[Impact of the Timing of Traditional Chinese Medicine Therapy on the Therapeutic Effect and Prognosis of Severe Coronavirus Disease 2019].

Objective To explore the optimal therapy time for the treatment of severe coronavirus disease 2019(COVID-19)by traditional Chinese medicine(TCM)and its influence on the therapeutic effect and prognosis. Methods The clinical data,laboratory findings,and outcomes of 64 patients with severe COVID-19 treated with TCM and western medicine in Chongqing from January 20,2020, to March 11,2020 were retrospectively analyzed.Patients were divided into early intervention group[TCM was initiated within 3 days (including day 3) after the first diagnosis of severe type/critical type COVID-19]and late intervention group[TCM was initiated after 7 days (including day 7) after the first diagnosis of severe type /critical type COVID-19].The changes in clinical parameters during the course of disease were compared between the two groups. Results On day 14,the oxygenation index was 292.5(252.0,351.0)mmHg in the early intervention group,which was significantly higher than that in the late intervention group [246.0(170.0,292.5)mmHg](P=0.005).The length of hospital stay [(18.56±1.11)d vs.(24.87±1.64)d,P=0.001],duration of ICU stay [(14.12±0.91)d vs.(20.00±1.53)d,P=0.000] and time to negativity [(16.77±1.04)d vs.(22.48±1.66)d,P=0.001] in the early intervention group were significantly shorter than those in the late intervention group.The intubation rate(7.3%)in the early intervention group was significantly lower than that in the late intervention group(30.4%)(P=0.028). Conclusion Early TCM therapy within three days after a diagnosis of severe COVID-19 can shorten the length of hospital stay,duration of ICU stay,and time to negativity and decrease intubation rate.

Association of Overlapped and Un-overlapped Comorbidities with COVID-19 Severity and Treatment Outcomes: A Retrospective Cohort Study from Nine Provinces in China.

OBJECTIVE: Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear. METHODS: A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients' medical records. Multivariable logistic regression models were used to estimate the odds ratio ( OR) and 95% confidence interval (95% CI) of the associations between comorbidities (cardiometabolic or non-cardiometabolic diseases), clinical severity, and treatment outcomes of COVID-19. RESULTS: Overall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30-6.32), type 2 diabetes (T2DM) (3.57, 2.32-5.49), cardiovascular disease (CVD) (3.78, 1.81-7.89), fatty liver disease (7.53, 1.96-28.96), hyperlipidemia (2.15, 1.26-3.67), other lung diseases (6.00, 3.01-11.96), and electrolyte imbalance (10.40, 3.00-26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89-12.75), CVD (8.47, 6.03-11.89), and electrolyte imbalance (19.44, 11.47-32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25-9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46-29.64) within two weeks. CONCLUSION: Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.

The effect of serum HMGB1 levels on the severity and prognosis of critical ill patients with early trauma-induced coagulopathy in the intensive care unit / 解放军医学杂志

Objective: To analyze the influence of serum high mobility group box-1 protein (HMGB1) levels on the severity and prognosis of critical ill patients at the early of trauma-induced coagulopathy (TIC) in intensive care unit (ICU). Methods: 43 cases of critical ill patients with severe trauma were included during January 1, 2017 to December 31, 2018 in ICU of Foshan Hospital of Traditional Chinese Medicine. International normalized ratio (INR) >1.2 was applied as the diagnosis criterion of TIC. The patients was divided into TIC group (n=23) and control group (n=20). Their age, sex, injury mechanism, the interval between injury and admission to ICU (delay time), the interval between injury and coagulopathy correction (correction time), ISS scores, APACHE II scores at admission to ICU were recorded, and the activated partial thromboplastin time (APTT), prothrombin time (PT), INR, fibrinogen (Fib), platelet counts (PLT), C-reactive protein (CRP) and procalcitonin (PCT) levels were detected meanwhile. The serum HMGB1 levels were examined through ELISA. The blood transfusion volume (red blood cells, RBC and fresh frozen plasma, FFP), ventilation time, ICU stay and 28-day mortality rate were statistically analyzed. Results: TIC occurred in 53.5% of critical ill trauma patients in ICU. There were no significant differences in the age, sex, injury mechanism, delay time, APACHE II scores, ISS scores, APTT, PT, CRP and PCT levels between two groups (P>0.05). Compared with control group, the Fib and PLT levels were significantly reduced in the TIC group, and the ventilation time, blood transfusion volume of RBC and FFP, infection rate and organ dysfunction rate were remarkably increased (P<0.05). Besides, the 28-day mortality rate revealed a raised tendency in TIC group (P=0.091). Simultaneously, the serum HMGB1 levels at admission to ICU were significantly increased in the TIC group, and the serum HMGB1 level in the death subgroup was much higher than that in the survivors, as same as those in the TIC subgroup analysis (P=0.000). The correlation analysis disclosed that serum HMGB1 levels at admission was positively related to delay time, correction time, APACHE II score, ISS score, ventilation time, INR levels, APTT, CRP and PCT levels at admission (r=0.648, 0754, 0.526, 0.516, 0.521, 0.509, 0.432, 0.592, 0.375), and was negatively associated with Fib levels, PLT value, infection incidence rate, organ dysfunction rate and 28-day mortality rate (r=-0.424, -0.571, -0.505, -0.396, -0.765). There were significant differences in the delay time, correction time, ISS scores, transfusion volume, serum HMGB1 levels, PLT value, APTT and CRP levels between death subgroup and survivor subgroup of TIC patients (P<0.05), and serum HMGB1 levels and PLT value at admission were independent risk factors in the multivariable logistic regression analysis (P=0.004, 0.011). For the TIC sub-group trauma patients, the AUC of serum HMGB1 levels was 0.897(95%CI 0.748-1.000, P=0.002), the best cutoff value was 54.60 ng/ml with Youden index of 0.808. Conclusions: The PLT levels and serum HMGB1 levels at admission to ICU are independent risk factors of critical ill patients with severe trauma. The serum HMGB1 levels is closely related to severity and prognosis, and can predict the 28-day mortality rate of critical ill patients with TIC.