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Rationale: The etiology of acute respiratory distress syndrome (ARDS) may play an important role in the failure of noninvasive ventilation (NIV). Objectives: To explore the association between ARDS...

Background: The failure rate of noninvasive ventilation (NIV) remains high in patients with acute respiratory distress syndrome (ARDS). The etiology of ARDS may play an important role in NIV failure.Methods: A multicenter prospective observational study was performed in 17 ICUs in China from September 2017 to December 2019. ARDS patients who used NIV as a first-line therapy were enrolled. The etiology of ARDS was recorded at study entry. Results: A total of 306 patients were enrolled. Of the patients, 146 were classified as having pulmonary ARDS (ARDSp) and 160 were classified as having extrapulmonary ARDS (ARDSexp). NIV improved PaO2/FiO2 from initiation to 24 h of NIV in both groups. However, it improved more slowly in patients with ARDSp than in those with ARDSexp (interaction effect: p < 0.01). ARDSp patients experienced more NIV failure (55% vs. 28%; p < 0.01) and higher 28-day mortality (47% vs. 14%; p < 0.01). The multivariate Cox regression also showed that ARDSp was independently associated with NIV failure (hazard ratio [HR] = 2.81, 95% confidence interval [CI]: 1.89-4.18) and 28-day mortality (HR = 7.49, 95% CI: 4.32-13.01). After propensity matching, 62 patients remained in each group. The baseline data were comparable between the two groups. ARDSp was still independently associated with NIV failure and 28-day mortality (HR = 2.62, 95%CI: 1.49-4.61; and 5.70, 2.59-12.55, respectively). Sensitivity analysis also confirmed these results. Conclusions: Among ARDS patients who used NIV as a first-line therapy, ARDSp was associated with slower improvement in oxygenation, more NIV failure, and higher 28-day mortality than ARDSexp.

BackgroundEffects of early rehabilitation therapy in severe and critical COVID-19 patients remains to be elucidated. MethodsWe recruited 80 severely and critically ill COVID-19 patients in Chongqing from January 21 to March 15, 2020, who had received rehabilitation therapies or standard treatments within 72 h of intensive care unit (ICU) admission. We analyzed mortality rates, length of stay in the ICU and hospital, ventilator-free days, and adverse events during hospitalization. Respiratory function, independent functional status, muscle strength, exercise capacity and life quality were measured at hospital discharge and during a three-month follow-up. ResultsWe found no significant differences between the intervention and control groups in terms of ICU, hospital, and 28-day mortality rates, and lengths of stay in the ICU and hospital. Additionally, early rehabilitation enhanced the duration of ventilator-free days, with no increased adverse events and complications. Total lung capacity and carbon monoxide diffusion capacity, Barthel index, and functional independence measure for patients in the intervention group were all higher than those in the control group at hospital discharge and one month after discharge. Compared to the control group, patients in the intervention group had significantly higher Medical Research Council scores and greater walking distance capacities within 6 min at hospital discharge, as well as one month and three months after discharge. The St. George's Respiratory Questionnaire score was lower in the intervention group than in the control group at one month and three months after hospital discharge.ConclusionsEarly physical and pulmonary rehabilitation is safe and effective for severely and critically ill COVID-19 patients to promote their functional, physical, and psychological recovery.

Background: Global outbreak of novel coronavirus 2019 (COVID-19) continues to constitute a public health emergency of international concern. However, few studies have directly compared the differences of clinical features and outcomes between imported and non-imported COVID-19 patients. We aimed to directly compare the differences of clinical features and outcomes between imported and non-imported COVID-19 patients.Methods: we enrolled 275 patients (53 imported and 222 non-imported cases) with laboratory-confirmed COVID-19 from four designated hospitals in Chongqing, China. Epidemiological, demographic, clinical, laboratory, treatment, and outcome data were collected and analyzed. Independent samples t- test, Mann- Whitney U test, Wilcoxon test,χ2 test, or Fisher’s exact test were adopted to compare the difference between imported and non-imported groups where appropriateResults: The imported group had a higher proportion of asymptomatic patients (18.9% vs. 3.8%, p=0.016), lower lymphocyte count (1.1×109/L vs. 1.5×109 /L, p=0.018), higher neutrophil-to-lymphocyte ratio (NLR) (2.6 vs. 2.3, p=0.0237), higher proportion of CD4+ T cells reduction (70% vs. 44.6%, p=0.043), longer duration of viral shedding (20 days vs. 18 days, p = 0.0416) than the non-imported group. The symptomatic non-imported group had a lower lymphocyte count (1.3×109/L vs. 1.6×109 /L, p=0.003), lower CD4+ and CD8+ T cells, longer viral shedding (20 days vs.13 days, p< 0.001) and hospital stay (17 days vs.14 days, p=0.015) than the asymptomatic non-imported group. Furthermore, when compared with imported group, asymptomatic non-imported group showed higher lymphocyte count (1.6×109/L vs. 1.1×109 /L, p< 0.001) and CD4+ T cells(567 vs.375, p=0.029), while the symptomatic non-imported group showed no difference in lymphocyte count, CD4+ or CD8+ T cells (p ≥ 0.0894).Conclusion: Our results indicated that when compared with imported patients, damage to the immune system by SARS-Cov-2 in non-imported patients was milder, and this might be mainly due to its higher asymptomatic proportion.Clinical trial registration: ChiCTR2000033980. Registered 19 June 2020 - Retrospectively registered, http:// www.chictr.org.cn.

Background To determine the diagnostic value of hematologic markers for coronavirus disease 2019 (COVID‐19) and explore their relationship with disease severity. Methods Subjects included 190 COVID‐19 patients, 190 healthy subjects, and 105 influenza pneumonia (IP) patients. COVID‐19 patients were divided into the ARDS and non‐ARDS groups. Routine blood examination, biochemistry indicator, days in hospital, body temperature, pneumonia severity index (PSI), CURB‐65, and MuLBSTA were recorded. Correlations between variables were assessed using Spearman's correlation analysis. Receiver operating characteristic (ROC) curves were used to study the accuracy of the various diagnostic tests. Results Compared with healthy subjects, COVID‐19 patients had lower white blood cell (WBC), lymphocyte, platelet, and hemoglobin levels; higher percentages of neutrophils and monocytes; lower percentages of lymphocytes and higher neutrophil‐to‐lymphocyte ratio (NLR), monocyte‐to‐lymphocyte ratio (MLR), and platelet‐to‐lymphocyte ratio (PLR) values (P, Hematologic markers, including neutrophils, lymphocytes, monocytes, platelets, neutrophil‐to‐lymphocyte ratio (NLR), monocyte‐to‐lymphocyte ratio (MLR), and platelet‐to‐lymphocyte ratio (PLR), have been proposed as indicators to assist in the diagnosis, early warning, and risk stratification of infectious diseases. We thus performed this study to determine the diagnostic value of hematological markers for coronavirus disease 2019 (COVID‐19) and explore their relationship with disease severity.

We read with interest the work by Weber et al 1 reporting that severe liver failure was observed in a patient during SARS-CoV-2 infection. They suggested that close monitoring of liver function is necessary, and further investigation is required to elucidate the risk factors for liver failure in patients with COVID-19. Previous studies have indicated that liver injury could affect the prognosis of patients with COVID-19, and mortality rate was significantly increased in patients with severe liver injury.2 3 However, the risk factors in patients with COVID-19 developing severe liver injury during hospitalisation have not been thoroughly investigated. Thus, in this study, patients with COVID-19 were recruited to identify the risk factors in patients with COVID-19 with severe liver injury. A total of 192 patients diagnosed with COVID-19 were consecutively hospitalised at Chongqing Public Health Medical Center from January to March 2020, and 12 patients with existing liver disease had been excluded in this study. Liver injury was detected in 75 (39.06%) enrolled patients at admission and 133 (69.27%) during hospitalisation, respectively. Interestingly, liver injury …

BackgroundIn January 19, 2020, first case of 2019 novel coronavirus (2019-nCoV) pneumonia (COVID-19) was confirmed in Chongqing municipality, China.MethodsIn this retrospective, descriptive, multiple-center study, total of 267 patients with COVID-19 confirmed by real-time RT-PCR in Chongqing from Jan 19 to Feb 16, 2020 were recruited. Epidemiological, demographic, clinical, radiological characteristics, laboratory examinations, and treatment regimens were collected on admission. Clinical outcomes were followed up until Feb 16, 2020.Results267 laboratory-confirmed COVID-19 patients admitted to 3 designated-hospitals in Chongqing provincial municipality from January 19 to February 16, 2020 were enrolled and categorized on admission. 217 (81.27%) and 50 (18.73%) patients were categorized into non-severe and severe subgroups, respectively. The median age of patients was 48.0 years (IQR, 35.0-65.0), with 129 (48.3%) of the patients were more than 50 years of age. 149 (55.8%) patients were men. Severe patients were significantly older (median age, 71.5 years [IQR, 65.8-77.0]vs43.0 years [IQR, 32.5-57.0]) and more likely to be male (110 [50.7%]vs39 [78.0%]) and have coexisting disorders (15 [30.0%]vs26 [12.0%]). 41 (15.4%) patients had a recent travel to Hubei province, and 139 (52.1%) patients had a history of contact with patients from Hubei. On admission, the most common symptoms of COVID-19 were fever 225(84.3%), fatigue (208 [77.9%]), dry cough (189 [70.8%]), myalgia or arthralgia (136 [50.9%]). Severe patients were more likely to present dyspnea (17 [34.0%]vs26 [12.0%]) and confusion (10 [20.0%]vs15 [6.9%]). Rales (32 [12.0%]) and wheezes (20 [7.5%]) are not common noted for COVID-19 patients, especially for the non-severe (11 [5.1%], 10 [4.6%]). 118 (44.2%). Most severe patients demonstrated more laboratory abnormalities. 231 (86.5%), 61 (22.8%) patients had lymphopenia, leukopenia and thrombocytopenia, respectively. CD4+T cell counts decrease was observed in 77.1 % of cases, especially in the severe patients (45, 100%). 53.1% patients had decreased CD+3 T cell counts, count of CD8+T cells was lower than the normal range in part of patients (34.4%). More severe patients had lower level of CD4+T cells and CD+3 T cells (45 [100.0%]vs29[56.9%], 31 [68.9%]vs20 [39.2%]). Most patients had normal level of IL-2, IL-4, TNF-α and INF-γ, while high level of IL-6 and IL-17A was common in COVID-19 patients (47 [70.1%], 35 [52.2%]). Level of IL-6, IL-17A and TNF-α was remarkably elevated in severe patients (32 [84.2%]vs15 [51.7%], 25 [65.8%]vs10 [34.5%], 17 [44.7%]vs5 [17.2%]). All patients received antiviral therapy (267, 100%). A portion of severe patients (38, 76.0%) received systemic corticosteroid therapy. Invasive mechanical ventilation in prone position, non-invasive mechanical ventilation, high-flow nasal cannula oxygen therapy was adopted only in severe patients with respiratory failure (5[10.0%], 35[70.0%], 12[24.0%]). Traditional Chinese medicine was adopted to most of severe patients (43,86.0%).ConclusionOur study firstly demonstrated the regional disparity of COVID-19 in Chongqing municipality and further thoroughly compared the differences between severe and non-severe patients. The 28-day mortality of COVID-19 patients from 3 designed hospitals of Chongqing is 1.5%, lower than that of Hubei province and mainland China including Hubei province. However, the 28-mortality of severe patients was relatively high, with much higher when complications occurred. Notably, the 28-mortality of critically severe patients complicated with severe ARDS is considerably as high as 44.4%. Therefore, early diagnosis and intensive care of critically severe COVID-19 cases, especially those combined with ARDS, will be considerably essential to reduce mortality.

Background: SARS-CoV-2 has been a global pandemic, but the emergence of asymptomatic patients has caused difficulties in the prevention of the epidemic. Therefore, it is significant to understand the epidemiological characteristics of asymptomatic patients with SARS-CoV-2 infection. Methods: In this single-center, retrospective and observational study, we collected data from 167 patients with SARS-CoV-2 infection treated in Chongqing Public Health Medical Center (Chongqing, China) from January to March 2020. The epidemiological characteristics and variable of these patients were collected and analyzed. Findings: 82.04% of the SARS-CoV-2 infected patients had a travel history in Wuhan or a history of contact with returnees from Wuhan, showing typical characteristics of imported cases, and the proportion of severe COVID-19 patients was 13.2%, of which 59% were imported from Wuhan. For the patients who was returnees from Wuhan, 18.1% was asymptomatic patients. In different infection periods, compared with the proportion after 1/31/2020, the proportion of asymptomatic patient among SARS-CoV-2 infected patient was higher(19% VS 1.5%). In different age groups, the proportion of asymptomatic patient was the highest(28.6%) in children group under 14, next in elder group over 70 (27.3%). Compared with mild and common COVID-19 patients, the mean latency of asymptomatic was longer (11.25 days VS 8.86 days), but the hospital length of stay was shorter (14.3 days VS 16.96 days). Conclusion: The SARS-CoV-2 prevention needs to focus on the screening of asymptomatic patients in the community with a history of contact with the imported population, especially for children and the elderly population. Funding Statement: This work was supported by the National Key Research and Development Program (No.2016YFC1101100) and National Science Fund for Distinguished Young Scholars (No. 31625011). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved by the Ethics Committee of Chongqing Public Health Medical Treatment Center (NO.2020-018-01-KY), informed consent was allowed to be waived.