Clinical characteristics and predictive value of lower CD4+T cell level in patients with moderate and severe COVID-19: a multicenter retrospective study.

BACKGROUND: In December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei, China. Moreover, it has become a global pandemic. This is of great value in describing the clinical symptoms of COVID-19 patients in detail and looking for markers which are significant to predict the prognosis of COVID-19 patients. METHODS: In this multicenter, retrospective study, 476 patients with COVID-19 were enrolled from a consecutive series. After screening, a total of 395 patients were included in this study. All-cause death was the primary endpoint. All patients were followed up from admission till discharge or death. RESULTS: The main symptoms observed in the study included fever on admission, cough, fatigue, and shortness of breath. The most common comorbidities were hypertension and diabetes mellitus. Patients with lower CD4+T cell level were older and more often male compared to those with higher CD4+T cell level. Reduced CD8+T cell level was an indicator of the severity of COVID-19. Both decreased CD4+T [HR:13.659; 95%CI: 3.235-57.671] and CD8+T [HR: 10.883; 95%CI: 3.277-36.145] cell levels were associated with in-hospital death in COVID-19 patients, but only the decrease of CD4+T cell level was an independent predictor of in-hospital death in COVID-19 patients. CONCLUSIONS: Reductions in lymphocytes and lymphocyte subsets were common in COVID-19 patients, especially in severe cases of COVID-19. It was the CD8+T cell level, not the CD4+T cell level, that reflected the severity of the patient's disease. Only reduced CD4+T cell level was independently associated with increased in-hospital death in COVID-19 patients. TRIAL REGISTRATION: Prognostic Factors of Patients With COVID-19, NCT04292964 . Registered 03 March 2020. Retrospectively registered.

Prognostic value of NT-proBNP in patients with severe COVID-19.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China has been declared a public health emergency of international concern. The cardiac injury is a common condition among the hospitalized patients with COVID-19. However, whether N terminal pro B type natriuretic peptide (NT-proBNP) predicted outcome of severe COVID-19 patients was unknown. METHODS: The study initially enrolled 102 patients with severe COVID-19 from a continuous sample. After screening out the ineligible cases, 54 patients were analyzed in this study. The primary outcome was in-hospital death defined as the case fatality rate. Research information and following-up data were obtained from their medical records. RESULTS: The best cut-off value of NT-proBNP for predicting in-hospital death was 88.64 pg/mL with the sensitivity for 100% and the specificity for 66.67%. Patients with high NT-proBNP values (> 88.64 pg/mL) had a significantly increased risk of death during the days of following-up compared with those with low values (≤88.64 pg/mL). After adjustment for potential risk factors, NT-proBNP was independently correlated with in-hospital death. CONCLUSION: NT-proBNP might be an independent risk factor for in-hospital death in patients with severe COVID-19. TRIAL REGISTRATION: ClinicalTrials, NCT04292964. Registered 03 March 2020.

TNAP inhibition attenuates cardiac fibrosis induced by myocardial infarction through deactivating TGF-ß1/Smads and activating P53 signaling pathways.

Tissue nonspecific alkaline phosphatase (TNAP) is expressed widely in different tissues, modulating functions of metabolism and inflammation. However, the effect of TNAP on cardiac fibrosis remains controversial and needs to be further studied. The present study aims to investigate the role of TNAP on myocardial infarction (MI)-induced fibrosis and its mechanism. TNAP was upregulated in patients with MI, both in serum and injured hearts, and predicted in-hospital mortality. TNAP was also significantly upregulated after MI in rats, mostly in the border zone of the infarcted hearts combined with collagen synthesis. Administration of TNAP inhibitor, tetramisole, markedly improved cardiac function and fibrosis after MI. In the primary cultures of neonatal rat cardiac fibroblasts (CFs), TNAP inhibition significantly attenuated migration, differentiation, and expression of collagen-related genes. The TGF-ß1/Smads signaling suppression, and p-AMPK and p53 upregulation were involved in the process. When p53 inhibitor was administered, the antifibrotic effect of TNAP inhibition can be blocked. This study provides a direct evidence that inhibition of TNAP might be a novel regulator in cardiac fibrosis and exert an antifibrotic effect mainly through AMPK-TGF-ß1/Smads and p53 signals.

[Clinical significance of absolute lymphocyte count in de novo patients with multiple myeloma].

This study was purposed to investigate the correlation of absolute lymphocyte count (ALC) in peripheral blood of de novo multiple myeloma (MM) patients with clinical characteristics, therapeutic efficacy and prognosis. The clinical data of 34 de novo patients with MM in our hospital from January 2002 to August 2011 were analysed retrospectively. According to ALC, patients were divided into ALC < 1.3×10(9)/L (n = 15) group and ALC ≥ 1.3×10(9)/L (n = 19) group. The correlation of incipient ALC levels of de novo MM patients with clinical data such as sex, age, type of MM, bone destruction, clinical staging and grouping, levels of LDH, ß(2)-MG, creatinine and albumin, as well as therapeutic efficacy was analysed. The results showed that ALC was (0.4 - 2.9)×10(9)/L (median ALC was 1.3×10(9)/L) in untreated patients. The effective rate of therapy was 20% in ALC < 1.3×10(9)/L group while it was 57.9% in ALC ≥ 1.3×10(9)/L group. There was statistical difference in effective rate between two groups (χ(2) = 4.9696, P < 0.05). Compared with the ALC ≥ 1.3×10(9)/L group, the percentage of the CD4 and CD4/CD8 ratio were reduced and the percentage of the CD8 increased (P < 0.05). But no significant differences were found in sex, age, type of MM, bone destruction, clinical staging and grouping, levels of LDH, ß(2)-MG, creatinine and albumin in those patients (P > 0.05). It is concluded that ALC in de novo patients with MM may be used as the important indication for analysing therapy effect and prognosis.

[Expression of the neopterin in serum and urine of the patients with non-Hodgkin's lymphoma].

To explore the relationship between the experimental parameters including the neopterin (Npt), LDH and beta(2)-MG concentrations in serum or urine and the therapeutic effect on non-Hodgkin's lymphoma (NHL). Npt, LDH and beta(2)-MG levels in serum and urine collected from 27 patients with NHL before and after chemotherapy were measured by ELISA, biochemistry analyzer and RIA. The relationship between the concentrations of the Npt, LDH, beta(2)-MG in serum or urine and the therapeutic effect of follow-up of NHL cases were analysed. The results indicated that the levels of serum and urine Npt and serum LDH, beta(2)-MG concentrations of pre- and post-chemotherapy in CR and PR patients were lower than that in NC and PD patients (P < 0.05). In conclusion, Npt levels of serum and urine and serum LDH, beta(2)-MG before chemotherapy can be used as prediction parameters of the therapeutic effect on NHL and the assay for Npt from the urine is more convenient than that from the serum.