Efficacy of corticosteroid in patients with COVID-19: A multi-center retrospective study and meta-analysis.

To evaluate the efficacy of corticosteroids on coronavirus disease 2019 (COVID-19) patients with different levels of disease severity. In our multicenter study, 543 patients with confirmed COVID-19 were classified as non-severe group and severe group, and then were compared respectively for all-cause mortality and length of hospital stay between those who received corticosteroids and not. By searching in PubMed, Web of Science, Embase, and CNKI, we identified 13 retrospective studies and 6 random control trials eligible for criteria of inclusion, and conducted comprehensive meta-analyses assessing the impacts of corticosteroids on mortality, length of stay, duration of RNA clearance and duration of fever. Our multicenter study demonstrated that low-dose corticosteroids can reduce mortality in the multivariable Cox regression analysis for severe patients (p = .03), while presented no influence in univariable analysis for non-severe patients (p = .14). From multivariable analyses, patients with corticosteroids in non-severe group had longer duration of hospitalization (p = .003), but did not in severe group (p = .18). Moreover, for severe patients, corticosteroids can evidently shorten duration of fever. The same results were summarized in the meta-analyses supplemented with the result that corticosteroids delayed viral clearing in non-severe patients. Corticosteroids should be considered based on patient's condition. For patients with non-severe COVID-19, corticosteroid was not recommended as a routine therapeutic initiative as that presented prolonged duration of hospitalization and delayed viral clearing, as well as no positive impact on prognosis. While low-dose corticosteroids may benefit patients with severe COVID-19 for it can manifestly lower risk of death and improve the clinical status to some extent.

Non-linear relationship between red blood cell distribution width and gastrointestinal bleeding risk in stroke patients: results from multi-center ICUs.

Background: The red blood cell distribution width (RDW) is closely linked to the prognosis of multiple diseases. However, the connection between RDW and gastrointestinal bleeding (GIB) in stroke patients is not well understood. This study aimed to clarify this association. Methods: This retrospective study involved 11,107 hospitalized patients from 208 hospitals in the United States, admitted between January 1, 2014, and December 31, 2015. We examined clinical data from 7,512 stroke patients in the intensive care unit (ICU). Multivariate logistic regression assessed the link between RDW and in-hospital GIB in stroke patients. Generalized additive model (GAM) and smooth curve fitting (penalty spline method) were utilized to explore the non-linear relationship between RDW and GIB in stroke patients. The inflection point was calculated using a recursive algorithm, and interactions between different variables were assessed through subgroup analyses. Results: Among the 11,107 screened stroke patients, 7,512 were included in the primary analysis, with 190 identified as having GIB. The participants had a mean age of (61.67 ± 12.42) years, and a median RDW of 13.9%. Multiple logistic analysis revealed RDW as a risk factor for in-hospital GIB in stroke patients (OR = 1.28, 95% CI 1.21, 1.36, p < 0.05). The relationship between RDW and in-hospital GIB in stroke patients was found to be non-linear. Additionally, the inflection point of RDW was 14.0%. When RDW was ≥14.0%, there was a positive association with the risk of GIB (OR: 1.24, 95% CI: 1.16, 1.33, p < 0.0001). Conversely, when RDW was <14.0%, this association was not significant (OR: 1.02, 95% CI: 0.97-1.07, p = 0.4040). Conclusion: This study showed a substantial non-linear link between RDW and the risk of GIB in stroke patients. Maintaining the patient's RDW value below 14.0% could lower the risk of in-hospital GIB.

Risk Factors for Macrosomia in Multipara: A Multi-Center Retrospective Study.

The increased incidence of macrosomia has caused an enormous burden after the transition from the almost 40-year one-child policy to the universal two-child policy in 2015 and further to the three-child policy in 2021 in China. However, studies on risk factors of macrosomia in multipara under the new fertility policy in China are limited. We aim to explore the incidence and risk factors for macrosomia in multipara to provide the scientific basis for preventing macrosomia in multipara. A multi-center retrospective study was conducted among 6200 women who had two consecutive deliveries in the same hospital and their second newborn was delivered from January to October 2018 at one of 18 hospitals in 12 provinces in China. Macrosomia was defined as birth weight ≥ 4000 g. Logistic regression models were performed to analyze risk factors for macrosomia in multipara. The incidence of macrosomia in multipara was 7.6% (470/6200) and the recurrence rate of macrosomia in multipara was 27.2% (121/445). After adjusting for potential confounders, a higher prepregnancy BMI, higher gestational weight gain, history of macrosomia, a longer gestation in the subsequent pregnancy were independent risk factors of macrosomia in multipara (p < 0.05). Healthcare education and preconception consultation should be conducted for multipara patients with a history of macrosomia to promote maintaining optimal prepregnancy BMI and avoid excessive gestational weight gain to prevent macrosomia.

Association Between Drug Treatments and the Incidence of Liver Injury in Hospitalized Patients With COVID-19.

The outbreak of coronavirus disease 2019 (COVID-19) has led to the emergence of global health care. In this study, we aimed to explore the association between drug treatments and the incidence of drug-induced liver injury (DILI) in hospitalized patients with COVID-19. A retrospective study was conducted on 5113 COVID-19 patients in Hubei province, among which 395 incurred liver injury. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards models. The results showed that COVID-19 patients who received antibiotics (HR 1.97, 95% CI: 1.55-2.51, p < 0.001), antifungal agents (HR 3.10, 95% CI: 1.93-4.99, p < 0.001) and corticosteroids (HR 2.31, 95% CI: 1.80-2.96, p < 0.001) had a higher risk of DILI compared to non-users. Special attention was given to the use of parenteral nutrition (HR 1.82, 95% CI: 1.31-2.52, p < 0.001) and enteral nutrition (HR 2.71, 95% CI: 1.98-3.71, p < 0.001), which were the risk factors for liver injury. In conclusion, this study suggests that the development of DILI in hospitalized patients with COVID-19 needs to be closely monitored, and the above-mentioned drug treatments may contribute to the risk of DILI.