我们可以用常规血液测试来预测冠状病毒疾病 2019 的严重程度吗？
- 作者列表："Zeng F","Li L","Zeng J","Deng Y","Huang H","Chen B","Deng G
INTRODUCTION:The ongoing worldwide pandemic of coronavirus disease 2019 (COVID‑19) has posed a huge threat to global public health. However, the issue as to whether routine blood tests could be used to monitor and predict the severity and prognosis of COVID‑19 has not been comprehensively investigated so far. OBJECTIVES:This study aimed to provide an overview of the association of markers in the routine blood test with the severity of COVID‑19. METHODS:PubMed, Embase, Cochrane Library, Wanfang, and China National Knowledge Infrastructure (CNKI) databases were searched to identify studies reporting data on markers in the routine blood test and the severity of COVID‑19, published until March 20, 2020. The STATA software was used for meta‑analysis. RESULTS:A total of 15 studies with 3090 patients with COVID‑19 were included in this analysis. Patients in the nonsevere group, compared with those in the severe group, had lower counts of white blood cells (weighted mean difference [WMD], -0.85 [×109/l]; 95% CI, -1.54 to -0.16; P = 0.02) and neutrophils (WMD, -1.57 [×109/l]; 95% CI, -2.6 to -0.54; P = 0.003), greater counts of lymphocytes (WMD, 0.29 [×109/l]; 95% CI, 0.22-0.36; P <0.001) and platelets (WMD, 19.05 [×109/l]; 95% CI, 3.04-35.06; P = 0.02), and a lower neutrophil‑to‑lymphocyte (NLR) ratio (WMD, -2.48; 95% CI, -3.81 to -1.15; P <0.001). There was no difference in the monocyte count (WMD, 0.01 [×109/l]; 95% CI, -0.01 to 0.03; P = 0.029) between these 2 groups. Sensitivity analysis and meta‑analysis based on standard mean difference did not change the conclusions regarding neutrophils, lymphocytes, and NLR, but yielded inconsistent results for white blood cells and platelets. CONCLUSIONS:Severe patients had more neutrophils, higher NLR level, and fewer lymphocytes than non-severe patients with COVID-19. Measurement of these markers might assist clinicians to monitor and predict the severity and prognosis of COVID-19.
引言: 冠状病毒疾病 2019 (covid ‑ 19) 正在全球范围内流行，对全球公共卫生构成了巨大威胁。然而，关于是否可以使用常规血液检查来监测和预测covid ‑ 19 的严重程度和预后的问题迄今尚未得到全面的研究。 目的: 本研究旨在概述血常规检验中标志物与covid ‑ 19 严重程度的相关性。 方法: PubMed、Embase、Cochrane图书馆、万方、中国国家知识基础设施 (CNKI) 检索数据库，以确定报告常规血液检测标志物和covid ‐ 19 严重程度数据的研究，这些研究发表至 2020 年 3 月 20 日。使用STATA软件进行荟萃分析。 结果: 本分析共纳入 15 项研究，3090 例covid ‑ 19 例患者。非重症组患者白细胞计数低于重症组 (加权均数差 [WMD]，-0.85 [× 109/l]; 95% CI，-1.54 ~-0.16; P = 0.02) 和中性粒细胞 (WMD，-1.57 [× 109/l]; 95% CI，-2.6 ~-0.54;P = 0.003) 、淋巴细胞 (WMD，0.29 [× 109/l]; 95% CI，0.22-0.36; P <0.001) 和血小板 (WMD，19.05 [× 109/l]; 95% CI，3.04-35.06; P = 0.02) 和较低的中性粒细胞与淋巴细胞 (NLR) 比值 (WMD，-2.48; 95% CI，-3.81 至-1.15; P <0.001)。这两组之间的单核细胞计数 (WMD，0.01 [× 109/l]; 95% CI，-0.01 ~ 0.03; P = 0.029) 无差异。基于标准平均差的敏感性分析和元分析没有改变关于中性粒细胞、淋巴细胞和NLR的结论，但对白细胞和血小板的结果不一致。 结论: 重症患者比非重症新型冠状病毒肺炎患者有更多的中性粒细胞、更高的NLR水平和更少的淋巴细胞。检测这些标记物有助于临床医生监测和预测新型冠状病毒肺炎的严重程度和预后。
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.