Validation of reported risk factors for disease classification and prognosis in COVID-19: a descriptive and retrospective study

Risk indicators viral load (ORF1ab Ct), lymphocyte percentage (LYM%), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT) and lactic acid (LA) in COVID-19 patients have been proposed in recent studies. However, the predictive effects of those indicators on disease classification and prognosis remains largely unknown. We dynamically measured those reported indicators in 132 cases of COVID-19 patients including the moderate-cured (moderated and cured), severe-cured (severe and cured) and critically ill (died). Our data showed that CRP, PCT, IL-6, LYM%, lactic acid and viral load could predict prognosis and guide classification of COVID-19 patients in different degrees. CRP, IL-6 and LYM% were more effective than other three factors in predicting prognosis. For disease classification, CRP and LYM% were sensitive in identifying the types between critically ill and severe (or moderate). Notably, among the investigated factors, LYM% was the only one that could distinguish between the severe and moderate types. Collectively, we concluded that LYM% was the most sensitive and reliable predictor for disease typing and prognosis. During the COVID-19 pandemic, the precise classification and prognosis prediction are critical for saving the insufficient medical resources, stratified treatment and improving the survival rate of critically ill patients. We recommend that LYM% be used independently or in combination with other indicators in the management of COVID-19.

A special case of COVID-19 with long duration of viral shedding for 49 days

Prolonged viral shedding is associated with severe status and poor prognosis of COVID-19 patients. Unexpectedly, here we report a non-severe patient with the longest duration of viral shedding. According to the investigation on the clinical and epidemiological information of this case, we concluded that this type of virus might have a low toxicity and transmissibility, but have a prolonged infective ability and was hardly to be eliminated in the body with regular therapy. However, infusion of plasma from recovered patients showed high efficiency in elimination of this virus. Our findings might shed light on the management of COVID-19.

Evaluation of Nucleocapsid and Spike Protein-based ELISAs for detecting antibodies against SARS-CoV-2

BackgroundAt present, PCR-based nucleic acid detection cannot meet the demands for coronavirus infectious disease (COVID-19) diagnosis. Methods214 confirmed COVID-19 patients who were hospitalized in the General Hospital of Central Theater Command of the Peoples Liberation Army between January 18 and February 26, 2020, were recruited. Two Enzyme-Linked Immunosorbent Assay (ELISA) kits based on recombinant SARS-CoV-2 nucleocapsid protein (rN) and spike protein (rS) were used for detecting IgM and IgG antibodies, and their diagnostic feasibility was evaluated. ResultsAmong the 214 patients, 146 (68.2%) and 150 (70.1%) were successfully diagnosed with the rN-based IgM and IgG ELISAs, respectively; 165 (77.1%) and 159 (74.3%) were successfully diagnosed with the rS-based IgM and IgG ELISAs, respectively. The positive rates of the rN-based and rS-based ELISAs for antibody (IgM and/or IgG) detection were 80.4% and 82.2%, respectively. The sensitivity of the rS-based ELISA for IgM detection was significantly higher than that of the rN-based ELISA. We observed an increase in the positive rate for IgM and IgG with an increasing number of days post-disease onset (d.p.o.), but the positive rate of IgM dropped after 35 d.p.o. The positive rate of rN-based and rS-based IgM and IgG ELISAs was less than 60% during the early stage of the illness 0-10 d.p.o., and that of IgM and IgG was obviously increased after 10 d.p.o. ConclusionsELISA has a high sensitivity, especially for the detection of serum samples from patients after 10 d.p.o, it can be an important supplementary method for COVID-19 diagnosis.

Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study

BackgroundCoronavirus disease-2019 (COVID-19) is a rapidly escalating epidemic caused by SARS-CoV-2. Identification of a simple and effective indicator to assess disease severity and prognosis is urgently needed. MethodsDynamic changes of blood lymphocyte percentage (LYM%) in 15 death cases, 15 severe cases as well as 40 moderate cases of COVID-19 patients were retrospectively analyzed. A Time-LYM% model (TLM) was established according to the descriptive studies and was validated in 92 hospitalized cases. ResultsResults from death and severe cases showed that LYM% in blood tests were inversely associated with the severity and prognosis of COVID-19. LYM% in moderate type of patients with COVID-19 remained higher than 20% 10-12 days after symptom onset. In contrast, LYM% was lower than 20% in severe cases. However, LYM% in severe cases was higher than 5% 17-19 days after the onset of the disease, while it fell below 5% in death cases. Accordingly, we established a Time-LYM% model (TLM), which was validated as an independent criterion of disease classification in another 92 hospitalized patients with COVID-19. ConclusionLymphopenia can be used as an indicator of disease severity and prognosis of COVID-19 patients. TLM is worth of application in the clinical practice.

The trend of strict liability: reflection on current trials for medical dispute lawsuits / 中华医院管理杂志

Existing laws in China indicate that the fault liability doctrine should be applied in tort lawsuits. However, there is currently the trend in the judicial field of applying strict liability with regard to medical institutions. Strict liability, realized chiefly through the reversal of the burden of relief, stresses the protection of the victims. By citing typical cases, the authors analyze the application of strict liability in medical malpractice disputes: ①Patients have no burden of relief on whether hospitals made errors in the harms brought about. ②There are limitations to reasons for hospitals to get exempted from liabilities; they cannot use reasonable care as pleas. ③The relationship between medical actions and patients' damages is presumed. The authors hold that although the use of strict liability may improve reasonable care by medical workers, yet when mature medical liability insurances are not in place, the application of strict liability in trials adds to the liability of medical institutions and their staff and cannot lead to genuine settlement of patient-doctor disputes. judicial institutions ought to apply strict liability in strict accordance with the law and avoid making compensations for patients at the compromise of judicial justice.

Discussion about judicial discretion in medical malpractice arbitration / 中华医院管理杂志

Results of medical malpractice arbitration are important evidence and proofs for public health departments and judicial institutions to handle properly disputes over medical accidents. Owing to the flaws that exist in the structure of medical malpractice arbitration, arbitration specialists sometimes find it difficult to accept the evidence and proofs. The author of the present paper suggests that judicial discretion be introduced in medical malpractice arbitration. When exercising judicial discretion, the specialists should comply with the following principles: (1)Review objectively the evidence and proofs provided by both the physicians and patients according to law. (2)Ensure neutral arbitration according to the ethics of arbitration. (3)Apply specialized knowledge, clinical experience and logical inference. (4)Make independent and lawful judgments and draw definite conclusions. Anyone who exercises judicial discretion should do so in the light of laws and regulations and bear corresponding legal responsibilities.

Amputation or Salvage-the Medical and Ethical Reflection on the Children with Lower Limbs Severe Injury / 中国医学伦理学

We often have to choosea between amputation and salvage after severe injuries in lower limbs of children.We have established the score scale and discriminatory equation in judging the severity of low limb injury in children.Through medical ethical analysis,the author makes a conclusion that the score scale and the discriminatory equation is valuable in determining severity of lower limbs injury in children.

The Investigation of Dialyzeer Reuse from Ethics / 中国医学伦理学

There existed conflictsin dialyzer reusing among medicine, economics and law in China. The author analyzed the causes and the problems of dialyzer reusing. In China, reusing dialyzer was determined by economical reason. The conclusions were draw that the dialyzer reusing would lessen the pressure of both patients and society, but it would increase the medical risks. Reusing dialyzer consisted with the principle of medical ethics.