- 作者列表："Giannakoulis VG","Papoutsi E","Siempos II
PURPOSE:Whether cancer is associated with worse prognosis among patients with COVID-19 is unknown. We aimed to quantify the effect (if any) of the presence as opposed to absence of cancer on important clinical outcomes of patients with COVID-19 by carrying out a systematic review and meta-analysis. METHODS:We systematically searched PubMed, medRxiv, COVID-19 Open Research Dataset (CORD-19), and references of relevant articles up to April 27, 2020, to identify observational studies comparing patients with versus without cancer infected with COVID-19 and to report on mortality and/or need for admission to the intensive care unit (ICU). We calculated pooled risk ratios (RR) and 95% CIs with a random-effects model. The meta-analysis was registered with PROSPERO (CRD42020181531). RESULTS:A total of 32 studies involving 46,499 patients (1,776 patients with cancer) with COVID-19 from Asia, Europe, and the United States were included. All-cause mortality was higher in patients with versus those without cancer (2,034 deaths; RR, 1.66; 95% CI, 1.33 to 2.07; P < .0001; 8 studies with 37,807 patients). The need for ICU admission was also more likely in patients with versus without cancer (3,220 events; RR, 1.56; 95% CI, 1.31 to 1.87; P < .0001; 26 studies with 15,375 patients). However, in a prespecified subgroup analysis of patients > 65 years of age, all-cause mortality was comparable between those with versus without cancer (915 deaths; RR, 1.06; 95% CI, 0.79 to 1.41; P = .71; 8 studies with 5,438 patients). CONCLUSION:The synthesized evidence suggests that cancer is associated with worse clinical outcomes among patients with COVID-19. However, elderly patients with cancer may not be at increased risk of death when infected with COVID-19. These findings may inform discussions of clinicians with patients about prognosis and may guide health policies.
目的: 癌症是否与新型冠状病毒肺炎患者的不良预后相关尚不清楚。我们旨在通过进行系统综述和荟萃分析，量化存在而不是不存在癌症对新型冠状病毒肺炎患者重要临床结局的影响 (如果有的话)。 方法: 我们系统检索了PubMed、medRxiv、新型冠状病毒肺炎开放研究数据集 (CORD-19)，以及截至 2020 年 4 月 27 日的相关文章的参考文献，确定比较新型冠状病毒肺炎感染癌症患者与未感染癌症患者的观察性研究，并报告死亡率和/或入住重症监护病房 (ICU) 的必要性。我们用随机效应模型计算了合并风险比 (RR) 和 95% ci。荟萃分析注册于PROSPERO (CRD42020181531)。 结果: 共纳入 32 项研究，包括来自亚洲、欧洲和美国的 46,499 例新型冠状病毒肺炎患者 (1,776 例癌症患者)。有癌症患者的全因死亡率高于无癌症患者 (2,034 例死亡; RR，1.66; 95% CI，1.33 ~ 2.07; P <0001; 8 项研究，37,807 例患者)。癌症患者与非癌症患者相比，需要入住ICU的可能性更大 (3,220 事件; RR，1.56; 95% CI，1.31 ~ 1.87; P < .0001; 26 项研究 15,375 例患者)。然而，在对> 65 岁患者的预先设定的亚组分析中，有和无癌症患者的全因死亡率相当 (915 例死亡; RR，1.06; 95% CI，0.79 至 1.41; P =。71; 8 项研究，5,438 例患者)。 结论: 综合证据表明，癌症与新型冠状病毒肺炎患者较差的临床预后相关。然而，老年癌症患者感染新型冠状病毒肺炎可能不会增加死亡风险。这些发现可能会告知临床医生与患者关于预后的讨论，并可能指导健康政策。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.