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      Clinical features of critically ill patients infected with SARS-CoV-2 outside Wuhan with and without diabetes

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          Abstract

          Aim

          Some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rapidly develop to critical condition. Here, we investigated the clinical features of critically ill SARS-CoV-2 patients with and without diabetes and identified risk factors for death of these patients.

          Methods

          The medical records including epidemiological, demographic, clinical, and laboratory data from 49 critically ill SARS-CoV-2 patients were collected and analyzed in Huanggang City and Xiaogan City, Hubei Province, outside Wuhan.

          Results

          Sixty-seven percent (33) of patients survived and 33% (16) of patients died in 49 critically ill patients (32 men, 17 women), with a median age of 63 years (IQR 53–73). Univariate analyses indicated that the deceased patients were more often associated with two or more comorbidities, one or more gastrointestinal symptoms, high neutrophil percentage, low lymphocytes and lymphocyte percentage, high C-reactive protein, high procalcitonin, high fasting blood glucose (FBG), and high lactate dehydrogenase (LDH) compared with the survivors; moreover, the patients with T2DM had the higher neutrophil percentage, the lower lymphocyte percentage, and the higher levels of FBG and LDH compared with the patients without T2DM. Multivariable logistic regression analyses indicated that gastrointestinal symptoms (≥ 1 symptoms), decreased lymphocytes (< 1.1 × 10 9/L), and increased FBG (≥ 7.0 mmol/L) were the independent risk factors for death of critically ill patients.

          Conclusions

          Critically ill COVID patients with T2DM had more severe damages of the lymphocytes, islet cells, and heart function, and gastrointestinal symptoms, lymphopenia, and increased FBG may be early predictors for poor prognosis.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s13410-020-00888-3.

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          Most cited references24

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Clinical Characteristics of Coronavirus Disease 2019 in China

            Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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              Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

              In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
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                Author and article information

                Contributors
                tangshaohui206@163.com
                Journal
                Int J Diabetes Dev Ctries
                Int J Diabetes Dev Ctries
                International Journal of Diabetes in Developing Countries
                Springer India (New Delhi )
                0973-3930
                1998-3832
                5 November 2020
                : 1-9
                Affiliations
                [1 ]GRID grid.449838.a, ISNI 0000 0004 1757 4123, Department of Endocrinology, , Affiliated Hospital (Clinical College) of Xiangnan University, ; Chenzhou, 423000 Hunan People’s Republic of China
                [2 ]GRID grid.258164.c, ISNI 0000 0004 1790 3548, Department of Gastroenterology, The First Affiliated Hospital, , Jinan University, ; Guangzhou, 510630 Guangdong People’s Republic of China
                [3 ]GRID grid.449838.a, ISNI 0000 0004 1757 4123, Department of Critical Medicine, , Affiliated Hospital (Clinical College) of Xiangnan University, ; Chenzhou, 423000 Hunan People’s Republic of China
                [4 ]GRID grid.460066.2, Department of Infectious Diseases, , the First People’s Hospital of Xiaochang County, ; Xiaogan, 432900 Hubei People’s Republic of China
                [5 ]GRID grid.449838.a, ISNI 0000 0004 1757 4123, Department of Interventional Vascular Surgery, , Affiliated Hospital (Clinical College) of Xiangnan University, ; Chenzhou, 423000 Hunan People’s Republic of China
                Article
                888
                10.1007/s13410-020-00888-3
                7642858
                4d92c711-36ac-4253-b45b-97c2a31a7395
                © Research Society for Study of Diabetes in India 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 24 August 2020
                : 21 October 2020
                Funding
                Funded by: Science and Technology Funding Project of Chenzhou, Hunan province, China
                Award ID: zdyf201848
                Award Recipient :
                Funded by: Health Commission Funding Project of Hunan province, China
                Award ID: B2019145
                Award Recipient :
                Funded by: Science and Technology Funding Project of Hunan Province, China
                Award ID: 2017SK4010
                Award Recipient :
                Funded by: Key Laboratory of Tumor Precision Medicine , Hunan colleges and Universities Project
                Award ID: 2019-379
                Award Recipient :
                Funded by: Science and Technology Funding Project of Chenzhou, Hunan province, China
                Award ID: Czkj2016031
                Award Recipient :
                Funded by: Medical Science and Technology Foundation of Guangdong Province
                Award ID: A2018011
                Award Recipient :
                Categories
                Original Article

                Endocrinology & Diabetes
                sars-cov-2,critically ill patients,clinical features,t2dm,independent risk factors

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