The pandemic of the Coronavirus Disease 2019 (COVID-19) is ongoing exacerbated worldwide. The clinical consequence of this disease was characterized with pneumonia and hypoxemia, even systemic injuries, especially in severe cases. Patients with underlying chronic cardiovascular diseases, or complicated with new onsetting cardiovascular problems, were correlated with a high mortality. However, the mechanisms of myocardial and vascular damage complicated with SARS-CoV-2 viral infection have not been clarified yet. They might be correlated with direct viral invasion, severe hypoxemia, and systemic cytokine storm. Hence, the therapeutic strategy for SARS-CoV2 viral infections related to myocardial and vascular damage, and the protocol for critical ill patients with emergent cardiovascular problems need comprehensive research urgently.
Objective To evaluate the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in coronavirus disease 2019 (COVID-19) patients. Methods PubMed, MedRxiv and bioRxiv, WangFang Data, CNKI, VIP, and Chinese Medical Journal Network databases were searched to collect researches for COVID-19 up to April 10, 2020. RevMan 5.3 software was used for meta-analysis. Two evaluators independently screened the literature, extracted the data, and evaluated the risk of bias of relevant studies. Results There were 18 studies included. Among the 2 405 patients, 1 898 of them suffered from not severe COVID-19 (non-severe group), and the rest 507 patients from severe COVID-19 (severe group). The severe group had significantly higher proportion of transaminase abnormality/liver injury when compared with the non-severe group (OR=0.35, 95%CI: 0.27~0.46, Z=7.78, P < 0.000 01; RR=0.53, 95%CI: 0.46~0.61, Z=8.60, P < 0.000 01). Obvious differences were seen in the transferase levels between the 2 groups (ALT: MD=-0.63 U/L, 95%CI: -1.26~-0.01, Z=2.00, P=0.05; AST: MD=-0.81 U/L, 95%CI: -1.45~-0.16, Z=2.46, P=0.01). Conclusion COVID-19 maybe accompanied with liver injury. There are a larger proportion of patients with transaminase abnormality/liver injury in the severe COVID-19 patients, especially in the abnormality.
Objective To investigate the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) in non-endemic areas. Methods From January 2020, the Nanjing Public Health Medical Center began to treat confirmed patients. Retrospective analysis was carried out in 57 patients with identified novel coronavirus-infected pneumonia and having been discharged for the epidemiological characteristics, clinical signs and symptoms, laboratory test results, and CT images. Results The 57 patients were at an age ranging from 5 to 97 years (median 37 years), and 29 males (50.9%) and 28 females (49.1%). Among them, 35 cases had clear contact with the epidemic area Wuhan, and 16 were clustered cases. The average incubation period was 7.4 d for the disease. In them, 54 cases occurred locally, 23 patients had fever as the first symptom, and 13 patients had normal temperature. Other main first symptoms included dry cough (14 cases, 24.6%) and body aches and fatigue (5 cases, 8.8%). The patients with decreased peripheral white blood cell count accounted for 26.3%, those with reduced lymphatic or eosinophils count for 47.4%, those with increased average platelet volume for 24.7%, elevated serum ALT or AST levels for 15.8%, raised CKMB for 5.3%, and those with decreased blood potassium for 40.4%. All patients had lung illness and were positive to nucleic acid test, and 66.7% of them got both lung involved. Of the 57 patients, 26.3% were mild and 73.7% were ordinary. Their average length of hospital stay was 10.1 d, and they had an average course of 15.6 d. All of them were treated with interferon αb1 combined with acetylcysteine, 47 cases were combined with kriging, and 18 cases with abidol. All the 57 cases were improved and discharged. Conclusion All these cases in Najing are almost imported from the epidemic area. The clinical classification is mainly ordinary type. Low fever, dry cough, sore throat and systemic soreness, decreased lymphocytes, ground glass shadow in CT images, and positive to nucleic acids are the main clinical features of the disease.
Objective: To explore the clinical features of 143 patients suffering from coronavirus disease 2019 (COVID-19) in the Northeast area of Chongqing
2019 coronavirus disease (COVID-19) is an infectious disease caused by SARS-COV-2 virus, and lacks specifically effective treatment till now. Its clinical manifestations and the concerning studies at home and abroad have shown that viral sepsis caused by SARS-COV-2 virus has typical characteristics of pathophysiology of sepsis, that is, early cytokine storm and subsequent immunosuppression stage. At present, although great attention has been paid to the treatment and clinical research on cytokine storm, the later stage of immunosuppression is neglected. Patients' lower immunity, secondary infection and multiple organ failure are quite common, and all these lead to rapid deterioration and even death. Therefore, it is of great significance to pay attention to the investigation and treatment of sepsis immunosuppression stage caused by COVID-19, and to study the drugs with bidirectional immune regulation such as artesunate so as order to reduce the mortality of patients with severe or critical COVID-19. What's more, we strongly recommend that chloroquine phosphate should be used with great caution for severe and critical patients.
