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BackgroundTo develop a sensitive risk score predicting the risk of mortality in patients with coronavirus disease 2019 (COVID-19) using complete blood count (CBC).MethodsWe performed a retrospective cohort study from a total of 13,138 inpatients with COVID-19 in Hubei, China, and Milan, Italy. Among them, 9,810 patients with ≥2 CBC records from Hubei were assigned to the training cohort. CBC parameters were analyzed as potential predictors for all-cause mortality and were selected by the generalized linear mixed model (GLMM).FindingsFive risk factors were derived to construct a composite score (PAWNN score) using the Cox regression model, including platelet counts, age, white blood cell counts, neutrophil counts, and neutrophil:lymphocyte ratio. The PAWNN score showed good accuracy for predicting mortality in 10-fold cross-validation (AUROCs 0.92-0.93) and subsets with different quartile intervals of follow-up and preexisting diseases. The performance of the score was further validated in 2,949 patients with only 1 CBC record from the Hubei cohort (AUROC 0.97) and 227 patients from the Italian cohort (AUROC 0.80). The latent Markov model (LMM) demonstrated that the PAWNN score has good prediction power for transition probabilities between different latent conditions.ConclusionsThe PAWNN score is a simple and accurate risk assessment tool that can predict the mortality for COVID-19 patients during their entire hospitalization. This tool can assist clinicians in prioritizing medical treatment of COVID-19 patients.FundingThis work was supported by National Key R&D Program of China (2016YFF0101504, 2016YFF0101505, 2020YFC2004702, 2020YFC0845500), the Key R&D Program of Guangdong Province (2020B1111330003), and the medical flight plan of Wuhan University (TFJH2018006).

Corticosteroid therapy is now recommended as a treatment in patients with severe COVID-19. But one key question is how to objectively identify severely ill patients who may benefit from such therapy. Here, we assigned 12,862 COVID-19 cases from 21 hospitals in Hubei Province equally to a training and a validation cohort. We found that a neutrophil-to-lymphocyte ratio (NLR) > 6.11 at admission discriminated a higher risk for mortality. Importantly, however, corticosteroid treatment in such individuals was associated with a lower risk of 60-day all-cause mortality. Conversely, in individuals with an NLR ≤ 6.11 or with type 2 diabetes, corticosteroid treatment was not associated with reduced mortality, but rather increased risks of hyperglycemia and infections. These results show that in the studied cohort corticosteroid treatment is associated with beneficial outcomes in a subset of COVID-19 patients who are non-diabetic and with severe symptoms as defined by NLR.

BackgroundThe coronavirus disease 2019 (COVID-19) is a recently emerged respiratory infectious disease with kidney injury as a part of the clinical complications. However, the dynamic change of kidney function and its association with COVID-19 prognosis are largely unknown.MethodsIn this multicenter retrospective cohort study, we analyzed clinical characteristics, medical history, laboratory tests, and treatment data of 12,413 COVID-19 patients. The patient cohort was stratified according to the severity of the outcome into three groups: non-severe, severe, and death.FindingsThe prevalence of elevated blood urea nitrogen (BUN), elevated serum creatinine (Scr), and decreased blood uric acid (BUA) at admission was 6.29%, 5.22%, and 11.66%, respectively. The trajectories showed the elevation in BUN and Scr levels, as well as a reduction in BUA level for 28 days after admission in death cases. Increased all-cause mortality risk was associated with elevated baseline levels of BUN and Scr and decreased levels of BUA.ConclusionsThe dynamic changes of the three kidney function markers were associated with different severity and poor prognosis of COVID-19 patients. BUN showed a close association with and high potential for predicting adverse outcomes in COVID-19 patients for severity stratification and triage.FundingThis study was supported by grants from the National Key R&D Program of China (2016YFF0101504), the National Science Foundation of China (81630011, 81970364, 81970070, 81970011, 81870171, and 81700356), the Major Research Plan of the National Natural Science Foundation of China (91639304), the Hubei Science and Technology Support Project (2019BFC582, 2018BEC473, and 2017BEC001), and the Medical Flight Plan of Wuhan University.

The prognostic power of circulating cardiac biomarkers, their utility, and pattern of release in coronavirus disease 2019 (COVID-19) patients have not been clearly defined. In this multicentered retrospective study, we enrolled 3219 patients with diagnosed COVID-19 admitted to 9 hospitals from December 31, 2019 to March 4, 2020, to estimate the associations and prognostic power of circulating cardiac injury markers with the poor outcomes of COVID-19. In the mixed-effects Cox model, after adjusting for age, sex, and comorbidities, the adjusted hazard ratio of 28-day mortality for hs-cTnI (high-sensitivity cardiac troponin I) was 7.12 ([95% CI, 4.60-11.03] P

The safety and efficacy of anti-diabetic drugs are critical for maximizing the beneficial impacts of well-controlled blood glucose on the prognosis of individuals with COVID-19 and pre-existing type 2 diabetes (T2D). Metformin is the most commonly prescribed first-line medication for T2D, but its impact on the outcomes of individuals with COVID-19 and T2D remains to be clarified. Our current retrospective study in a cohort of 1,213 hospitalized individuals with COVID-19 and pre-existing T2D indicated that metformin use was significantly associated with a higher incidence of acidosis, particularly in cases with severe COVID-19, but not with 28-day COVID-19-related mortality. Furthermore, metformin use was significantly associated with reduced heart failure and inflammation. Our findings provide clinical evidence in support of continuing metformin treatment in individuals with COVID-19 and pre-existing T2D, but acidosis and kidney function should be carefully monitored in individuals with severe COVID-19.

Statins are lipid-lowering therapeutics with favorable anti-inflammatory profiles and have been proposed as an adjunct therapy for COVID-19. However, statins may increase the risk of SARS-CoV-2 viral entry by inducing ACE2 expression. Here, we performed a retrospective study on 13,981 patients with COVID-19 in Hubei Province, China, among which 1,219 received statins. Based on a mixed-effect Cox model after propensity score-matching, we found that the risk for 28-day all-cause mortality was 5.2% and 9.4% in the matched statin and non-statin groups, respectively, with an adjusted hazard ratio of 0.58. The statin use-associated lower risk of mortality was also observed in the Cox time-varying model and marginal structural model analysis. These results give support for the completion of ongoing prospective studies and randomized controlled trials involving statin treatment for COVID-19, which are needed to further validate the utility of this class of drugs to combat the mortality of this pandemic.

Health check-ups constitute an essential part of China's primary health care policy and a key measure for health screening and risk assessment for elderly people with hypertension and chronic diseases. The role of health check-ups in reducing the incidence of cardiovascular and all-cause mortality remains controversial. This study aimed to investigate the relationship between health check-ups and cardiovascular and all-cause mortality in elderly individuals with hypertension. Retrospective cohort study. This study included 625,279 elderly participants with hypertension. Associations of regular and irregular health check-ups with cardiovascular disease related (CVD-related) mortality, all-cause mortality and non-CVD-related mortality were tested via the inverse probability of treatment weighting (IPTW) matching and Cox proportional hazard models. Adjusted hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated for mortality. A total of 625,279 participants completed health assessments. During a median follow-up of 5.43 years, 45,927 CVD-related deaths and 25,519 non-CVD-related deaths were recorded. After IPTW, regular health check-ups were significantly associated with reduced CVD-related mortality and all-cause mortality (HR: 0.442, 95 % CI: 0.434–0.450; and HR: 0.441, 95 % CI: 0.435–0.448, respectively). An even stronger association between regular health check-ups and reduced CVD-related mortality was observed in participants with diabetes (HR: 0.40, 95 % CI: 0.39–0.42, P for interaction <0.001), dyslipidaemia (HR: 0.43, 95 % CI: 0.42–0.44, P for interaction <0.001) and a high risk or very high risk of hypertension (HR: 0.41, 95 % CI: 0.40–0.42, P for interaction <0.001). Regular health check-ups may be associated with reductions in CVD mortality and all-cause mortality in the elderly population with hypertension, especially in individuals with diabetes, dyslipidaemia and a high risk or very high risk of hypertension. [ABSTRACT FROM AUTHOR]

Type 2 diabetes (T2D) is a major comorbidity of COVID-19. However, the impact of blood glucose (BG) control on the degree of required medical interventions and on mortality in patients with COVID-19 and T2D remains uncertain. Thus, we performed a retrospective, multi-centered study of 7,337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing T2D. We found that subjects with T2D required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio [HR], 1.49) and multiple organ injury than the non-diabetic individuals. Further, we found that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared to individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization. These findings provide clinical evidence correlating improved glycemic control with better outcomes in patients with COVID-19 and pre-existing T2D. • A cohort of 7,337 COVID-19 patients with or without diabetes was retrospectively studied • Diabetes status increased the need for medical interventions during COVID-19 • Diabetes status increased the mortality risk of patients with COVID-19 • Well-controlled blood glucose correlated with improved outcomes in infected patients Type 2 diabetes (T2D) correlates with a worse outcome for COVID-19. Here, Zhu et al. show that among ∼7,300 cases of COVID-19, T2D is associated with a higher death rate, but diabetics with better controlled blood glucose die at a lower rate than diabetics with poorly controlled blood glucose. [ABSTRACT FROM AUTHOR]

This study aimed to explore the profile of multimorbidity phenotype clusters and their discrepancy in mortality and the efficiency of combined interventions on blood pressure, glucose and lipid in each cluster. Fine and Gray competing risk regression models and Kaplan–Meier curves were used to assess the association between multimorbidity and mortality and rehospitalization. Fine and Gray competing risk regression models and subgroup analyses were used to estimate the relations between combined interventions and mortality. Three distinct multimorbidity clusters were observed: Class 1 named severe class, Class 2 termed moderate class, and Class 3 named mild class. Competing risk regression models revealed that patients in Class 1 have the greatest burden of mortality and rehospitalization compared to Class 3 after confounder adjustment, with HRs 1.43 (95% CI 1.30–1.56, P < 0.001) and 2.97 (95% CI 2.74–3.21, P < 0.001), respectively. The patients in Class 2 have moderate risk of mortality and rehospitalization compared to Class 3 after confounder adjustment, with HRs 1.41 (95% CI 1.30–1.52, P < 0.001) and 2.39 (95% CI 2.23–2.56, P < 0.001), respectively. Furthermore, we found that combined interventions on blood pressure, glucose and lipid simultaneously could further benefit on survival compared to each individual intervention or two in combine. This study found that multimorbidity among patients with CHD was common and increased the risks of death and rehospitalization. Three multimorbidity clusters that were significantly associated with death and rehospitalization were identified. Simultaneous intervention on blood pressure, glucose and lipid level may further benefit CHD patient in survival. • 37,448 of 49,453 (75.7%) patients with coronary heart disease (CHD) in this study had at least 1 comorbidity. • Three distinct multimorbidity clusters of patients with CHD were identified in our study: severe, moderate and mild class. • Concurrent combined interventions on blood pressure, blood glucose and blood lipid further benefited on survival. [ABSTRACT FROM AUTHOR]