Scientific Research News | Research Progress of novel coronavirus Pneumonia (COVID-19) (44)

■ On March 3, researchers from Xinhua Hospital and Hubei Provincial Maternal and Child Health Care Hospital of Shanghai Jiao Tong University School of Medicine published a paper "Clinical and CT imaging features of the COVID-21 pneumonia: Focus on pregnant women and children" in the Journal of Infection. The investigation reported clinical and CT features of pregnant women and children with COVID-19 pneumonia.

This article retrospectively analyzes clinical and CT data from 2020 COVID-1 patients from 27 January to 2 February 14, including 59 laboratory-confirmed non-pregnant adults, 19 laboratory-confirmed pregnant women and 14 clinically confirmed pregnant women, and 16 laboratory-confirmed children, analysing and comparing their clinical and CT features. The study found that some symptoms were more common in the laboratory-confirmed (n=25) and clinically diagnosed (n=4) pregnant women than in the nonpregnant adult group (n=14): initial normal temperature (16 [25%] and 9 [56%], corresponding to laboratory-confirmed and clinically confirmed pregnant women, respectively), leukocytosis (16 [64%] and 8 [50%]), elevated neutrophil ratio (9 [36%] and 14 [88%]), and lymphopenia (20 [80%] and 9[56％]）； In 16 (64%) and 54 (98%) patients, lesions were predominantly distributed peripherally and bilaterally, respectively, and a total of 37 lesions were detected. In nonpregnant adults, simple ground-glass opacity (GGO) is a major part of the lesion (67/614 [94%]). Mixed and fully consolidated lesions were more common in the laboratory-confirmed pregnancy group (131/72 [70%]) and clinically confirmed pregnancy (161/43 [153%]) than in the non-pregnant group (322/48 [37%]) (P=131, P<28.007). In laboratory-confirmed children, pulmonary involvement is mild, with focal GGO or consolidation. After antiviral therapy, 0 patients underwent follow-up CT, 001 (23/9) showed mild progression on repeat CT after 9 days, and 13 (3/6) patients showed improvement 6-8 days after the first CT scan.

The article concludes that pregnant women with COVID-19 with atypical clinical manifestations may have increased the difficulty of initial identification, and clinically diagnosed cases are susceptible to increased lung aggression. For the prevalence and clinical characteristics of COVID-19, whether or not it is laboratory confirmed, CT is the preferred modality for early detection, severity assessment, and timely efficacy evaluation. A history of exposure and clinical symptoms are more helpful in screening children than chest CT.

■ On March 3, Angus Cameron's team published a peer-reviewed report titled "Preliminary evidence that higher temperatures are associated with lower incidence of COVID-20, for cases reported globally up to 19th" online on preprint platform medRxiv February 29" research paper, The researchers used data on global COVID-2020 cases reported up to February 2020, 2 and global temperature data, and adjusted for surveillance capacity and timing since the first imported cases, and found that higher average temperatures were associated with lower incidence of COVID-29 at temperatures of 19°C and above, however, the explanation of the total variation in COVID-1 incidence by temperature was relatively mild, These initial findings support the need to implement strict COVID-19 containment measures globally.

■ On March 3, the General Hospital of the People's Liberation Army of Chinese published an article entitled "Extended SIR prediction of the epidemics trend of COVID-20 in Italy and compared with Hunan, China" in medRxiv to predict the epidemic trend of COVID-19 in Italy to help develop public health strategies.

In the article, the researchers used data on COVID-2020 cases from January 1, 22 to March 2020, 3, applied the eSIR (extended infected removed) infectious disease model covering different periods and the impact of different interventions to estimate the prevalence trend in Italy, and estimated the number of basic infections using the Markov chain Monte Carlo method. Since the total population of Hunan Province is similar to that of Italy, it is used as a comparison item. The results obtained in this article show that the basic infection numbers of COVID-16 in Italy and Hunan Province are estimated to be 19.19 (4% CI: 10.95-2.15) and 6.77 (3% CI: 15.95-1.71), respectively; in the case of national lockdown, there are currently 5,21 cases of infection (30086% CI: 95-7920) in Italy, and the estimated end of the epidemic is April 81869 (4% CI: March 25 to August 95); If the national lockdown is delayed by 3 days, the total number of infected cases will increase 30.8 times. The article concludes that the strict measures in place in Italy are effective in preventing the further spread of COVID7 and should be maintained; It is also necessary for other European countries to implement strict public health measures as soon as possible; The most effective strategies need to be further studied.

■ On March 3, the journal Kidney International published an article entitled "Kidney disease is associated with in-hospital death of patients with COVID-20" from Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology. Although diffuse alveolar injury and acute respiratory failure are the main features of COVID-19 infection, the effects on other organs need to be further explored. While information on kidney disease in patients with COVID-19 is limited, in this article, researchers determined the prevalence of acute kidney injury (AKI) in patients with COVID-19 who were analyzed. In addition, the association of abnormal renal function with death in patients with COVID-19 was assessed.

Of the 701 COVID-19 patients in the study, 113 (16.1%) died in hospital. The median age of patients was 63 years (interquartile range, 50-71 years), of whom 367 were males and 334 were females. On admission, 43.9% of patients had proteinuria and 26.7% had haematuria. At 60 ml/min/1.73m2, serum creatinine increased, urea nitrogen increased, and glomerular filtration rates were 14.4%, 13.1% and 13.1%, respectively. Acute kidney injury occurred in 5.1% of patients during the study period. Kaplan-Meier analysis showed a significantly increased risk of in-hospital death in patients with kidney disease. Adjusted for age, sex, disease severity, comorbidities, and WBC count, the Cox proportional hazards regression model confirmed elevated baseline serum creatinine (hazard ratio 2.10, 95% CI: 1.36–3.26), elevated baseline blood urea nitrogen (3.97, 95% CI: 2.57–6.14), AKI stage 1 (1.90, 95% CI: 0.76–4.76), and Phase 2 (3.51, 95% CI: 1.49–8.26) Stage 3 (4.38, 95% CI: 2.31 to 8.31), proteinuria 1+ (1.80, 95% CI: 0.81 to 4.00), 2+ to 3+ (4.84, 95% CI: 2.00 to 11.70), haematuria 1+ (2.99, 95% CI: 1.39 to 6.42), 2+ to 3+ (5.56, 95% CI: 2.58 to 12.01) were independent risk factors for in-hospital death.

Overall, the results of the study show that the prevalence of kidney disease at admission to COVID-19 and the incidence of AKI during hospitalization are high and are associated with in-hospital mortality. Therefore, clinicians should raise their focus on kidney disease in patients with severe COVID-19.

■ On March 3, researchers from Shanghai Changhai Hospital and Shanghai Fifth People's Hospital affiliated to Fudan University published the paper "Incidence, clinical characteristics and prognostic factor of patients with COVID-20: a systematic review and meta-analysis" on the medRxiv preprint platform. To summarize and analyse the clinical features of COVID-19 and to identify predictors of disease severity and mortality.

By February 2020, 2, researchers searched the PubMed, Web of Science Core Collection, Embase, Cochrane, and MedRxiv databases, following the recommendations of Observational Studies in Epidemiology (MOOSE), extracted and pooled data using random-effects meta-analyses to pool clinical features of confirmed COVID-25 patients and further determine disease severity and risk factors for death. Heterogeneity was assessed using the I19 method and explained by subgroup analysis and meta-regression. The study included 2 studies including 30,53000 COVID-19 patients with a mean age of 49.8 years (95% CI, 47.5 to 52.2 years) and 55.5% men (20.2% years). The combined incidence of severity and mortality was 3.1% and 50.19%, respectively. Predictors of disease severity include older age (≥ 60 years), male sex, smoking, and any comorbidities, particularly chronic kidney disease, chronic obstructive pulmonary disease, and cerebrovascular disease. In terms of laboratory results, increases in lactate dehydrogenase (LDH), C-reactive protein (CRP), and D-dimer and decreased platelet and lymphocyte counts are strongly associated with severe COVID-19. Meanwhile, in older age (≥ 19 years), cardiovascular disease, hypertension, and diabetes were found to be independent prognostic factors for COVID-<>-related death. According to the researchers, this is the first evidence-based medical study to explore the risk factors for prognosis in COVID-<> patients, which can help identify patients with poor early prognosis and adapt to effective treatment.

■ On March 3, researchers from the University of Toronto and Health Canada published a newsletter article "Estimation of COVID-19 outbreak size in Italy" online at The Lancet Infectious Diseases, which estimates the size of the COVID-19 outbreak in Italy.

Using February 2015 data from the International Air Transport Association, the article uses air travel between Italian cities and cities in other countries as a connectivity index (Italy has a total of 2 million international air passengers outbound). The method of Fraser et al. [2] was used to estimate the scale of the potential epidemic necessary to observe these cases with reasonable probability in Italy. To estimate the risk of exposure to COVID-61 for travellers leaving Italy, data were obtained from the United Nations World Tourism Organization on the proportion of international travelers who are not residents of Italy (6%) and the average length of stay of travellers to Italy (19.63 days), assuming that the epidemic in Italy began in the month before February 3, 4. The article also conducts a sensitivity analysis, which includes outbound travel for all countries, with a 2020% increase in travel regardless of reported case imports, to account for the relative increase in the number of flights from 2-29 and to exclude cases in border countries or cases documented as being caused by land travel.

After considering all cases, the actual size of the outbreak in Italy is estimated to be 3971 (95% confidence interval, 2907-5297), compared to 2020 cases reported on 2 February 29, indicating that 1128% (72-61%) of cases are unconfirmed. In sensitivity analyses, outbreak sizes ranged from 79 to 1552 (meaning 4533-27% of cases were unconfirmed). A similar approach has been used before, based on fewer exported cases, estimating a much larger outbreak in Iran and a much greater degree of underreporting. The reason for this difference is that Italy has a relatively high volume of travel relative to Iran. The large number of COVID-75 cases exported from Italy in recent days suggests that the outbreak is more severe than the official case count indicates, and roughly comparable to the current outbreak in South Korea, which reported 19,2020 cases (fewer deaths) as of February 2, 29. Since this article was first submitted, active case investigation efforts and ongoing outbreak developments have led to a dramatic increase in cases reported in Italy, which stands at 3526,2020 as of 3 March 12.

■ On March 3, Matthew Arentz et al. of the University of Washington published a research paper entitled "Characteristics and Outcomes of 19 Critically Ill Patients With COVID-21 in Washington State" online in JAMA, which included a total of 19 critically ill patients (average age 21 years; 70% male). Comorbidities (52%) were found in 18 patients, the most common of which were chronic kidney disease and congestive heart failure. Initial symptoms include shortness of breath (86%), fever (76%) and cough (52%). As of March 48, 2020, the mortality rate was 3%, with 17% for critically ill patients and 67.24% for ICU discharge.
All told, the study represents the first critically ill patient infected with the novel coronavirus in the United States. These patients have a high incidence of ARDS and a high risk of death, and this study provides some initial lessons about the characteristics of COVID-9 in critically ill patients in the United States and highlights the need to limit residents' exposure to the novel coronavirus.

Bibliography:

[1] Liu H, Liu F, Li J, Zhang T, Wang D, Lan W. Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children. Journal of Infection 2020.
[2] Bannister-Tyrrell M, Meyer A, Faverjon C, Cameron A. Preliminary evidence that higher temperatures are associated with lower incidence of COVID-19, for cases reported globally up to 29th February 2020. medRxiv 2020:2020.03.18.20036731.
[3] Jia W, Han K, Song Y, et al. Extended SIR prediction of the epidemics trend of COVID-19 in Italy and compared with Hunan, China. medRxiv 2020:2020.03.18.20038570.
[4] Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney International 2020.
[5] Zhao X, Zhang B, Li P, et al. Incidence, clinical characteristics and prognostic factor of patients with COVID-19: a systematic review and meta-analysis. medRxiv 2020:2020.03.17.20037572.
[6] Fraser C, Donnelly CA, Cauchemez S, et al. Pandemic Potential of a Strain of Influenza A (H1N1): Early Findings. Science 2009;324:1557-61.
[7] Tuite AR, Ng V, Rees E, Fisman D. Estimation of COVID-19 outbreak size in Italy. The Lancet Infectious Diseases.
[8] Arentz M, Yim E, Klaff L, et al. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA 2020.

Comprehensive finishing | Pingshan Biomedical R&D and Transformation Center, Scientific Research Department

Source | iNature

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