In December 2019,the corona virus disease 2019(COVID-19)caused by novel coronavirus(SARS-CoV-2)emerged in Wuhan,China and rapidly spread worldwide.Few information on clinical features and immunological profile of COVI...In December 2019,the corona virus disease 2019(COVID-19)caused by novel coronavirus(SARS-CoV-2)emerged in Wuhan,China and rapidly spread worldwide.Few information on clinical features and immunological profile of COVID-19 in paediatrics.The clinical features and treatment outcomes of twelve paediatric patients confirmed as COVID-19 were analyzed.The immunological features of children patients was investigated and compared with twenty adult patients.The median age was 14.5-years(range from 0.64 to 17),and six of the patients were male.The average incubation period was 8 days.Clinically,cough(9/12,75%)and fever(7/12,58.3%)were the most common symptoms.Four patients(33.3%)had diarrhea during the disease.As to the immune profile,children had higher amount of total T cell,CD8t T cell and B cell but lower CRP levels than adults(P<0.05).Ground-glass opacity(GGO)and local patchy shadowing were the typical radiological findings on chest CT scan.All patients received antiviral and symptomatic treatment and the symptom relieved in 3e4 days after admitted to hospital.The paediatric patients showed mild symptom but with longer incubation period.Children infected with SARS-CoV-2 had different immune profile with higher T cell amount and low inflammatory factors level,which might ascribed to the mild clinical symptom.We advise that nucleic acid test or examination of serum IgM/IgG antibodies against SARS-CoV-2 should be taken for children with exposure history regardless of clinical symptom.展开更多
Background： Urine output （UO） is an essential criterion of the Kidney Disease Improving Global Outcomes （KD1GO） definition and classification system tbr acute kidney injury （AKI）, of which the diagnostic value ...Background： Urine output （UO） is an essential criterion of the Kidney Disease Improving Global Outcomes （KD1GO） definition and classification system tbr acute kidney injury （AKI）, of which the diagnostic value has not been extensively studied. We aimed to determine whether AKI based on KDIGO UO criteria （KDtGOLro） could improve the diagnostic and prognostic accuracy, compared with KDIGO serum creatinine criteria （KDIGOscr）.Methods： We conducted a secondary analysis of the database of a previous study conducted by China Critical Care Clinical Trial Group （CCCCTG）, which was a 2-month prospective cohort study （July 1,2009 to August 31,2009） involving 3063 patients in 22 tertiary Intensive Care Units in Mainland of China. AKI was diagnosed and classified separately based on KDIGOt,o and KDlGOsc,. Hospital mortality of patients with more severe AKI classification based on KDIGOvo was compared with other patients by univariate and multivariate regression analyses. Results： The prevalence of AKl increased from 52.4% based on KDIGOscr to 55.4% based on KD1GOsc~ combined with KDIGOuo. KDIGOv~~ also restllted in an upgrade of AKI classification in 7.3% of patients, representing those with more severe AK1 classification based on KDIGOvo. Compared with non-AKI patients or those with maximum AKI classification by KDIGOscr, those with maximum AKI classification by KDIGOuo had a significantly higher hospital mortality of 58.4% （odds ratio [OR]： 7.580, 95% confidence interval [CI]： 4.141-13.873, P 〈 0.001）. In a multivariate logistic regression analysis, AKI based on KDIGOuo （OR： 2.891, 95% CI： 1.964-4.254, P 〈 0.001）, but not based on KDIGOscr （OR： 1.322, 95% CI： 0.902-1.939, P = 0.152）, was an independent risk factor for hospital mortality. Conclusion： UO was a criterion with additional value beyond creatinine criterion for AKI diagnosis and classification, which can help identify a group of patients with high risk of death.展开更多
Coronavirus Disease 2019(COVID-19)was first identified in China at the end of 2019.Acute respiratory distress syndrome(ARDS)represents the most common and serious complication of COVID-19.Cytokine storms are a pathoph...Coronavirus Disease 2019(COVID-19)was first identified in China at the end of 2019.Acute respiratory distress syndrome(ARDS)represents the most common and serious complication of COVID-19.Cytokine storms are a pathophysiological feature of COVID-19 and play an important role in distinguishing hyper-inflammatory subphenotypes of ARDS.Accordingly,in this review,we focus on hyper-inflammatory host responses in ARDS that play a critical role in the differentiated development of COVID-19.Furthermore,we discuss inflammationrelated indicators that have the potential to identify hyper-inflammatory subphenotypes of COVID-19,especially for those with a high risk of ARDS.Finally,we explore the possibility of improving the quality of monitoring and treatment of COVID-19 patients and in reducing the incidence of critical illness and mortality via better distinguishing hyper-and hypoinflammatory subphenotypes of COVID-19.展开更多
基金This work was supported by National Natural Science Foundation of China(Grant No.81871656 and 8181101099 to J C)National Science and Technology Major Project(Grant No.2017ZX10202203 to AL H).
文摘In December 2019,the corona virus disease 2019(COVID-19)caused by novel coronavirus(SARS-CoV-2)emerged in Wuhan,China and rapidly spread worldwide.Few information on clinical features and immunological profile of COVID-19 in paediatrics.The clinical features and treatment outcomes of twelve paediatric patients confirmed as COVID-19 were analyzed.The immunological features of children patients was investigated and compared with twenty adult patients.The median age was 14.5-years(range from 0.64 to 17),and six of the patients were male.The average incubation period was 8 days.Clinically,cough(9/12,75%)and fever(7/12,58.3%)were the most common symptoms.Four patients(33.3%)had diarrhea during the disease.As to the immune profile,children had higher amount of total T cell,CD8t T cell and B cell but lower CRP levels than adults(P<0.05).Ground-glass opacity(GGO)and local patchy shadowing were the typical radiological findings on chest CT scan.All patients received antiviral and symptomatic treatment and the symptom relieved in 3e4 days after admitted to hospital.The paediatric patients showed mild symptom but with longer incubation period.Children infected with SARS-CoV-2 had different immune profile with higher T cell amount and low inflammatory factors level,which might ascribed to the mild clinical symptom.We advise that nucleic acid test or examination of serum IgM/IgG antibodies against SARS-CoV-2 should be taken for children with exposure history regardless of clinical symptom.
文摘Background： Urine output （UO） is an essential criterion of the Kidney Disease Improving Global Outcomes （KD1GO） definition and classification system tbr acute kidney injury （AKI）, of which the diagnostic value has not been extensively studied. We aimed to determine whether AKI based on KDIGO UO criteria （KDtGOLro） could improve the diagnostic and prognostic accuracy, compared with KDIGO serum creatinine criteria （KDIGOscr）.Methods： We conducted a secondary analysis of the database of a previous study conducted by China Critical Care Clinical Trial Group （CCCCTG）, which was a 2-month prospective cohort study （July 1,2009 to August 31,2009） involving 3063 patients in 22 tertiary Intensive Care Units in Mainland of China. AKI was diagnosed and classified separately based on KDIGOt,o and KDlGOsc,. Hospital mortality of patients with more severe AKI classification based on KDIGOvo was compared with other patients by univariate and multivariate regression analyses. Results： The prevalence of AKl increased from 52.4% based on KDIGOscr to 55.4% based on KD1GOsc~ combined with KDIGOuo. KDIGOv~~ also restllted in an upgrade of AKI classification in 7.3% of patients, representing those with more severe AK1 classification based on KDIGOvo. Compared with non-AKI patients or those with maximum AKI classification by KDIGOscr, those with maximum AKI classification by KDIGOuo had a significantly higher hospital mortality of 58.4% （odds ratio [OR]： 7.580, 95% confidence interval [CI]： 4.141-13.873, P 〈 0.001）. In a multivariate logistic regression analysis, AKI based on KDIGOuo （OR： 2.891, 95% CI： 1.964-4.254, P 〈 0.001）, but not based on KDIGOscr （OR： 1.322, 95% CI： 0.902-1.939, P = 0.152）, was an independent risk factor for hospital mortality. Conclusion： UO was a criterion with additional value beyond creatinine criterion for AKI diagnosis and classification, which can help identify a group of patients with high risk of death.
基金This work was supported by the National Medical Team in Wuhan(from The First Affiliated Hospital of Chongqing Medical University)and Wuhan No.1 Hospital.This article also commemorates the Chinese medical staff who gave their lives in the first-line defense against COVID-19.Finally,we thank Accdon(www.accdon.com)for its linguistic assistance during the preparation of this manuscript.
文摘Coronavirus Disease 2019(COVID-19)was first identified in China at the end of 2019.Acute respiratory distress syndrome(ARDS)represents the most common and serious complication of COVID-19.Cytokine storms are a pathophysiological feature of COVID-19 and play an important role in distinguishing hyper-inflammatory subphenotypes of ARDS.Accordingly,in this review,we focus on hyper-inflammatory host responses in ARDS that play a critical role in the differentiated development of COVID-19.Furthermore,we discuss inflammationrelated indicators that have the potential to identify hyper-inflammatory subphenotypes of COVID-19,especially for those with a high risk of ARDS.Finally,we explore the possibility of improving the quality of monitoring and treatment of COVID-19 patients and in reducing the incidence of critical illness and mortality via better distinguishing hyper-and hypoinflammatory subphenotypes of COVID-19.
