RESUMEN
Obesity has caused wide concerns due to its high prevalence in patients with severe coronavirus disease 2019 (COVID-19). Coexistence of diabetes and obesity could cause an even higher risk of severe outcomes due to immunity dysfunction. We conducted a retrospective study in 1,637 adult patients who were admitted into an acute hospital in Wuhan, China. Propensity score-matched logistic regression was used to estimate the risks of severe pneumonia and requiring in-hospital oxygen therapy associated with obesity. After adjustment for age, sex, and comorbidities, obesity was significantly associated with higher odds of severe pneumonia (odds ratio [OR] 1.47 [95% CI 1.15-1.88]; P = 0.002) and oxygen therapy (OR 1.40 [95% CI 1.10-1.79]; P = 0.007). Higher ORs of severe pneumonia due to obesity were observed in men, older adults, and those with diabetes. Among patients with diabetes, overweight increased the odds of requiring in-hospital oxygen therapy by 0.68 times (P = 0.014) and obesity increased the odds by 1.06 times (P = 0.028). A linear dose-response curve between BMI and severe outcomes was observed in all patients, whereas a U-shaped curve was observed in those with diabetes. Our findings provide important evidence to support obesity as an independent risk factor for severe outcomes of COVID-19 infection in the early phase of the ongoing pandemic.
Asunto(s)
COVID-19/epidemiología , Diabetes Mellitus/epidemiología , Obesidad/epidemiología , Factores de Edad , Anciano , Índice de Masa Corporal , COVID-19/fisiopatología , COVID-19/terapia , China/epidemiología , Oxigenación por Membrana Extracorpórea , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Sobrepeso/epidemiología , Terapia por Inhalación de Oxígeno , Respiración Artificial , Estudios Retrospectivos , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Factores SexualesRESUMEN
PURPOSE: Rhabdomyolysis (RM) has been associated with many viral infectious diseases, and associated with poor outcomes. We aim to evaluate the clinical features and outcomes of RM in patients with coronavirus disease 2019 (COVID-19). METHOD: This was a single-center, retrospective, cohort study of 1,014 consecutive hospitalized patients with confirmed COVID-19 at the Huoshenshan Hospital in Wuhan, China, between February 17 and April 12, 2020. RESULTS: The overall incidence of RM was 2.2%. Compared with patients without RM, those with RM tended to have a higher risk of deterioration. Patients with RM also constituted a greater percentage of patients admitted to the intensive care unit (90.9% vs. 5.3%, Pâ<â0.001) and a greater percentage of patients undergoing mechanical ventilation (86.4% vs. 2.7% Pâ<â0.001). Moreover, patients with RM had laboratory test abnormalities, including the presence of markers of inflammation, activation of coagulation, and kidney injury. Patients with RM also had a higher risk of in-hospital death (Pâ<â0.001). Cox's proportional hazard regression model analysis confirmed that RM indicators, including peak creatine kinase levels >â1,000âIU/L (HRâ=â6.46, 95% CI: 3.02-13.86) and peak serum myoglobin concentrations >â1,000âng/mL (HRâ=â9.85, 95% CI: 5.04-19.28), were independent risk factors for in-hospital death. Additionally, patients with COVID-19 that developed RM tended to have delayed viral clearance. CONCLUSION: RM might be an important contributing factor to adverse outcomes in COVID-19 patients. The early detection and effective intervention of RM may help reduce mortality among COVID-19 patients.
Asunto(s)
COVID-19/complicaciones , COVID-19/mortalidad , Mortalidad Hospitalaria , Rabdomiólisis/complicaciones , Rabdomiólisis/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , China/epidemiología , Femenino , Hospitalización , Humanos , Incidencia , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Músculo Esquelético/fisiopatología , Modelos de Riesgos Proporcionales , Respiración Artificial , Estudios Retrospectivos , SARS-CoV-2 , Resultado del Tratamiento , Adulto JovenRESUMEN
The coronavirus disease 2019 (COVID-19) has outbroken globally. As an acute infectious disease, COVID-19 has significant impacts on multiple organs and systems throughout the body. Among patients with COVID-19, especially severe and critical cases, a variety of potential risk factors for coagulation dysfunction exist. Furthermore, the coagulation dysfunction of COVID-19 patients was mainly characterized by elevated D-dimer levels. The coagulation dysfunction could directly affect the prognosis of COVID-19 patients and is a major cause of death in patients with severe COVID-19. In this article, the literatures on the basic clinical manifestations, clinical risk factor, mechanism of coagulation dysfunction and evaluation of coagulation function in COVID-19 were reviewed.
Asunto(s)
Betacoronavirus , Trastornos de la Coagulación Sanguínea , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Trastornos de la Coagulación Sanguínea/etiología , COVID-19 , Infecciones por Coronavirus/complicaciones , Productos de Degradación de Fibrina-Fibrinógeno , Humanos , Neumonía Viral/complicaciones , SARS-CoV-2RESUMEN
Hypertension is a common comorbidity in hospitalized patients with COVID-19 infection. This study aimed to estimate the risks of adverse events associated with in-hospital blood pressure (BP) control and the effects of angiotensin II receptor blocker (ARB) prescription in COVID-19 patients with concomitant hypertension. In this retrospective cohort study, the anonymized medical records of COVID-19 patients were retrieved from an acute field hospital in Wuhan, China. Clinical data, drug prescriptions, and laboratory investigations were collected for individual patients with diagnosed hypertension on admission. Cox proportional hazards models were used to estimate the risks of adverse outcomes associated with BP control during the hospital stay. Of 803 hypertensive patients, 67 (8.3%) were admitted to the ICU, 30 (3.7%) had respiratory failure, 26 (3.2%) had heart failure, and 35 (4.8%) died. After adjustment for confounders, the significant predictors of heart failure were average systolic blood pressure (SBP) (hazard ratio (HR) per 10 mmHg 1.89, 95% confidence interval (CI): 1.15, 3.13) and pulse pressure (HR per 10 mmHg 2.71, 95% CI: 1.39, 5.29). The standard deviations of SBP and diastolic BP were independently associated with mortality and ICU admission. The risk estimates of poor BP control were comparable between patients receiving ARBs and those not receiving ARBs, with the only exception of a high risk of heart failure in the non-ARB group. Poor BP control was independently associated with higher risks of adverse outcomes of COVID-19. ARB drugs did not increase the risks of adverse events in hypertensive patients.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Hipertensión/complicaciones , Neumonía Viral/complicaciones , Anciano , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Presión Sanguínea/efectos de los fármacos , COVID-19 , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , SARS-CoV-2RESUMEN
RESEARCH BACKGROUND: Nonspecific lower back pain (LBP) has been a major public health problem in western countries since the second half of the 20â¯tâ¯h century. The trend has expanded to non-western countries, and LBP is currently a significant cause of disability in the working population. OBJECTIVE: To investigate the prevalence of nonspecific lower back pain (LBP) and its risk factors among soldiers in the Chinese army. METHODS: A total of 2876 Chinese army soldiers were requested to complete a self-administered questionnaire on demographic, anthropometric factors, and their non-specific LBP symptoms. The LBP evaluation and risk factor analysis were based on the self-questionnaire survey. RESULTS: The prevalence of non-specific LBP with physical state, one-child family, educational status, resident location and ethnicity were not associated (Pâ¯>â¯0.05); while smoking, LBP history, LBP family history, nightmare frequency, sleep quality, and self-perceived fitness had significant effects on LBP (Pâ¯<â¯0.05, Table 2). Multivariate logistic regression analysis showed that smoking (ORâ¯=â¯2.153,95% CIâ¯=â¯1.045-4.433), History of LBP (ORâ¯=â¯2.503,95% CIâ¯=â¯1.580-3.966), LBP family history (ORâ¯=â¯1.615,95%CIâ¯=â¯1.015-2.572), nightmare frequency (ORâ¯=â¯3.386, 95% CIâ¯=â¯2.047-5.603), sleep quality (ORâ¯=â¯2.391, 95% CIâ¯=â¯1.085-5.269) and self-perceived fitness (ORâ¯=â¯1.93,95%CIâ¯=â¯1.045-3.765) had significant effects on LBP (Pâ¯<â¯0.05)) (Table 3). CONCLUSIONS: Smoking, history of LBP, LBP family history, nightmare frequency, sleep quality, self-perceived fitness were important factors in the occurrence and persistence of LBP.
Asunto(s)
Dolor de la Región Lumbar/epidemiología , Personal Militar/estadística & datos numéricos , Enfermedades Profesionales/epidemiología , Adulto , China/epidemiología , Estudios Transversales , Humanos , Modelos Logísticos , Dolor de la Región Lumbar/etiología , Masculino , Análisis Multivariante , Enfermedades Profesionales/etiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: The objective of the study was to investigate the pharmacokinetics of mycophenolate mofetil (MMF) in Chinese adults early after renal transplantation by an enzyme multiplied immunoassay technique and to establish a limited sampling strategy to predict the area under the concentration-time curve for plasma levels of mycophenolic acid (MPA-AUC). METHODS: Fifty-eight recipients who underwent renal transplantation with an organ donated after cardiac death used a triple immunosuppressant strategy of MMF, tacrolimus, and prednisone. On the seventh day posttransplantation, plasma samples were collected at 0 hours (pre-dose) and at 0.5, 1, 1.5, 2, 4, 6, 8, 10, and 12 hours postdose (C0h, C0.5h, C1h, C1.5h, C2h, C4h, C6h, C8h, C10h, and C12h, respectively). Enzyme multiplied immunoassay technique was used to measure mycophenolic acid concentration, and model equations were generated by multiple stepwise regression analysis to determine MPA-AUC0-12h. RESULTS: The 3-point equation obtained by multiple linear regression analysis was MPA-AUC = 7.951 + 4.04C6h + 1.893C2h + 4.542C10h (adjusted r = 0.863); the 4-point equation was MPA-AUC = 4.272 + 4.074C6h + 1.896C2h + 4.680C10h + 0.859C0.5h (adjusted r = 0.918). The % mean prediction error, % mean absolute error, and % root mean squared prediction error for the best-fit formula using C6h, C2h, C10h, and C0.5h were -0.2%, 8.7%, and 14.2%, respectively. CONCLUSIONS: In Chinese adults receiving MMF and tacrolimus early after renal transplantation, the best equation for predicting MPA-AUC0-12h is 4.272 + 4.074C6h + 1.896C2h + 4.680C10h + 0.859C0.5h.