Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

https://www.commed.vcu.edu/Chronic_Disease/2012/cochranrvwrschbias.pdf

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

Endometriosis

The pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused an unprecedented global social and economic impact, and high numbers of deaths. Many risk factors have been identified in the progression of COVID-19 into a severe and critical stage, including old age, male gender, underlying comorbidities such as hypertension, diabetes, obesity, chronic lung diseases, heart, liver and kidney diseases, tumors, clinically apparent immunodeficiencies, local immunodeficiencies, such as early type I interferon secretion capacity, and pregnancy. Possible complications include acute kidney injury, coagulation disorders, thoromboembolism. The development of lymphopenia and eosinopenia are laboratory indicators of COVID-19. Laboratory parameters to monitor disease progression include lactate dehydrogenase, procalcitonin, high-sensitivity C-reactive protein, proinflammatory cytokines such as interleukin (IL)-6, IL-1β, Krebs von den Lungen-6 (KL-6), and ferritin. The development of a cytokine storm and extensive chest computed tomography imaging patterns are indicators of a severe disease. In addition, socioeconomic status, diet, lifestyle, geographical differences, ethnicity, exposed viral load, day of initiation of treatment, and quality of health care have been reported to influence individual outcomes. In this review, we highlight the scientific evidence on the risk factors of severity of COVID-19.

Risk factors for severe and critically ill COVID-19 patients: A review.

Coronavirus disease-2019 (COVID-19) is a life-threatening infection caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. Diabetes has rapidly emerged as a major comorbidity for COVID-19 severity. However, the phenotypic characteristics of diabetes in COVID-19 patients are unknown. We conducted a nationwide multicentre observational study in people with diabetes hospitalised for COVID-19 in 53 French centres in the period 10–31 March 2020. The primary outcome combined tracheal intubation for mechanical ventilation and/or death within 7 days of admission. Age- and sex-adjusted multivariable logistic regressions were performed to assess the prognostic value of clinical and biological features with the endpoint. ORs are reported for a 1 SD increase after standardisation. The current analysis focused on 1317 participants: 64.9% men, mean age 69.8 ± 13.0 years, median BMI 28.4 (25th–75th percentile: 25.0–32.7) kg/m2; with a predominance of type 2 diabetes (88.5%). Microvascular and macrovascular diabetic complications were found in 46.8% and 40.8% of cases, respectively. The primary outcome was encountered in 29.0% (95% CI 26.6, 31.5) of participants, while 10.6% (9.0, 12.4) died and 18.0% (16.0, 20.2) were discharged on day 7. In univariate analysis, characteristics prior to admission significantly associated with the primary outcome were sex, BMI and previous treatment with renin–angiotensin–aldosterone system (RAAS) blockers, but not age, type of diabetes, HbA1c, diabetic complications or glucose-lowering therapies. In multivariable analyses with covariates prior to admission, only BMI remained positively associated with the primary outcome (OR 1.28 [1.10, 1.47]). On admission, dyspnoea (OR 2.10 [1.31, 3.35]), as well as lymphocyte count (OR 0.67 [0.50, 0.88]), C-reactive protein (OR 1.93 [1.43, 2.59]) and AST (OR 2.23 [1.70, 2.93]) levels were independent predictors of the primary outcome. Finally, age (OR 2.48 [1.74, 3.53]), treated obstructive sleep apnoea (OR 2.80 [1.46, 5.38]), and microvascular (OR 2.14 [1.16, 3.94]) and macrovascular complications (OR 2.54 [1.44, 4.50]) were independently associated with the risk of death on day 7. In people with diabetes hospitalised for COVID-19, BMI, but not long-term glucose control, was positively and independently associated with tracheal intubation and/or death within 7 days. 
clinicaltrials.gov

 NCT04324736.

/pdf/phenotypic-characteristics-and-prognosis-of-inpatients-with-2w5rrn6uht.pdf

Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study.

DK-crush, an elegant way to correct stent de-crimping and loss.

A 74-year-old woman was admitted in circulatory shock and acute respiratory failure. Standard 12-lead electrocardiogram showed sinus rhythms with an incomplete right bundle branch block. Chest X-ray revealed an area of focal oligemia in the right lower lung (Westermark’s sign) (Fig. 1, panel A, area between the two white triangles) and a significantly dilated right descending pulmonary artery with a “sausage-like” appearance (Palla’s sign), (Fig. 1, panel A, arrow). Subsequent emergent computed tomography angiography (CTA) demonstrated a largesized pulmonary embolus (Fig. 1, panel B, arrow) into the right pulmonary artery, consistent with acute pulmonary embolism (PE). Catheter-direct treatment (CDT) was successfully performed. The concomitant existence of both Westermark’s and Palla’s has been rarely reported. However, their presence is helpful to suspect acute PE also in the CTA era.

Chest X-ray in acute pulmonary embolism: forgiven but not forgotten.

Mathematics and thrombolysis: Role of the mathematical modelling in understanding and developing blood clot fragmentation.

Game theory and microarray analysis in coronary artery disease and atherosclerosis: Math helps the cardiology research.

Current guidelines on the management of dyslipidemias of the European Society of Cardiology/European Atherosclerosis Society recommend reducing low-density lipoprotein cholesterol (LDL-C) in patients after an acute coronary syndrome (ACS) by ≥50% compared to baseline values with a LDL-C level below 1.4 mmol/l (55 mg/dl) (class I recommendation, level of evidence A). However, in the real world, a low proportion of patients is treated according to the recommended lipid-lowering therapies and, as a consequence, very few people reach these targets. We analyzed seven recent studies reporting data on lipid control in 36 354 patients who were at very high risk because of a previous ACS in Europe. Overall, only 12.1% (95% confidence interval 9.8-13.5) of the patients achieved the recommended LDL-C levels, highlighting the gap between guidelines and current clinical practice. Indeed, the so-called stepwise strategy, although effective from a theoretical point of view, seems hardly applicable in the real world, underlying the need for new therapeutic strategies and algorithms. Based on these observations, a protocol has been proposed for the appropriate management of LDL-C levels in post-ACS patients both in terms of therapeutic choice and timing of treatment use.

Marco Zuin

Papers

DK-crush, an elegant way to correct stent de-crimping and loss.

Chest X-ray in acute pulmonary embolism: forgiven but not forgotten.

Mathematics and thrombolysis: Role of the mathematical modelling in understanding and developing blood clot fragmentation.

Game theory and microarray analysis in coronary artery disease and atherosclerosis: Math helps the cardiology research.

[Real-world efficacy of current lipid-lowering strategies in patients with acute coronary syndrome. Time to change the paradigm for treatment].