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OBJECTIVE: Coagulopathy is one of the characteristics observed in critically ill patients with coronavirus disease 2019 (COVID-19). Antiphospholipid antibodies (aPLs) contribute to coagulopathy, though their role in COVID-19 remains unclear. This study was undertaken to determine the prevalence and characteristics of aPLs in patients with COVID-19. METHODS: Sera collected from 66 COVID-19 patients who were critically ill and 13 COVID-19 patients who were not critically ill were tested by chemiluminescence immunoassay for anticardiolipin antibodies (aCLs), anti-s2 -glycoprotein I (anti-s2 GPI) (IgG, IgM, and IgA), and IgG anti-s2 GPI-domain 1 (anti-s2 GPI-D1) and IgM and IgG anti-phosphatidylserine/prothrombin (anti-PS/PT) antibodies were detected in the serum by enzyme-linked immunosorbent assay. RESULTS: Of the 66 COVID-19 patients in critical condition, aPLs were detected in 31 (47% ). Antiphospholipid antibodies were not present among COVID-19 patients who were not in critical condition. The IgA anti-s2 GPI antibody was the most commonly observed aPL in patients with COVID-19 and was present in 28.8% (19 of 66) of the critically ill patients, followed by IgA aCLs (17 of 66, or 25.8%) and IgG anti-s2 GPI (12 of 66, or 18.2%). For multiple aPLs, IgA anti-s2 GPI + IgA aCLs was the most common antibody profile observed (15 of 66, or 22.7%), followed by IgA anti-s2 GPI + IgA aCL + IgG anti-s2 GPI (10 of 66, or 15.2%). Antiphospholipid antibodies emerge ~35-39 days after disease onset. A dynamic analysis of aPLs revealed 4 patterns based on the persistence or transient appearance of the aPLs. Patients with multiple aPLs had a significantly higher incidence of cerebral infarction compared to patients who were negative for aPLs (P = 0.023). CONCLUSION: Antiphospholipid antibodies were common in critically ill patients with COVID-19. Repeated testing demonstrating medium to high titers of aPLs and the number of aPL types a patient is positive for may help in identifying patients who are at risk of developing cerebral infarction. Antiphospholipid antibodies may be transient and disappear within a few weeks, but in genetically predisposed patients, COVID-19 may trigger the development of an autoimmune condition similar to the antiphospholipid syndrome (APS), referred to as "COVID-19-induced APS-like syndrome." Long-term follow-up of COVID-19 patients who are positive for aPLs would be of great importance in understanding the pathogenesis of this novel coronavirus.

Purpose: A phenotype of COVID-19 ARDS patients with extremely low compliance and refractory hypercapnia was found in our ICU. In the context of limited number of ECMO machines, feasibility of a low-flow extracorporeal carbon dioxide removal (ECCO2R) based on the renal replacement therapy (RRT) platform in these patients was assessed.Methods: Single-center, prospective study. Refractory hypercapnia patients with COVID-19-associated ARDS were included and divided into the adjusted group and unadjusted group according to the level of PaCO2 after the application of the ECCO2R system. Ventilation parameters [tidal volume (VT), respiratory rate, and PEEP], platform pressure (Pplat) and driving pressure (DP), respiratory system compliance, arterial blood gases, and ECCO2R system characteristics were collected.Results: Twelve patients with refractory hypercapnia were enrolled, and the PaCO2 was 64.5 [56-88.75] mmHg. In the adjusted group, VT was significantly reduced from 5.90 ± 0.16 to 5.08 ± 0.43 ml/kg PBW; DP and Pplat were also significantly reduced from 23.5 ± 2.72 mmHg and 29.88 ± 3.04 mmHg to 18.5 ± 2.62 mmHg and 24.75 ± 3.41 mmHg, respectively. In the unadjusted group, PaCO2 decreased from 94 [86.25, 100.3] mmHg to 80 [67.50, 85.25] mmHg but with no significant difference, and the DP and Pplat were not decreased after weighing the pros and cons.Conclusions: A low-flow ECCO2R system based on the RRT platform enabled CO2 removal and could also decrease the DP and Pplat significantly, which provided a new way to treat these COVID-19 ARDS patients with refractory hypercapnia and extremely low compliance.Clinical Trial Registration:https://www.clinicaltrials.gov/, identifier NCT04340414.

Purpose To prospectively assess the diagnostic value of quick Sequential Organ Failure Assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) scores for sepsis in ward patients with infections. Materials and methods Consecutive patients admitted with infection or developing infection during hospital stay were included. All variables for calculating qSOFA, SIRS, and SOFA scores were collected, and the maximum scores were determined until hospital discharge, death, or day 28, whichever occurred earlier. The primary outcome was sepsis at 28 days. Diagnostic and prognostic values were assessed using the area under the receiver operating characteristic curve (AUROC) with the conventional cutoff value of 2. Results Of 409 general ward patients, 146 patients and 371 patients met qSOFA and SIRS criteria, 229 patients developed sepsis. Although qSOFA score had a better overall diagnostic performance of sepsis (AUROC 0.75 vs. 0.69), it had a much lower sensitivity (53% vs. 98%) and higher specificity (87% vs. 18%) than SIRS score. In addition, qSOFA score had a better prognostic value than SIRS score (AUROC 0.86 vs. 0.67). Conclusions Neither SIRS score nor qSOFA score could serve as an ideal screening tool for early identification sepsis, whereas qSOFA score might help to identify patients with higher risk of poor clinical outcome. Trial registration clinicaltrials.gov Identifier: NCT 02930070.

Background: We aimed to evaluate the accuracy of quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) for the diagnosis of sepsis-3, and to analyze the prognosis of infected patients in wards over-diagnosed with qSOFA but missed by sepsis-3, and those missed by qSOFA but in accordance with sepsis-3 criteria. We also intended to validate the performance of qSOFA as one predictor of outcome in patients with suspicion of infection. Methods: We reviewed the medical records of 1716 adult patients with infection who were hospitalized from July 1 st , 2012 to June 30 th , 2014 in the Yuetan subdistrict of Beijing, China. Based on the sepsis-3 criteria and qSOFA score proposed by the Third International Consensus Definitions for Sepsis and Septic Shock, these patients were categorized into four groups: qSOFA(−)sepsis(−), qSOFA(+)sepsis(−), qSOFA(−) sepsis(+), and qSOFA(+)sepsis(+). Multivariate logistic regression analysis was used to determine the independent risk factors for in-hospital mortality. The area under the receiver operating characteristic curves (AUROCs) of the qSOFA(+) group were compared with the sepsis(+) group for in-hospital mortality, ICU admission, and invasive ventilation. Results: Among the 1,716 patients with infection, there were 935 patients (54.5%) with sepsis, and 640 patients (37.3%) with qSOFA ≥2. There were 610 patients in the qSOFA(−)sepsis(−) group, 171 in the qSOFA(+)sepsis(−) group, 466 in the qSOFA(−)sepsis(+) group, and 469 in the qSOFA(+)sepsis(+) group. In the logistic regression analysis, increasing age, bedridden status, and malignancy were all independent risk factors of hospital mortality. Sepsis and qSOFA ≥2 were also independent risk factors of hospital mortality, with an adjusted OR of 3.85 (95% CI: 2.70–5.50) and 13.92 (95% CI: 9.87–16.93) respectively. qSOFA had a sensitivity of 50.2% and a specificity of 78.1% for sepsis-3. The false-positive [qSOFA(+)sepsis(−)] group had 38 patients (22.2%) die during hospitalization, and an adjusted OR of 9.20 (95% CI: 4.86–17.38). In addition, the false-negative [qSOFA(−)sepsis(+)] group had a hospital mortality rate of 7.3% (34/466) and an adjusted OR of 2.59 (95% CI: 1.39–4.83). In comparison, patients meeting neither qSOFA nor sepsis criteria had the lowest hospital mortality [2.6% (16/610)], whereas patients with both qSOFA ≥2 and sepsis had the highest hospital mortality [56.5% (265/469)], with an adjusted OR of 42.02 (95% CI: 24.31–72.64). The discrimination of in-hospital mortality using qSOFA (AUROC, 0.846; 95% CI, 0.824–0.868) was greater compared with sepsis-3 criteria (AUROC, 0.834; 95% CI, 0.805–0.863; P Conclusions: In our analysis, the sensitivity(Se) of qSOFA for the diagnosis of sepsis was lower, and qSOFA score ≥2 might identify a group of patients at a higher risk of mortality, regardless of being septic or not.

Background: The complications of coronavirus disease 2019 (COVID-19) involved multiple organs or systems, especially in critically ill patients. We aim to investigate the neurological complications in critically ill patients with COVID-19. Methods: This retrospective single-center case series analyzed critically ill patients with COVID-19 at the intensive care unit of Tongji Hospital, Wuhan, China from February 5 to April 2, 2020. Demographic data, clinical and laboratory findings, comorbidities and treatments were collected and analyzed. Results: Among 86 patients with confirmed COVID-19, 54 patients (62.8%) were male, and the mean (SD) age was 66.6 (11.1) years. Overall, 65% patients presented with at least one neurological symptom. Twenty patients (23.3%) had symptoms involving the central nervous system, including delirium, cerebrovascular diseases and hypoxic-ischemic brain injury, while 6 patients (7%) had neuromuscular involvement. Seven of 86 patients exhibited new stroke and 6 (7%) cases were ischemic. A significantly higher prevalence of antiphospholipid antibodies was observed in patients with ischemic stroke than in those without stroke (83.3 vs. 26.9%, p < 0.05). Patients with ischemic stroke were more likely to have a higher myoglobulin level, and a lower hemoglobin level. Conclusions: The clinical spectrum of neurological complications in critically ill patients with COVID-19 was broad. Stroke, delirium and neuromuscular diseases are common neurological complications of COVID-19. Physicians should pay close attention to neurological complications in critically ill patients with COVID-19.

The etiologies of acute respiratory failure in patients with systemic rheumatic diseases (SRDs) requiring intensive care remain unknown. This study was undertaken to investigate the etiologies and outcomes.A medical records review study was performed of 259 adult SRDs patients with respiratory failure admitted to medical ICU across a 5-year period. The etiologies were classified as infection, SRD exacerbation, and undetermined. The factors associated with ICU mortality were identified with multivariate logistic regression analysis.The etiologies of respiratory failure included infection (n = 209, 80.7%), SRD exacerbation (n = 71, 27.4%), and undetermined (n = 21, 8.1%). The most common pathogen was Pneumocystis jirovecii (39.8%), followed by Aspergillus spp. (33.2%), and cytomegalovirus (23.2%). The ICU mortality rate was 59.8%. A high acute physiology and chronic health evaluation II score (OR 1.118, 95% CI 1.054 to 1.186, p 0.001), a PaOOpportunistic infections and SRD exacerbation were the most common etiologies of acute respiratory failure in patients with SRDs requiring ICU admission, with high ICU mortality. Development of a standard protocol for differential diagnosis in this population might help initiate definitive therapy and improve clinical outcome. Key Points • Infections, especially with opportunistic infections, were the leading cause of acute respiratory failure in critically ill rheumatology patients, with high mortality. • Severity of illness, certain types of rheumatic diseases, and opportunistic fungal infections were associated with increased mortality. • Using a comprehensive diagnostic workup might help to confirm the infective etiology and improve outcome.

Background Pharmacologic stress ulcer prophylaxis (SUP) is recommended in critically ill patients with high risk of stress-related gastrointestinal (GI) bleeding. However, as to patients receiving enteral feeding, the preventive effect of SUP is not well-known. Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of pharmacologic SUP in enterally fed patients on stress-related GI bleeding and other clinical outcomes. Methods We searched PubMed, Embase, and the Cochrane database from inception through 30 Sep 2017. Eligible trials were RCTs comparing pharmacologic SUP to either placebo or no prophylaxis in enterally fed patients in the ICU. Results were expressed as risk ratio (RR) and mean difference (MD) with accompanying 95% confidence interval (CI). Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were explored. Results Seven studies (n = 889 patients) were included. There was no statistically significant difference in GI bleeding (RR 0.80; 95% CI, 0.49 to 1.31, p = 0.37) between groups. This finding was confirmed by further subgroup analyses and sensitivity analysis. In addition, SUP had no effect on overall mortality (RR 1.21; 95% CI, 0.94 to 1.56, p = 0.14), Clostridium difficile infection (RR 0.89; 95% CI, 0.25 to 3.19, p = 0.86), length of stay in the ICU (MD 0.04 days; 95% CI, −0.79 to 0.87, p = 0.92), duration of mechanical ventilation (MD −0.38 days; 95% CI, −1.48 to 0.72, p = 0.50), but was associated with an increased risk of hospital-acquired pneumonia (RR 1.53; 95% CI, 1.04 to 2.27; p = 0.03). Conclusions Our results suggested that in patients receiving enteral feeding, pharmacologic SUP is not beneficial and combined interventions may even increase the risk of nosocomial pneumonia. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1937-1) contains supplementary material, which is available to authorized users.

Purpose To evaluate whether the changes of central venous oxygen saturation (Scvo 2 ) after fluid challenge can define fluid responsiveness in patients with septic shock. Methods In this prospective observational study, septic shock patients with invasive cardiac output monitoring requiring fluid challenge were included. Cardiac index (CI) and Scvo 2 were measured before and after fluid challenges. The changes of CI (ΔCI) and the changes of Scvo 2 (ΔScvo 2 ) were calculated and analyzed using Pearson correlation. Receiver operating characteristics curve (ROC) analysis was used to classify fluid responders and nonresponders. Area under ROC was calculated. Results Forty patients were included and 18 patients (45%) were fluid responders. In the responders, CI increased from 3.4±1.1 to 4.4±1.0 L min −1 m −2 and Scvo 2 from 69.6%±9.8% to 77.1%±8.9% (both P 2 changed (4.1±1.3 vs 4.1±1.3 L min −1 m −2 , 71.0%±13.8% vs 70.6%±14.1%, both P >.05). The correlation between ΔScvo 2 and ΔCI was significant ( r =0.702, P 2 to define fluid responsiveness was 0.88 (95% confidence interval [95% CI], 0.76-0.99). A ΔScvo 2 threshold value of 5.0% discriminated responders from nonresponders with sensitivity of 0.78 (95% CI, 0.52-0.93) and specificity of 0.95 (95% CI, 0.75-1.00). Conclusions The changes of Scvo 2 correlate with the changes of CI, and the changes of Scvo 2 define fluid responsiveness in patients with septic shock.

Background The US Centers for Disease Control and Prevention (CDC) recently released simplified eSOFA organ dysfunction criteria of Adult Sepsis Event for sepsis surveillance in the US. Our study aimed to compare the prevalence, characteristics, and outcomes of sepsis patients identified by eSOFA criteria versus Sequential Organ Failure Assessment (SOFA) Score (Sepsis-3) and assess the external validity of eSOFA criteria in China. Methods We conducted a retrospective cohort study of adult residents of Yuetan Subdistrict, Beijing, China, who were hospitalized from July 1, 2012 to June 30, 2014. Among patients with infection, sepsis was identified if there was a concurrent rise in SOFA score by 2 or more points (Sepsis-3) or the presence of 1 or more eSOFA criteria: vasopressor initiation, mechanical ventilation initiation, doubling in creatinine, doubling in bilirubin to 2.0 mg/dL or above, 50% or greater decrease in platelet count to less than 100 cells/μL, or lactate equal to or above 2.0 mmol/L. Areas under the receiver operating characteristic curves (AUROCs) for in-hospital mortality were compared between sepsis patients detected by the two criteria, adjusting for baseline characteristics. Results Of 1716 hospitalized patients with infection, 935 (54.5%) met Sepsis-3 criteria, 573 (33.4%) met eSOFA criteria, while 475 (27.7%) met both criteria. Demographic and clinical characteristics of sepsis patients meeting Sepsis-3 or eSOFA criteria were similar. In-hospital mortality was higher with eSOFA criteria versus Sepsis-3 (46.6% vs. 32.0%, p p p = 0.097). The predicted probability for in-hospital mortality was higher with eSOFA criteria versus Sepsis-3 (AUROC 0.830 vs. 0.795, p = 0.001) adjusting for baseline characteristics. Conclusions The CDC Adult Sepsis Event’s eSOFA criteria identify a smaller, more severely ill cohort of sepsis patients with similar demographic and clinical characteristics as the more complex Sepsis-3 SOFA score. These results suggest similar performance of eSOFA criteria across diverse populations, with low sensitivity and high specificity for the diagnosis of Sepsis-3.

Compared to conventional chemotherapy with subcutaneous and intravenous injection, injection of self-healing hydrogel drug-delivery system to tumor site brings less toxicity for normal tissues, but also better specificity for tumor cells on account of spontaneous repair and better retention. More importantly, it is essential to introduce multifunctional nanomaterials into self-healing hydrogel loading chemotherapeutic drugs to significantly enhance tumor treatment effect. Therefore, Rhodamin B isothiocyanate (RBITC)-labeled mesoporous silica nanospheres with Mn-Zn Ferrite (Mn0.6Zn0.4Fe2O4) nanoparticle core (MMSN-RBITC) are prepared and well-dispersed into hydrogel system. The generated heat under alternate magnetic field induces hyperthermia effect for magnetothermal therapy, which could also promote the sensibilization of chemotherapy. Hydroxyl radicals are produced via Fenton-like catalyzation after the cellular uptake of MMSN-RBITCs further promoting the cell apoptosis via chemodynamic therapy. The nanoplatform also presents excellent T2-weighted magnetic resonance imaging contrast enhancement. As a result, the hydrogel system is effectively enhanced and enriched via the introduction of the nanospheres. In vitro and in vivo results indicate that this strategy of self-healing hydrogel loading DOX and MMSN-RBITC can achieve tumor diagnosis and efficiently synergistic magnetothermal-chemo-chemodynamic therapy. This strategy could inspire people to construct more promising platforms combining self-healing hydrogel with multifunctional nanomaterials for more efficient cancer treatment with versatile therapeutic methods.

Background Patients undergoing major vascular surgery often develop postoperative pneumonia that impacts their outcomes. Conflicting data exist concerning the potential benefit of tapered-shaped cuffs on tracheal sealing. The primary objective of this study was to assess the efficiency of a polyvinyl chloride tapered-cuff endotracheal tube at reducing the postoperative pneumonia rate after major vascular surgery. Secondary objectives were to determine its impact on microaspiration, ventilator-associated pneumonia rate, and inner cuff pressure. Methods This prospective randomized controlled study included 109 patients who were randomly assigned to receive either spherical- (standard cuff) or taper-shaped (tapered cuff) endotracheal tubes inserted after anesthesia induction and then admitted to the intensive care unit after major vascular surgery. Cuff pressure was continuously recorded over 5 h. Pepsin and α-amylase concentrations in tracheal aspirates were quantified on postoperative days 1 and 2. The primary outcome was the early postoperative pneumonia frequency. Results Comparing the tapered-cuff with standard-cuff group, respectively, postoperative pneumonia rates were comparable (42 vs. 44%, P = 0.87) and the percentage (interquartile range) of cuff-pressure time with overinflation was significantly higher (16.1% [1.5 to 50] vs. 0.6% [0 to 8.3], P = 0.01), with a 2.5-fold higher coefficient of variation (20.2 [10.6 to 29.4] vs. 7.6 [6.2 to 10.2], P < 0.001). Although microaspiration frequencies were high, they did not differ between groups. Conclusion For major vascular surgery patients, polyvinyl chloride tapered-cuff endotracheal tubes with intermittent cuff-pressure control did not lower the early postoperative pneumonia frequency and did not prevent microaspiration.

Background:Several studies showed two main clinical phenotypes of antiphospholipid syndrome which could be independent, but only a few data contrast features between these two groups.Objectives:To investigate whether obstetric and thrombotic manifestations of APS are independent subtypes.Methods:This was a single center prospective study from the PUMCH database of primary antiphospholipid syndrome followed for over 4years. Comparing demographic data, laboratory tests, pregnancy morbidity and thrombotic events during follow-up between IoAPS (isolated obstetric APS) and ItAPS (isolated thrombotic APS).Results:A total of 244 patients was registered in PUMCH primary APS cohorts, 157(64.34%) were female patients. In female patients, 44(28.03%) were diagnosed with IoAPS, 42(26.75%) were ItAPS. Demography showed patients in ItAPS group were older than IoAPS group (40 vs 33, pConclusion:IoAPS and ItAPS shared similar antibody profile, but presented isolated clinical complications, different demographic features and maintained independent manifestation during follow-up, indicating the underlying pathogeneses are different.References:[1]Meroni P L, Borghi M O, Grossi C, et al. Obstetric and vascular antiphospholipid syndrome: same antibodies but different diseases?[J]. Nat Rev Rheumatol, 2018, 14(7): 433-440Table1.Demographic characteristicsIoAPS(n=44)ItAPS(n=42)P-valueAge, years, Median (Q1-Q3)33 (30.00, 36.00)40(33.75, 55.25).00B.M.I. Median (Q1-Q3)22.86 (20.70,24.45)23.52 (21.44, 27.70).10Flow-up time, month,Median (Q1-Q3)48.50 (36.00,77.00)49.50 (23.00,103.75).44Smoke (n%)1(2.27)0(0)1.00Cardiovascular risk factors (n%)3 (6.82)14 (33.33).00Coronary heart disease0(0)2(4.76).24Hypertension1(2.27)5(11.90).11Obesity2(4.55)9(21.43).03Diabetes mellitus0(0)0(0)Complications (n%)16 (36.36)30 (71.43).00Kidney diseases2(4.55)3(7.14).67Thrombocytopenia9(20.45)20(47.62).01Neurological Disorders1(2.27)10(23.81).00Stroke0(0)8(19.05).00Non stroke CNS manifestations1(2.27)2(4.76).61Valvular heart diseases4(9.09)2(4.76).68Failed pregnancy during follow-up (%)116/154(75.32)5/90(5.56).00Thrombosis during follow-up (n%)0(0)4(9.52).05Table 2.Laboratory testsIoAPS(n=44)ItAPS(n=42)P-valueAntibody categoriesTriple positive (n%)ACL+β2GPI+LA11(25.00)15(35.71).35Double positive (n%)7(15.90)11(26.19).29LA+ACL0(0)1(2.38).49LA+anti-β2GPI2(4.55)3(7.14).67ACL+anti-β2GPI5(11.36)7(16.67).55Single positive (n%)26(59.10)16(38.10).04ACL1(2.27)1(2.38)1.00anti-β2GPI23(52.27)10(23.81).01LA2(4.55)5(11.90).26Negative after treatment4(9.09)1(2.38).36ESR10(6, 27)9(4, 16).06CRP1.03(0.56, 3.85)1.11(0.43, 3.18).63HCY9.9(8.10, 12.10)11.5 (9.30, 14.65).04*aCL: anticardiolipin antibodies; anti-β2-GPI: anti-β2 glycoprotein I antibodies; LA: lupus anticoagulant; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; HCY: homocysteine.Acknowledgments:The authors thank Department of Rheumatology in Peking Union Medical College Hospital for support with statistics.Disclosure of Interests:None declared

Coagulopathy in Critical Illness with Covid-19 The authors describe a 69-year-old man with Covid-19 diagnosed in January 2020 in Wuhan, China, along with two other critically ill patients with Covi...

Background Pneumocystis jiroveci pneumonia (PJP) in non-HIV patients is still a challenge for intensivists. The aim of our study was to evaluate mortality predictors of PJP patients requiring Intensive care unit (ICU) admission. Methods Retrospectively review medical records of patients with diagnosis of PJP admitted to four ICUs of two academic medical centers from October 2012 to October 2015. Results Eighty-two patients were enrolled in the study. Overall hospital mortality was 75.6 %. Compared with survivors, the non-survivors had older age (55 ± 16 vs. 45 ± 17, p = 0.014), higher APACHE II score (20 ± 5 vs. 17 ± 5, p = 0.01), lower white blood cell count (7.68 ± 3.44 vs. 10.48 ± 4.62, p = 0.005), less fever (80.6%vs. 100 %, p = 0.033), more hypotension (58.1 % vs. 20 %, p = 0.003), more pneumomediastinum (29 % vs. 5 %, p = 0.027). Logistic regression analysis demonstrated that age [odds ratio (OR)1.051; 95 % CI 1.007-1.097; p = 0.022], white blood cell count [OR 0.802; 95 % CI 0.670-0.960; p = 0.016], and pneumomediastinum [OR 16.514; 95 % CI 1.330-205.027; p = 0.029] were independently associated with hospital mortality. Conclusions Mortality rate for non-HIV PJP patients requiring ICU admission was still high. Poor prognostic factors included age, white blood cell count and pneumomediastinum. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1855-x) contains supplementary material, which is available to authorized users.

Recently, chloroquine (CQ) has been widely used to improve the efficacy of different chemotherapy drugs to treat tumors. However, the effects of single treatment of CQ on liver cancer have not been investigated. In the present study, we examined the effects of CQ on the growth and viability of liver cancer cells in vitro and in vivo, and revealed that CQ treatment triggered G0/G1 cell cycle arrest, induced DNA damage and apoptosis in a dose- and time-dependent manner in liver cancer cells. Moreover, administration of CQ to tumor-bearing mice suppressed the tumor growth in an orthotopic xenograft model of liver cancer. These findings extend our understanding and suggest that CQ could be repositioned as a treatment option for liver cancer as a single treatment or in combination.