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MeSH Disease

Human Phenotype


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    Hypernatremia HP Hypernatremia MESHD is common in patients with severe COVID-19 and indicates a poor prognosis

    Authors: Anna Sjöström; Susanne Rysz; Henrik Sjöström; Charlotte Höybye

    doi:10.21203/ Date: 2020-09-22 Source: ResearchSquare

    Background: Fluid homeostasis, including electrolyte balance, is dependent on an interaction between the renin-angiotensin-aldosterone system (RAAS) and the release of arginine vasopressin from the pituitary. An imbalance can lead to both hypo- and hypernatremia HP hypernatremia MESHD. We investigated the frequency, dynamics and severity of electrolyte imbalance in critically ill MESHD patients with COVID-19. Methods: In this retrospective cohort study 223 patients with confirmed COVID-19, treated at the intensive care unit (ICU), were included. Levels of electrolytes, base excess, pH and serum SERO osmolality were collected from the laboratory database. Clinical data was retrieved from patients’ medical records.Results: Hyponatremia HP Hyponatremia MESHD was present in 63% of the patients, at admission. Within two weeks of hospitalization, 65% of the patients developed hypernatremia HP hypernatremia MESHD often combined with a rise of base excess. The mortality rate was twice as high in the group with hypernatremia HP hypernatremia MESHD compared to the patients not developing hypernatremia HP hypernatremia MESHD. Treatment of hypertension HP hypertension MESHD before the onset of COVID-19 was more common in patients without hypernatremia HP hypernatremia MESHD.Conclusion: Our study shows that hypernatremia HP hypernatremia MESHD is very common in severe COVID-19. Patients that developed hypernatremia HP hypernatremia MESHD needed longer time in ICU and had a higher risk of dying, suggesting that the level of sodium is an important indicator of severity in COVID-19.

    Hyponatremia HP Hyponatremia MESHD is Associated with Poor Outcome in COVID-19

    Authors: Hugo DE CARVALHO; Thibault LETELLIER; Matilde KARAKACHOFF; Geoffrey DESVAUX; Hélène CAILLON; Emmanuelle PAPUCHON; Maxime BENTOUMI-LOAEC; Nesrine BENAOUICHA; Emmanuel CANET; Guillaume CHAPELET; Paul LE TURNIER; Emmanuel MONTASSIER; Armine ROUHANI; Nicolas GOFFINET; Lucile FIGUERES

    doi:10.21203/ Date: 2020-08-19 Source: ResearchSquare

    Background Hyponatremia HP Hyponatremia MESHD has been described in severe acute respiratory syndrome MESHD. Our objective was to describe the impact of hyponatremia HP hyponatremia MESHD on COVID-19 patients’ outcome (intensive care unit [ICU] admission, mechanic ventilation or death MESHD).Methods According to natremia at admission, two groups were retrospectively screened: hyponatremic (< 135 mM, n = 101) or normonatremic ( natremia ≥ 135 mM MESHD, n = 222) patients. Pearson’s chi-2 (qualitative variables) and Student tests (quantitative variables) were used to compare the two groups. A multiple logistic regression model was used to assess the association of outcome and patients’ data.Results Hyponatremia HP Hyponatremia MESHD was generally mild. There were more male TRANS patients in the hyponatremic group (p = 0.005). Pulmonary lesions on the first thoracic CT-scanner performed during the hospitalization were significantly more extended in the hyponatremic group (p = 0.03). ICU admission, mechanic ventilation or death MESHD were significantly higher in hyponatremic compared to normonatremic patients (34 versus 14%; p < 0.001; 16% versus 5%; p = 0.002; 19 versus 9%, p = 0.021, respectively). Hyponatremia HP Hyponatremia MESHD was an independent predictor of poor outcome (adjusted Odds-ratio: 2.49 [1.18–5.33, p = 0.017]).Conclusions Our study showed an independent relationship between hyponatremia HP hyponatremia MESHD at admission and transfer to ICU, use of mechanic ventilation or death MESHD in COVID-19. Hyponatremia HP Hyponatremia MESHD may reflect the potential severity of underlying pulmonary lesions MESHD. Our results support the use of natremia as a simple bedside screening tool for early identification of SARS-CoV-2 infected MESHD patients at high risk of poor outcome.

    The involvement of Central Nervous System and sequence variability of Severe Adult Respiratory Syndrome MESHD Adult TRANS Respiratory Syndrome – Coronavirus-2 revealed in autopsy tissue samples: a case report.

    Authors: Lis Høy Marbjerg; Christina Jacobsen; Jannik Fonager; Claus Bøgelund; Morten Rasmussen; Anders Fomsgaard; Jytte Banner; Veronika Vorobieva Solholm Jensen

    doi:10.21203/ Date: 2020-08-18 Source: ResearchSquare

    Background: The case presented here illustrates that interdisciplinary teamwork can be essential for the understanding of the COVID-19 disease presentation and enlightening of the pathophysiology. Case presentation: A 60-years-old overweight HP woman without any comorbidities was found dead in her apartment after 14 days of home isolation due to suspicion on the Coronavirus disease MESHD 2019 (COVID-19). She had reported symptoms of tachycardia HP tachycardia MESHD, fever HP fever MESHD, and increasing respiratory difficulty one day before her death MESHD. Due to the Danish legal act on sudden deaths a forensic autopsy was performed including a thorough examination and biosampling. The results of the forensic autopsy displayed sever densified, almost airless, firm lungs, and an unspecific reactive minimal focal perivascular inflammation MESHD consisting of macrophages of the brain tissue. The final diagnosis, COVID-19 with involvement of the central nervous system was established by use of the RT-RNA analysis on cerebrospinal fluid, as well as by serologic detection of the specific antibodies for SARS-CoV-2 SERO in cerebrospinal fluid and serum SERO. The genetic analysis displayed a 2 % variation between SARS-CoV-2 isolates recovered from the tracheal sample, cerebrospinal fluid, and tissues from both lungs.Conclusion: The combination of all available results revealed that the cause of death MESHD was COVID-19 with severe pulmonary disease MESHD and neuroinvasion, as well as renal affection resulting in hyponatremia HP hyponatremia MESHD. To our knowledge, it was not shown previously that neuroinvasion could be confirmed by the detection of specific antibodies for SARS-CoV-2 SERO and SARS-CoV-2 specific RNA in cerebrospinal fluid. This case supports hypotheses that SARS-CoV-2 may cause central nervous system infection MESHD. The genetic distinction between SARS-CoV-2 isolates was done by whole-genome sequencing, where the isolate recovered from the cerebrospinal fluid was the most different. 

    Suspected Serious Adverse Drug Reactions in Hospitalized COVID-19 Patients

    Authors: Elena Ramírez; Mikel Urroz; Amelia Rodríguez Mariblanca; Alberto Martín-Vega; Yuri Villán; Enrique Seco; Jaime Monserrat; Jesús Frías; Antonio J. Carcas; Alberto M. Borobia

    id:10.20944/preprints202008.0283.v1 Date: 2020-08-12 Source:

    BACKGROUND: From March to April 2020, Spain was the center of the SARS-CoV-2 pandemic, particularly Madrid with approximately 30% of the cases in Spain. The aim of this study is to report the suspected serious adverse drug reactions (SADRs) in COVID-19 patients versus non-COVID-19 patients detected by the prospective pharmacovigilance program based on automatic laboratory signals (ALSs) in the hospital (PPLSH) during that period. We also compared the results with the suspected SADRs detected during the same period for 2019. METHODS: All ALSs that reflected potential SADRs (including neutropenia HP, pancytopenia HP, thrombocytopenia HP, anemia HP, eosinophilia HP, leukocytes in cerebrospinal fluid, hepatitis HP, pancreatitis, acute HP kidney injury, rhabdomyolysis HP and hyponatremia HP were prospectively monitored in hospitalized patients during the study periods. We analyzed the incidence and the distribution of causative drugs for the COVID-19 patients. RESULTS: The incidence rate of SADRs detected in the COVID-19 patients was 760.63 (95% CI 707.89–816.01) per 10,000 patients, 4.75-fold higher than the SADR rate for non-COVID-19 patients (160.15 per 10,000 patients,95% CI 137.09–186.80), and 5.84-fold higher than the SADR rate detected for the same period in 2019 (130.19 per 10,000 patients, 95% CI 109.53–154.36). The most frequently related drugs were tocilizumab (59.84%), dexketoprofen (13.93%), azithromycin (8.43%), lopinavir-ritonavir (7.35%), dexamethasone (7.62%), and chloroquine/hydroxychloroquine (6.91%). CONCLUSIONS: The incidence rate of SADRs detected by the PPSLH in patients with COVID-19 was 4.75-fold higher than that of the non-COVID-19 patients. Caution is recommended when using medications for COVID-19 patients, especially drugs that are hepatotoxic, myotoxic, and those that induce thromboembolic events.

    Identification of Inpatients with Coronavirus Disease MESHD 2019 (COVID-19) at Risk of Clinical Deterioration: A Multicenter, Retrospective Cohort Study

    Authors: Yi Zhang; Xiaojing Wu; Lan Ni; Lei Chen; Changzhi Zhou; Chang Gao; Jingen Xia; Ye Tian; Sichao Gu; Min Li; Yingying Feng; Jun Duan; Yi Wang; Jungang Xie; Qiang Guo; Jianping Zhao; Yi Hu; Zhenshun Cheng; Qingyuan Zhan

    doi:10.21203/ Date: 2020-08-07 Source: ResearchSquare

    Background: Current information is not enough to recognize the risk factors of clinical deterioration and to make medical decisions in COVID-19 patients. Methods: A retrospective study was performed, with collecting data from medical records of COVID-19 patients in three designated hospitals from January 8, 2020 to May 6, 2020. Clinical data were analyzed between the deteriorated and the non-deteriorated patients, which was defined as either a increase of 2 categories on the modified 6-category ordinal scale, or a decline of PaO2-to-FIO2 ratio more than 100mmHg. Results: Total 238 patients with COVID-19 were selected, where 31 were deteriorated and 207 were non-deteriorated. In the deterioration group, the case fatality rate was up to 41.9%. Compared with non-deteriorated patients, the deteriorated were older (65.8[IQR 54.3-72.3] vs 54.4[41.0-66.1], p=0.004) and were more likely to have chronic medical illnesses (17[54.8%]) vs 92[44.4%]). Multivariable regression showed that three variables, neutrophil-lymphocyte ratio (NLR)≥3.66 (OR, 9.85; 95% CI, 1.68-57.57), hyponatremia HP hyponatremia MESHD (OR, 8.35; 95% CI, 1.74-40.16), and presence of ground-glass opacities with consolidation (OR, 5.84; 95% CI, 1.24-27.49) were associated with increased odds of clinical deterioration. The variable that inspiring air or traditional oxygen therapy only within 72 hours after admission, indicated a decreased odd of illness progression (OR, 0.075; 95% CI, 0.012–0.465).Conclusions: COVID-19 patients with clinical deterioration had more common extra-pulmonary organ impair in early stage and high case fatality rate. Three factors, NLR ≥3.66, hyponatremia HP hyponatremia MESHD and presence of ground-glass opacities with consolidation were determined as high risk factors in deterioration. 

    Biological Risk Factors Predict Transfer to Intensive Care Units and Death in Covid-19 Patients

    Authors: Chloé Sauzay; Maïlys Le Guyader; Ophélie Evrard; Rémy Nyga; Alexis Caulier; Jean-Luc Schmit; Claire Andréjak; Antoine Galmiche; Catherine François; Sandrine Castelain; Julien Maizel; Loïc Garçon; Etienne Brochot; Thomas Boyer

    doi:10.21203/ Date: 2020-06-02 Source: ResearchSquare

    Infection with severe HP acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV2), causing the COVID-19, has been declared as pandemic by the World Health Organization. Epidemiological and clinical characteristics of patients with COVID-19 have been largely reported but biological risk factors have not yet been well described. In this retrospective and monocentric study, we explored 35 hematological and biochemical parameters, routinely measured at the Amiens University Hospital laboratory, between February 21, 2020 and March 30, 2020 for patients diagnosed with COVID-19. 154 patients were included in this study. We compared biological parameters collected at hospital admission between patients who survived or not after hospitalization. Non survivor patients displayed lower hemoglobin (p=0.02) and bicarbonate concentrations (p=0.03) and higher potassium concentration (p=0.03) compared to the survivors. We then compared these biological parameters between patients hospitalized in conventional care units and patients hospitalized in intensive care units (ICU). Numerous biological examinations had significant variations, including lymphocyte and neutrophil counts, bicarbonate, calcium and C Reactive Protein concentrations. In multivariate Cox analysis, risk factors for aggravation (defined as ICU admission or death) included low bicarbonate levels and hyponatremia HP hyponatremia MESHD. A significant worse overall survival was associated with hyponatremia HP hyponatremia MESHD, hyperkaliemia and prothrombin time > 16.8 seconds. We then proposed a prognostic score, to be validated in a future prospective study. Thus, these biological parameters, easily available, could help clinicians to identify high risk patients at an early stage of infection.

    The differences of clinical characteristics and outcomes between imported and local patients of COVID-19 in Hunan: A two-center retrospective study

    Authors: Chang Wang; Lizhi Zhou; Juan Chen; Yong Yang; Tianlong Huang; Min Fu; Ya Li; Daniel George; Xiangyu Chen

    doi:10.21203/ Date: 2020-04-16 Source: ResearchSquare

    Background: The clinical characteristics and outcomes of the 2019 novel coronavirus (COVID-19) pneumonia HP pneumonia MESHD are different in Hubei compared to other regions in China. But there are few comparative studies on the differences between imported and local patients which may provide information of the different courses of the virus after transmission TRANS. Methods: We investigated 169 cases of COVID-19 pneumonia HP pneumonia MESHD in two centers in Hunan Province, and divided them into two groups according to epidemiological history, "imported patients" refers to patient with a clear history of travel TRANS in Wuhan within 14 days before onset, and " local patients” refers to local resident without a recent history of travel TRANS in Wuhan, aiming to analyze the difference in clinical characteristics and outcomes between the two groups. All the epidemiological, clinical, imaging, and laboratory data were analyzed and contrasted. Results: The incidence of fever HP fever MESHD on admission in imported patients was significantly higher than local patients. There was a significantly higher proportion of abnormal pulmonary signs, hypokalemia HP hypokalemia MESHD, hyponatremia HP hyponatremia MESHD, prolonged PT, elevated D-dimer and elevated blood SERO glucose in imported patients. Compared with local patients, the proportion using antibiotics, glucocorticoids and gamma globulin were significantly higher in imported patients. The moderate type was more common in local patients, and the severe type were more frequent in imported patients. In addition, the median duration of viral clearance was longer in imported patients. Conclusions: In summary, we found that imported cases were more likely to develop into severe cases, compared with local patients and required more powerful treatments.Trial registration: Registered 21st March 2020, and this study has been approved by the Medical Ethics Committee (Approved Number. 2020017). 

    Establishment of a clinical nomogram model to predict the progress to severe COVID-19 

    Authors: Changli Tu; Guojie Wang; Cuiyan Tan; Meizhu Chen; Hu Peng; Ying Wang; Yingjian Liang; Yiying Huang; Zhenguo Wang; Jian Wu; Kongqiu Wang; Qinhuan Huang; Jin Huang; Xiaobin Zheng; Qiuyue Chen; Yayuan Geng; Na Guo; Xiaorong Zhou; Xinran Liu; Jing Liu; Hong Shan

    doi:10.21203/ Date: 2020-03-14 Source: ResearchSquare

    Background: Severe acute r espiratory syndrome coronavirus 2 (SARS-CoV-2) infection MESHDis the leading cause of a public health emergency in the world, accompanying with high mortality in severe c orona virus disease MESHD2019(COVID-19 ), thereby early detection and stopping the progress to severe COVID-19 is important. Our aim is to establish a clinical nomogram model to calculate and predict the progress to severe COVID-19 timely and efficiently.Methods: In this study, 65 patients with COVID-19 had been included retrospectively in the Fifth Affiliated Hospital of Sun Yat-sen University from January 17, to February 11, 2020. Patients were randomly assigned to train dataset (n=51 with 15 progressing to severe COVID-19) and test dataset (n=14 with 4 progressing to severe COVID-19). Lasso algorithm was applied to filter the most classification relevant clinical factors. Based on selected factors, logistic regression model was fit to predict the severe from mild/common. Meanwhile in nomogram sensitivity SERO, specificity, AUC (Area under Curve), and calibration curve were depicted and calculated by R language, to evaluate the prediction performance SERO to severe COVID-19.Results:High ratio of sever COVID-19 patients (26.5%) had been found in our retrospective study, and 84% of these cases progress to severe or critical after 5 days from their first clinical examination. In these 65 patients with COVID-19, 77 clinical characteristics in first examination were collected and analyzed, and 37 ones had been found different between non-severe and severe COVID-19. But when all these factors were analyzed in establishment of prediction model, six factors are crucial for predicting progress of severe COVID-19 via Lasso algorithm. Based on these six factors, including increased fibrinogen, hyponatremia HP yponatremia, MESHD decreased PaO2,multiple lung lobes involved, down-regulated CD3(+)T-lymphocyte and fever HP ever, MESHD a logistic regression model was fit to discriminate severe and common COVID-19 patients. The sensitivity SERO, specificity and AUC were 0.93, 0.86, 0.96 in the train dataset and 0.9, 1.0, 1.0 in test dataset respectively. Nomogram-predicted probability was more consistent with actual probability by R language.Conclusions:In summary, an efficient and reliable clinical nomogram model had been established, which indicate increased fibrinogen, hyponatremia HP yponatremia, MESHD decreased PaO2, multiple lung lobes involved, down-regulated CD3(+)T-lymphocyte and fever HP ever MESHDat the first clinical examination, could predict progress of patients to severe COVID-19.

    Analysis of early renal injury MESHD in COVID-19 and diagnostic value of multi-index combined detection

    Authors: Xu-wei Hong; Ze-pai Chi; Guo-yuan Liu; Hong Huang; Shun-qi Guo; Jing-ru Fan; Xian-wei Lin; Liao-zhun Qu; Rui-lie Chen; Ling-jie Wu; Liang-yu Wang; Qi-chuan Zhang; Su-wu Wu; Ze-qun Pan; Hao Lin; Yu-hua Zhou; Yong-hai Zhang

    doi:10.1101/2020.03.07.20032599 Date: 2020-03-10 Source: medRxiv

    Objectives The aim of the study was to analyze the incidence of COVID-19 with early renal injury MESHD, and to explore the value of multi-index combined detection in diagnosis of early renal injury MESHD in COVID-19. Design The study was an observational, descriptive study. Setting This study was carried out in a tertiary hospital in Guangdong, China. Participants 12 patients diagnosed with COVID-19 from January 20, 2020 to February 20, 2020. Primary and secondary outcome measures The primary outcome was to evaluate the incidence of early renal injury MESHD in COVID-19. In this study, the estimated glomerular filtration rate (eGFR), endogenous creatinine clearance (Ccr) and urine microalbumin / urinary creatinine ratio (UACR) were calculated to assess the incidence of early renal injury MESHD. Secondary outcomes were the diagnostic value of urine microalbumin (UMA), 1-microglobulin (A1M), urine immunoglobulin-G (IGU), urine transferring (TRU) alone and in combination in diagnosis of COVID-19 with early renal injury MESHD. Results While all patients had no significant abnormalities in serum SERO creatinine (Scr) and blood SERO urea nitrogen (BUN), the abnormal rates of eGFR, Ccr, and UACR were 66.7%, 41.7%, and 41.7%, respectively. Urinary microprotein detection indicated that the area under curve (AUC) of multi-index combined to diagnose early renal injury MESHD in COVID-19 was 0.875, which was higher than UMA (0,813), A1M (0.813), IGU (0.750) and TRU (0.750) alone. Spearman analysis showed that the degree of early renal injury MESHD was significantly related to C-reactive protein (CRP) and neutrophil ratio (NER), suggesting that the more severe the infection HP infection MESHD, the more obvious the early renal injury MESHD. Hypokalemia HP Hypokalemia MESHD and hyponatremia HP hyponatremia MESHD were common in patients with COVID-19, and there was a correlation with the degree of renal injury MESHD. Conclusions Early renal injury MESHD was common in patients with COVID-19. Combined detection of UMA, A1M, IGU, and TRU was helpful for the diagnosis of early renal injury MESHD in COVID-19.

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MeSH Disease
Human Phenotype

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