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SARS-CoV-2 proteins

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    Myocardial Injury at Early Stage and Its Association with Death Risk of Patients with COVID-19 MESHD: A Hospital-Based Prospective Case-Cohort Study

    Authors: Lin Fu; Xiu-Yong Li; Jun Fei; Ying Xiang; Hui-Xian Xiang; Meng-Die Li; Fang-Fang Liu; Ying Li; Hui Zhao; De-Xiang Xu

    doi:10.21203/rs.3.rs-34902/v1 Date: 2020-06-12 Source: ResearchSquare

    Background: There are growing evidence demonstrating that coronavirus disease 2019 MESHD ( COVID-19 MESHD) is companied by acute myocardial injury MESHD. However, the association of SARS-CoV-2-induced myocardial injury MESHD with death risk of COVID-19 MESHD is unclear.Methods: This prospective case-cohort study analyzed 355 COVID-19 MESHD patients from two hospitals in different regions. Clinical and demographic information were collected. Myocardial injury MESHD was evaluated and its prognosis was followed up. Results: Of 355 hospitalized patients with COVID-19 MESHD, 213 were mild, 90 severe and 52 critically ill MESHD patients. On admission, 220 (62.0%) patients were with myocardial injury MESHD. Myocardial injury MESHD was more popular in critically ill MESHD patients. Using multivariate logistic regression, male, older age and comorbidity with hypertension MESHD were three crucial independent risk factors predicting myocardial injury MESHD of COVID-19 MESHD patients. Among 220 COVID-19 MESHD patients with myocardial injury MESHD, 33 (15.0%) died on mean 10.9 day after hospitalization. Mortality was increased among COVID-19 MESHD patients with myocardial injury MESHD (15.0% vs 1.74%, RR=8.625, P<0.001). Follow-up study observed that at least one myocardial index of 21.3% patients remained abnormal 14 days after discharge. Conclusion: Myocardial injury MESHD at early stage elevates mortality of COVID-19 MESHD patients. Male elderly patients with hypertension MESHD are more vulnerable to myocardial injury MESHD. SARS-CoV-2-induced myocardial injury MESHD has not completely recovered 14 days after discharge.

    Life-threatening cardiogenic shock in a pediatric patient with SARS-CoV-2-associated myocarditis treated with remdesivir: a case description and report of similar cases from the Literature

    Authors: Silvia Molinari; Lucia M.D. Colasanto; Maria L. Melzi; Alessandro Cattoni; Roberto Panceri; Michela Bombino; Giuseppe Lapadula; Andrea Biondi

    doi:10.21203/rs.3.rs-34802/v1 Date: 2020-06-12 Source: ResearchSquare

    BackgroundChildren are relatively spared from Coronavirus disease 2019 MESHD ( COVID-19 MESHD), but some severe cases have been reported. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection MESHD in children may affect the cardiovascular system. We hereby report about a case of myocarditis MESHD evolving to cardiogenic shock MESHD in a SARS-CoV-2 positive child.Case presentationAn otherwise healthy 12-year-old patient was admitted with fever MESHD, vomiting MESHD, diarrhoea and drowsiness MESHD, without any respiratory symptoms. He was diagnosed with COVID-19 MESHD on nasopharyngeal swab. He developed hypotension MESHD and cardiogenic shock MESHD. Bedside echocardiography revealed left ventricular impairment MESHD with an ejection fraction (LVEF) below 25%. Plasmatic markers of myocardial injury MESHD were remarkably raised, as well as inflammatory biomarkers, including procalcitonin (highest recorded value: 66 ng/mL) and interleukin-6 HGNC (8209 pg/mL). The child was transferred to Intensive Care Unit and he was treated with catecholamine support, mechanical ventilation and empiric anti-infectious therapy, including broad spectrum antibiotics and the antiviral agent remdesivir. All additional microbiological investigations yielded negative results. We observed a gradual improvement of LVEF within 5 days. A cardiac magnetic resonance confirmed the suspicion of myocarditis MESHD. After 21 days of hospitalisation, the child was discharged without sequelae.ConclusionsOur hypothesis is that the child suffered from SARS-CoV-2-induced fulminant myocarditis MESHD, probably in the setting of cytokine release syndrome (CRS). The peculiarity of this SARS-CoV-2 infection MESHD is the presence of cardiac failure MESHD in a previously healthy child without a respiratory illness MESHD. The positive outcome is in line with published Literature about the overall better prognosis of COVID-19 MESHD children compared to adults. Remdesivir, an investigational antiviral therapy, may have played a role on the clinical improvement of the child.

    Risk factors and electrocardiogram characteristics for mortality of critical inpatients with COVID-19 MESHD

    Authors: Lingzhi Li; Shudi Zhang; Bing He; Xiaobei Chen; Shihong Wang; Zhao Qingyan

    doi:10.21203/rs.3.rs-33824/v1 Date: 2020-06-05 Source: ResearchSquare

    Background The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has subsequently spread worldwide. The number of death MESHD has increased rapidly. However, the possible risk factors that lead to death in critical inpatients with coronavirus disease 2019 MESHD ( COVID-19 MESHD) are not yet fully known. This study was to explore the risk factors for mortality of critical inpatients with COVID-19 MESHD.Methods In this single-centered, retrospective study, we enrolled 113 critical patients with COVID-19 MESHD in Renmin Hospital of Wuhan University between Feb 1, 2020 and Mar 15, 2020. Data were collected using a standard method including clinical records and laboratory findings. Outcomes of survivors and death were compared.Results A total of 113 critical patients (from 29 to 95 years) with COVID-19 MESHD were recruited, 50 (44.25%) died and 63 recovered (55.75%). The proportion of patients with ventricular arrhythmia MESHD was higher in the death group than the recovery group (24.0% vs 4.4%; p = 0.021), and was higher among myocardial damage MESHD cases than non-myocardial damage cases (26.1% vs 4.3%; p = 0.013). Multivariate analysis confirmed four independent predictors related to mortality of COVID-19 MESHD: age > 70 yrs (HR 1.84, 95% CI 1.03–3.28), initial neutrophil count more than 6.5 × 109/L (HR 3.43, 95% CI 1.84–6.40), C-reactive protein HGNC greater more than 100 mg/L (HR 1.93, 95% CI 1.04–3.59), and lactate dehydrogenase more than 300 U/L (HR 2.90, 95% CI 1.26–6.67). Immunoglobulin treatment (HR 0.39, 95% CI 0.21–0.73) can reduce the risk of death MESHD. There was no significant difference in the QT interval between patients with and without hydroxychloroquine treatment.Conclusions Old age (> 70 years), neutrophilia, C-reactive protein greater more than 100 mg/L and lactate dehydrogenase more than 300 U/L are high-risk factors for mortality of critical patients with COVID-19 MESHD. The incidence of ventricular arrhythmia MESHD was higher in deceased patients than survivors.

    Role of pulmonary circulation assessment in CT imaging in evaluating the severity and tendency of severe and critical COVID-19 MESHD pneumonia

    Authors: Qiongjie Hu; Yiwen liu; Yueying Pan; Ziyan Sun; Min Xiang; Kaiyan li; Liming Xia; huilan Zhang; Hanxiong Guan

    doi:10.21203/rs.3.rs-32243/v1 Date: 2020-05-28 Source: ResearchSquare

    Objective: To investigate the value of changes of pulmonary circulation in CT imaging in evaluating the severity and tendency of 2019 novel coronavirus disease MESHD ( COVID-19 MESHD) pneumonia MESHD.Methods: This retrospective study analyzed 99 severe and critical COVID-19 MESHD pneumonia MESHD patients including the 47 improved cases and 52 dead cases. Demographic data, laboratory findings, comorbidities, and CT imaging features including the diameters of pulmonary vein (PV), pulmonary artery MESHD ( PA MESHD) and ascending aorta were collected and assessed.Results: The PV diameters of the deceased patients were larger than recovered patients in the severe phase. Compared with the severe phase in the improvement group, the diameters of the pulmonary veins during the improved phase were smaller, and the total CT scores were significantly decreased (p < 0.001). Instead, there was no significant difference in the ratio of main PA MESHD to aorta diameter between the recovered group and the deceased group, nor did the self control of the recovered group and the deceased group (p > 0.05). Construction of a ROC curve yielded an optimal cut-off value of the PV diameters for prediction of survival (p < 0.05).Conclusion: The changes of the PV diameters might indirectly reflect the activity of pulmonary inflammation MESHD and cardiac insufficiency MESHD. Pulmonary manifestations of severe and critical COVID-19 MESHD pneumonia MESHD might be related to myocardial injury MESHD and cardiac insufficiency MESHD, expecially accompanied by dilated PVs. Evaluation of changes in pulmonary circulation by chest CT images may be considered as a useful tool for determining the severity, fatal outcome and tendency of COVID-19 MESHD.Key words: COVID-19 MESHD, pneumonia MESHD, pulmonary circulation MESHD, Computed Tomography

    THE LOW-HARM SCORE FOR PREDICTING MORTALITY IN PATIENTS DIAGNOSED WITH COVID-19 MESHD: A MULTICENTRIC VALIDATION STUDY

    Authors: Adrian Soto-Mota; Braulio A. Marfil Garza; Erick Martinez Rodriguez; Jose Omar Barreto Rodriguez; Alicia Estela Lopez Romo; Paolo Alberti Minutti; Juan Vicente Alejandre Loya; Felix Emmanuel Perez Talavera; Freddy Jose Avila-Cervera; Adriana Nohemi Velazquez Burciaga; Oscar Morado Aramburo; Luis Alberto Pina Olguin; Adrian Soto-Rodriguez; Andres Castaneda Prado; Patricio Santillan-Doherty; Juan O Galindo Galindo; Daniel Hernandez Gordillo; Juan Gutierrez Mejia

    doi:10.1101/2020.05.26.20111120 Date: 2020-05-27 Source: medRxiv

    ABSTRACT - Importance: Many COVID-19 MESHD prognostic factors for disease severity have been identified and many scores have already been proposed to predict death MESHD and other outcomes. However, hospitals in developing countries often cannot measure some of the variables that have been reported as useful. - Objective: To assess the sensitivity, specificity, and predictive values of the novel LOW-HARM score ( Lymphopenia MESHD, Oxygen saturation, White blood cells, Hypertension MESHD, Age, Renal injury MESHD, and Myocardial injury MESHD). - Design: Demographic and clinical data from patients with known clinical outcomes ( death MESHD or discharge) was obtained. Patients were grouped according to their outcome. The LOW-HARM score was calculated for each patient and its distribution, potential cut-off values and demographic data were compared. - Setting: Thirteen hospitals in ten different cities in Mexico. - Participants: Data from 438 patients was collected. A total of 400 (200 per group) was included in the analysis. - Exposure: All patients had an infection with SARS-CoV-2 confirmed by PCR. - Main Outcome: The sensitivity, specificity, and predictive values of different cut-offs of the LOW-HARM score to predict death. - Results: Mean scores at admission and their distributions were significantly lower in patients who were discharged compared to those who died during their hospitalization 10 (SD: 17) vs 71 (SD: 27). The overall AUC of the model was 95%. A cut-off > 65 points had a specificity of 98% and a positive predictive value of 96%. More than a third of the cases (34%) in the sample had a LOW-HARM score > 65 points. - Conclusions and relevance: The LOW-HARM score measured at admission is highly specific and useful for predicting mortality. It is easy to calculate and can be updated with individual clinical progression. The proposed cut-off can assist the decision-making process in more than a third of the hospital admissions.

    Acute cardiac injury in patients with COVID-19 MESHD

    Authors: Andrea De Lorenzo; Daniel Kasal; Bernardo Tura; Cristiane Lamas; Helena Rey

    doi:10.1101/2020.05.18.20105866 Date: 2020-05-22 Source: medRxiv

    Introduction: Cardiac complications of COVID-19 MESHD are potentially life-threatening. The occurrence of myocardial injury MESHD in the context of COVID-19 MESHD is multifactorial and has generated increasing interest. Methods: A systematic review with meta-analysis of the literature was performed. MEDLINE and EMBASE were searched. Two independente reviewers evaluated the selected manuscripts for the outcome myocardial injury MESHD, defined by troponin elevation above the 99th percentile. Study heterogeneity and risk of bias were evaluated. Results: Eight studies, with a total of 1229 patients, were included. The frequency of myocardial injury MESHD was 16% (95% CI: 9% - 27%). The heterogeneity among studies was high (93%). Conclusions: Myocardial injury MESHD may occur in patients with COVID-19 MESHD, with a frequency of 16% among current studies. Continuous research is needed to update these findings, as the pandemic evolves, and to define the implications of myocardial injury MESHD in the context of this infection.

    Pre-existing Cardiovascular Disease in United States Population at High Risk for Severe COVID-19 MESHD Infection

    Authors: Adnan I Qureshi

    doi:10.1101/2020.05.11.20089714 Date: 2020-05-15 Source: medRxiv

    Background and Purpose There is increasing recognition of a relatively high burden of pre-existing cardiovascular disease MESHD in Corona Virus Disease MESHD 2019 (COVID 19) infected MESHD patients. We determined the burden of pre-existing cardiovascular disease MESHD in persons residing in United States (US) who are at risk for severe COVID-19 MESHD infection. Methods Age (60 years or greater), presence of chronic obstructive pulmonary disease MESHD, diabetes MESHD, mellitus MESHD, hypertension MESHD, and/or malignancy were used to identify persons at risk for admission to intensive care unit, or invasive ventilation, or death MESHD with COVID-19 MESHD infection. Persons were classified as low risk (no risk factors), moderate risk (1 risk factor), and high risk (two or more risk factors present) using nationally representative sample of US adults from National Health and Nutrition Examination Survey 2017 and 2018 survey. Results Among a total of 5856 participants, 2386 (40.7%) were considered low risk, 1325 (22.6%) moderate risk, and 2145 persons (36.6%) as high risk for severe COVID-19 MESHD infection. The proportion of patients who had pre-existing stroke MESHD increased from 0.6% to 10.5% in low risk patients to high risk patients (odds ratio [OR]19.9, 95% confidence interval [CI]11.6-34.3). The proportion of who had pre-existing myocardial infection MESHD ( MI MESHD) increased from 0.4% to 10.4% in low risk patients to high risk patients (OR 30.6, 95% CI 15.7-59.8). Conclusions A large proportion of persons in US who are at risk for developing severe COVID 19 infection are expected to have pre-existing cardiovascular disease MESHD. Further studies need to identify whether targeted strategies towards cardiovascular diseases MESHD can reduce the mortality in COVID-19 MESHD infected MESHD patients.

    Myocardial characteristics as the prognosis for COVID-19 MESHD patients

    Authors: Jianguo Zhang; Daoyin Ding; Can Cao; Jinhui Zhang; Xing Huang; Peiwen Fu; Guoxin Liang; Wenrong Xu; Zhimin Tao

    doi:10.1101/2020.05.06.20068882 Date: 2020-05-09 Source: medRxiv

    Background Amid the crisis of coronavirus disease 2019 MESHD ( COVID-19 MESHD) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), front-line clinicians in collaboration with backstage medical researchers analyzed clinical characteristics of COVID-19 MESHD patients and reported the prognosis using myocardial data records upon hospitalization. Methods We reported 135 cases of laboratory-confirmed COVID-19 MESHD patients admitted in The First People's Hospital of Jiangxia District in Wuhan, China. Demographic data, medical history, and laboratory parameters were taken from inpatient records and compared between patients at the Intensive Care Unit (ICU) and non-ICU isolation wards for prognosis on disease severity. In particular, survivors and non-survivors upon ICU admission were compared for prognosis on disease mortality. Results For COVID-19 MESHD patients, blood test results showed more significantly deranged values in the ICU group than those in non-ICU. Among those parameters for ICU patients, myocardial variables including troponin T, creatine kinase isoenzymes, myoglobin HGNC, were found significantly higher in non-survivors than in survivors. Conclusions Upon hospitalization abnormal myocardial metabolism MESHD in COVID-19 MESHD patients could be prognostic indicators of a worsened outcome for disease severity and mortality.

    Development and External Validation of a Nomogram for Early Predicting in-hospital Mortality of Patients with SARS-CoV-2 Pneumonia: A Two-Center, Retrospective Analysis

    Authors: Miao Luo; Junlin Lu; Jing Liu; Shuli Xia; Shuang Wei

    doi:10.21203/rs.3.rs-27780/v1 Date: 2020-05-08 Source: ResearchSquare

    Background At present, the death cases with SARS-CoV-2 pneumonia MESHD are continuing to increase globally. However, the information on death cases and predictive methods are substantial lacking. We aimed to develop a nomogram, which was validated by both internal and external cohorts, for early predicting mortality in hospitalized patients with SARS-CoV-2 pneumonia MESHD.Methods We retrospectively collected data on 1,540 patients confirmed SARS-CoV-2 pneumonia MESHD from two hospitals. Multivariate logistic regression analysis was performed to examine factors associated with in-hospital mortality. We investigated the mortality related risk factors and their weights, thereafter designed and validated a predictive nomogram model to facilitate early discrimination of in-hospital death. We assessed the nomogram performance by examining calibration (calibration plots and Hosmer–Lemeshow calibration test) and discrimination (AUROC). We also plotted survival curves and decision curves to evaluate the clinical usefulness of the nomogram.Results In the 1,540 patients from two centers, 248 cases died (16.1%). In the predictive nomogram calculated by a multivariate logistic regression analysis, eight independent risk factors associated mortality included age ≥ 60 years (odd ratio(OR) = 2.840; 95%CI, 1.467–5.495; P = 0.002), respiratory rate ≥ 30 breaths per minute (OR = 3.308; 95%CI, 1.408–7.770; P = 0.006), neutrophil count ≥ 7 × 109/L (OR = 3.084; 95%CI, 1.667–5.707; P < 0.001), lymphocyte count ≤ 0.8 × 109/ L (OR = 4.688; 95%CI, 2.500-8.791; P < 0.001), d-dimer ≥ 1.5 µg/mL(OR = 2.159; 95%CI, 1.169–3.989; P = 0.014), lactate dehydrogenase ≥ 350U/L(OR = 4.385; 95%CI, 2.299–8.362; P < 0.001), procalcitonin ≥ 0.1 ng/mL(OR = 4.972; 95%CI, 2.537–9.746; P < 0.001), and presence of myocardial injury MESHD (OR = 2.289; 95%CI, 1.260–4.160; P = 0.007) on admission. Calibration curves showed good fitting of the nomogram model with no statistical significance (P = 0.740) by Hosmer-Lemeshow test. This predictive nomogram had better predictive ability than CURB-65 score in training set (AUROC = 0.956 vs 0.828,P < 0.001). The good predictive performance of the nomogram is suggested by calibration, discrimination, and survival curve analysis, whether in the training, internal or external validation set. The decision curve analysis showed that predicting mortality risk applying this nomogram would be better than having all patients or none patients.Conclusions This nomogram is a reliable prognostic method that can accurately and early predict in-hospital mortality in patients with SARS-CoV-2 pneumonia MESHD. It can guide clinicians to improve their abilities to evaluate patient prognosis, enhance patient stratification, make earlier and reasonable decisions.Trail registration: This is a retrospective observational study without a trial registration number.

    Favorable outcomes of elderly COVID-19 MESHD patients in Guangzhou, China: a retrospective, observational study

    Authors: Gang Xu; Jun Zhao; Fuchun Zhang; Feng Liu; Congrui Feng; Yudong Hu; Yuluo Chen; Liuqian Wang; Yuwei Tong; Yueping Li; Haiyan Shi; Wei Ma

    doi:10.21203/rs.3.rs-26511/v1 Date: 2020-05-02 Source: ResearchSquare

    Objective: To clarify the outcomes of elderly patients with COVID-19 MESHD.Methods: All 265 confirmed adult patients with COVID-19 MESHD were included in this retrospective study, 43 (16.2%) of whom were 65 years and older. Electronic medical records of the subjects were reviewed to obtain information on clinical characteristics and outcomes. The allocations of medical resource were also recorded.Results: Only one death case occurred in the elderly. The mortality of elderly patients was no higher than that of young patients (2.3% vs. 0%, P = 0.126). The cure rate was 95.3% in elderly patients and 99.5% in young patients (P = 0.067), and the duration of hospitalization is 27 days in elderly patients and 18 days in young patients (P = 0.001). The elderly suffered from more comorbidities (67.4% vs. 24.8%, P < 0.001), most of which is hypertension MESHD. Significantly more severe cases occurred in elderly patients compared with young patients (37.2% vs. 16.7%, P = 0.004). The elderly were more likely to present with complications including acute respiratory distress syndrome MESHD, acute myocardial injury MESHD, septic shock MESHD and acute kidney injury MESHD (all P < 0.05), respectively. No medical staffs were infected during the treatment of COVID-19 MESHD.Conclusion: The cure rate and the mortality of the elderly seemed to be no worse than that of the young, though the elderly were with longer hospitalization. Elderly patients with COVID-19 MESHD could be treatable if handled properly. More severe cases and complications in elderly patients should prompt for more complex treatment and special considerations.

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MeSH Disease
HGNC Genes
SARS-CoV-2 Proteins


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