only 44% (including the dead) of patients had received treatment in the intensive care unit. 5 (56%) ordinary type patients had been discharged, while the 1 (11%) critical type patient died 3 days after admission. Cancer comorbidity seems to have no direct relationship with severe events, and the combination of traditional Chinese medicine and western medicine may be effective in the prevention and treatment of novel coronavirus-infected pneumonia (NICP).
Bo Zhang, Yong Zeng, Xufeng Zhang, Cun-Jian Yi
Clinical Characteristics of Covid-19 among Old Adult Patients with Chronic Diseases: A Systematic Review Study
vulnerability, older adults, COVID-19, New coronavirus, global pandemic
Background: COVID-19[1] is a new infectious disease that has been declared by WHO[2] as a public health emergency worldwide due to its rapid spread to China and then to other parts of the world. The present study was designed to evaluate the clinical manifestations of this disease in the elderly. Methods: We performed a systematic review on the database of the World Health Organization, CDC[3], PubMed, Google Scholar, Scopus, and lancet. All of the articles published until March 15, 2020, have been extracted from the above articles in English on coronavirus infection, disease, virology, epidemiology, clinical features, treatment, and prevention of the disease. Of the 1376 articles, 5 were selected out of recently published articles focusing on the epidemiological information of the virus, pneumonia caused by new corona virus, and the effects of the disease on different age groups, especially the elderly, and the rest were excluded from the review. The mean age of the patients, the mean age of mortality and the underlying diseases were chosen as the criteria of data extraction. Findings: Based on the researchers' perceptions of the text of the articles, 342 cases were included in these 5 studies. The mean age of the patients was 58.4 and that of the diceased patients was 66.5. More than 50% of the total cases had one or more underlying diseases. Conclusion: Despite the involvement of various age groups in this infection, the virus is most likely to cause severe complications and fatalities in older people with underlying diseases.
Abdolrahim Asadollahi, Ogholgol Ghajari, Farzaneh Kasraie
Journal of Health Sciences and Surveillance System