Lactate dehydrogenase and susceptibility to deterioration of mild COVID-19 patients: a multicenter nested case-control study.
- 作者列表："Shi J","Li Y","Zhou X","Zhang Q","Ye X","Wu Z","Jiang X","Yu H","Shao L","Ai JW","Zhang H","Xu B","Sun F","Zhang W
BACKGROUND:Coronavirus disease 2019 (COVID-19) has infected more than 4 million people within 4 months. There is an urgent need to properly identify high-risk cases that are more likely to deteriorate even if they present mild diseases on admission. METHODS:A multicenter nested case-control study was conducted in four designated hospitals in China enrolling confirmed COVID-19 patients who were mild on admission. Baseline clinical characteristics were compared between patients with stable mild illness (stable mild group) and those who deteriorated from mild to severe illness (progression group). RESULTS:From Jan 17, 2020, to Feb 1, 2020, 85 confirmed COVID-19 patients were enrolled, including 16 in the progression group and 69 in the stable mild group. Compared to stable mild group (n = 69), patients in the progression group (n = 16) were more likely to be older, male, presented with dyspnea, with hypertension, and with higher levels of lactase dehydrogenase and c-reactive protein. In multivariate logistic regression analysis, advanced age (odds ratio [OR], 1.012; 95% confidence interval [CI], 1.020-1.166; P = 0.011) and the higher level of lactase dehydrogenase (OR, 1.012; 95% CI, 1.001-1.024; P = 0.038) were independently associated with exacerbation in mild COVID-19 patients. CONCLUSION:Advanced age and high LDH level are independent risk factors for exacerbation in mild COVID-19 patients. Among the mild patients, clinicians should pay more attention to the elderly patients or those with high LDH levels.
背景: 冠状病毒病 2019 (新型冠状病毒肺炎) 在 4 个月内感染了超过 400万人。迫切需要适当识别更容易恶化的高危病例，即使它们在入院时呈现轻度疾病。 方法: 在中国 4 家定点医院进行多中心巢式病例对照研究，入组确诊的新型冠状病毒肺炎入院时病情较轻的患者。比较病情稳定的轻度患者 (病情稳定的轻度组) 和病情从轻度恶化到严重的患者 (病情进展组) 的基线临床特征。 结果: 从 2020 年 1 月 17 日至 20 年 2 月 1 日，85 例确诊的新型冠状病毒肺炎患者入选，其中进展组 16 例，稳定轻度组 69 例。与稳定轻度组 (n = 69) 相比，进展组 (n = 16) 的患者更容易年龄较大，男性，出现呼吸困难，伴有高血压，并且具有较高水平的乳糖酶脱氢酶和c反应蛋白。在多变量logistic回归分析中，高龄 (优势比 [OR]，1.012; 95% 置信区间 [CI]，1.020-1.166; P = 0.011) 乳糖酶脱氢酶水平升高 (OR，1.012; 95% CI，1.001-1.024; P = 0.038) 与轻度新型冠状病毒肺炎患者病情加重独立相关。 结论: 高龄、高LDH水平是轻度新型冠状病毒肺炎患者病情加重的独立危险因素。轻症患者中，老年患者或LDH水平较高的患者应引起临床医师的重视。
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.