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BackgroundSince the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) outbreaks in Wuhan, China, healthcare systems capacities in highly endemic areas have been overwhelmed. Approaches to efficient management are urgently needed and key to a quicker control of the outbreaks and casualties. We aimed to characterize the clinical features of hospitalized patients with confirmed or suspected COVID-19, and develop a mortality risk index for COVID-19 patients. MethodsIn this retrospective one-centre cohort study, we included all the confirmed or suspected COVID-19 patients hospitalized in a COVID-19-designated hospital from January 21 to February 5, 2020. Demographic, clinical, laboratory, radiological and clinical outcome data were collected from the hospital information system, nursing records and laboratory reports. ResultsOf 577 patients with at least one post-admission evaluation, the median age was 55 years (interquartile range [IQR], 39 - 66); 254 (44.0%) were men; 22.8% (100/438) were severe pneumonia on admission, and 37.7% (75/199) patients were SARS-CoV-2 positive. The clinical, laboratory and radiological data were comparable between positive and negative SARS-CoV-2 patients. During a median follow-up of 8.4 days (IQR, 5.8 - 12.0), 39 patients died with a 12-day cumulative mortality of 8.7% (95% CI, 5.9% to 11.5%). A simple mortality risk index (called ACP index), composed of Age and C-reactive Protein, was developed. By applying the ACP index, patients were categorized into three grades. The 12-day cumulative mortality in grade three (age [≥] 60 years and CRP [≥] 34 mg/L) was 33.2% (95% CI, 19.8% to 44.3%), which was significantly higher than those of grade two (age [≥] 60 years and CRP < 34 mg/L; age < 60 years and CRP [≥] 34 mg/L; 5.6% [95% CI, 0 to 11.3%]) and grade one (age < 60 years and CRP < 34 mg/L, 0%) (P <0.001), respectively. ConclusionThe ACP index can predict COVID-19 related short-term mortality, which may be a useful and convenient tool for quickly establishing a COVID-19 hierarchical management system that can greatly reduce the medical burden and therefore mortality in highly endemic areas.
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Objective To evaluate the effect of adrenocortical hormone on detection of NMO-IgG in neuromyelitis optica ( NMO ) patients.Methods 30 cases with NMO collected in the hospital according to the figures were randomly divided into adrenocorticotropic hormone group and control group, 15 cases in each group.adrenocorticotropic hormone group were given glucocorticoid therapy on the basis of conventional therapy.The control group were treated with conventional therapy, and The serum NMO-IgG levels were detected by indirect immunofluorescence taking stable expression of human origin aquaporin -4 (AQP4) in human embryonic kidney 293 (HEK293) cell line as substrate.Results 19 cases (63.3%) serum NMO-IgG positive patients in 30 cases with spinal cord inflammation, serum antibody titers from 1:115 to 1砄6355.The positive rate of serum NMO-IgG in adrenocorticotropic hormone group was 86.7%, which was higher than 40.0% in control group (χ2 =7.03,P<0.05).Conclusion The adrenocortical hormone could help the detection of NMO-IgG antibody and increase the efficiency of clinical diagnosis.