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

The tuberculosis (TB) dispensary patients are often diagnosed with cardiac diseases, but the regulatory documents associated with TB care refer to the procedures and standards of examination and treatment of TB patients or patients with suspected TB while the management of associated chronic diseases is carried out in other medical institutions. There is lack of continuity between doctors of diff erent specialties. Patients face organizational problems of accessibility and quality of medical care. The creation of Department of Medical and Social Care and Rehabilitation in TB dispensary with therapeutic profi le specialists became especially urgent in the period of coronavirus pandemic.Aim. The aim of the study was to estimate the expediency and eff ectiveness of Department of Medical and Social Care and Rehabilitation in detection and treatment of comorbid cardiac pathology in patients of TB dispensary during coronavirus (COVID-19) pandemic.Material and Methods. All patients of the St. Petersburg TB dispensary No. 5 were examined according to specially developed algorithm to detect and treat the cardiac pathology comorbid with TB. Results. Cardiac diseases comorbid with tuberculosis were detected using an integrated multidisciplinary approach to examination of TB patients during the pandemic of coronavirus infection. Examination, consultation, and necessary treatment were carried out directly in TB dispensary allowing to avoid disease exacerbations and complications during the entire period of monitoring.Conclusion. The establishment of Department of Medical and Social Care and Rehabilitation in TB dispensary No. 5 showed the relevance and timeliness of this measure. The coronavirus genesis of some cardiac diseases required to revise the management tactics of aff ected tuberculosis patients.

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Interdisciplinary approach to revealing cardiac pathology in TB patients during the COVID-19 pandemic

The article presents a review of bibliographic data on risk factors and mechanisms of the damage to the heart tissues in a new coronavirus infection. The direct viral-associated injury, as well as the influence of the components of the cytokine storm are analyzed. Myocarditis, cardiac arrhythmias are considered. In addition, the first results of long-term follow-up observations of patients who underwent COVID-19 were summarized, and the change in arterial stiffness was assessed.

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O. V. Khlynova

Papers

Heart injury in COVID-19: immediate and long-term follow-up