Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis.
血液、生化和免疫生物标志物异常与冠状病毒疾病 2019 (新型冠状病毒肺炎) 严重疾病和死亡率相关: 荟萃分析。
- 作者列表："Henry BM","de Oliveira MHS","Benoit S","Plebani M","Lippi G
:Background As coronavirus disease 2019 (COVID-19) pandemic rages on, there is urgent need for identification of clinical and laboratory predictors for progression towards severe and fatal forms of this illness. In this study we aimed to evaluate the discriminative ability of hematologic, biochemical and immunologic biomarkers in patients with and without the severe or fatal forms of COVID-19. Methods An electronic search in Medline (PubMed interface), Scopus, Web of Science and China National Knowledge Infrastructure (CNKI) was performed, to identify studies reporting on laboratory abnormalities in patients with COVID-19. Studies were divided into two separate cohorts for analysis: severity (severe vs. non-severe and mortality, i.e. non-survivors vs. survivors). Data was pooled into a meta-analysis to estimate weighted mean difference (WMD) with 95% confidence interval (95% CI) for each laboratory parameter. Results A total number of 21 studies was included, totaling 3377 patients and 33 laboratory parameters. While 18 studies (n = 2984) compared laboratory findings between patients with severe and non-severe COVID-19, the other three (n = 393) compared survivors and non-survivors of the disease and were thus analyzed separately. Patients with severe and fatal disease had significantly increased white blood cell (WBC) count, and decreased lymphocyte and platelet counts compared to non-severe disease and survivors. Biomarkers of inflammation, cardiac and muscle injury, liver and kidney function and coagulation measures were also significantly elevated in patients with both severe and fatal COVID-19. Interleukins 6 (IL-6) and 10 (IL-10) and serum ferritin were strong discriminators for severe disease. Conclusions Several biomarkers which may potentially aid in risk stratification models for predicting severe and fatal COVID-19 were identified. In hospitalized patients with respiratory distress, we recommend clinicians closely monitor WBC count, lymphocyte count, platelet count, IL-6 and serum ferritin as markers for potential progression to critical illness.
背景: 随着冠状病毒疾病 2019 (新型冠状病毒肺炎) 的流行，迫切需要确定临床和实验室预测指标，以发展为严重和致命形式的这种疾病。在这项研究中，我们旨在评估血液，生化和免疫生物标志物在有和没有严重或致命形式的新型冠状病毒肺炎患者中的辨别能力。方法在Medline (PubMed接口) 、Scopus、Web of Science和中国知网 (CNKI) 中进行电子检索，以确定报告新型冠状病毒肺炎患者实验室异常的研究。研究分为两个独立的队列进行分析: 严重 (严重vs.非严重和死亡率，即非幸存者vs.幸存者)。将数据合并到一项荟萃分析中，估计每个实验室参数的加权平均差 (WMD)，95% 置信区间 (95% CI)。结果共纳入 21 项研究，共计 3377 例患者，33 项实验室参数。18 项研究 (n = 2984) 比较了重症和非重症新型冠状病毒肺炎患者的实验室检查结果，其他三项 (n = 393) 比较疾病幸存者和非幸存者，因此分别进行分析。与非严重疾病和幸存者相比，严重和致命疾病患者的白细胞 (WBC) 计数显著升高，淋巴细胞和血小板计数降低。炎症，心脏和肌肉损伤，肝肾功能和凝血指标的生物标志物在严重和致命的新型冠状病毒肺炎患者中也显著升高。白细胞介素 6 (IL-6) 和 10 (IL-10) 以及血清铁蛋白对重症疾病有较强的鉴别作用。结论确定了几种可能有助于危险分层模型预测严重和致命新型冠状病毒肺炎的生物标志物。在呼吸窘迫的住院患者中，我们建议临床医生密切监测白细胞计数、淋巴细胞计数、血小板计数、IL-6 和血清铁蛋白作为潜在进展为危重疾病的标志物。
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.