2023年 · 第03卷第02期

The neutrophil-to-lymphocyte ratio (NLR) is an important predictive prognostic tool. However, its accuracy for predicting sepsis remains debatable. This study aimed to evaluate the factors influencing the ability of NLR to predict sepsis. Adult patients with sepsis or septic shock from the eICU database were enrolled in this study. Results showed that there was a significant difference in NLR between the survival and nonsurvival groups (median [lower quartile-upper quartile], 15.27 [7.92-26.28] vs. 17.97 [8.94-31.85], P = 0.008). Area under the curve (AUC) of NLR on the sixth day was the highest. AUC of NLR was significantly higher in the Simplified Acute Physiological Score (SAPS) 3 ≤52 group than that in the SAPS3 > 52 group (0.78 ± 0.05 vs. 0.69 ± 0.03, P = 0.007). AUC of NLR in the nonshock group was significantly higher than that in the shock group (0.72 ± 0.04 vs. 0.65 ± 0.05, P < 0.01). The ability of NLR as a prognosis predictor of sepsis was influenced by admission time, SAPS3, and shock.

Luteolin is a natural flavonoid that has a variety of pharmacological activities, such as anti-inflammatory, anti-allergic, anti-bacterial, antiviral, apoptosis inhibition, cell autophagy regulation, and anti-tumor activity. It is one of the main ingredients of an expert-recommended herbal formula for the prevention and treatment of coronavirus disease 2019 (COVID-19). This suggests that luteolin has strong pharmacological effects on the prevention and treatment of COVID-19. The aims of this study were to identify the molecular targets of luteolin and to infer the possible mechanisms by which it exerts its pharmacological effects. The GSE159787 data set was obtained from the Gene Expression Omnibus online database, and differentially expressed genes were analyzed. There were 22 upregulated differentially expressed genes enriched in the COVID-19 signaling pathway, suggesting that the upregulation of these genes may be closely related to the occurrence of COVID-19. Molecular docking results showed that luteolin had strong binding efficiency to 20 of these 22 key genes. Six of these genes (CFB, EIF2AK2, OAS1, MAPK11, OAS3, and STAT1) showed strong binding activity. Luteolin can regulate the COVID-19 signaling pathway by combining with these targets, which may have a therapeutic effect on COVID-19.

In China, a pilot project for the prevention of mother-to-child transmission (PMTCT) of the HIV was initiated in 2001. For the PMTCT of HIV, the Chinese government has released versions of the guidelines since 2004. In 2014, the World Health Organization released guidance on global processes and criteria for the validation of elimination of mother-to-child transmission of HIV and syphilis. To promote the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B virus in China, the Chinese government updated the Guideline for PMTCT of HIV, Syphilis, and Hepatitis B in 2020 (briefly as Guideline-2020). The Guideline-2020 comprises 5 parts: goals, interventions, support measures, duties and cooperation of departments, and definition indicators for PMTCT of HIV and corresponding calculation formulas. Compared with the previous versions, the key points updated in the Guideline-2020 are that the goals are set again, and health education and promotion, the procedure of HIV testing for pregnant women, and the antiretroviral therapy regimen for HIV-positive pregnant women and antiretroviral) prophylaxis regimen for infants are all updated. The antiretroviral prophylaxis regimen as zidovudine-lamivudine-nevirapine/lopinavir/ritonavir twice per day for 6 weeks is recommended for infants at high exposure risk to HIV, whereas the third antiretroviral therapy regimen as tenofovir-lamivudine-lopinavir/ritonavir is recommended for HIV-positive pregnant women, and indicators for PMTCT of HIV and corresponding calculation formulas are defined.

Background: The continued spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains an international public health emergency, resulting in a significant global disease burden. The long-term effects of SARS-CoV-2 infection in humans and the long-term prognosis of patients with coronavirus disease 2019 (COVID-19) after discharge remain unclear. We aimed to assess the quality of life (QoL) and sequelae in patients with COVID-19 after discharge from the hospital by conducting multiple follow-up visits to understand the long-term effects of SARS-CoV-2 on patients' health and its possible influencing factors. Methods: COVID-19 patients discharged from Huoshenshan Hospital (Wuhan, China) between February 15 and April 5, 2020, were followed up at 6, 9, and 12 months after discharge. They completed questionnaires on postdischarge QoL and sequelae under the guidance of medical staff with professional training. The demographic and clinical characteristics of the COVID-19 patients were analyzed using descriptive statistics. A generalized estimating equation model was used to analyze the QoL-related factors. The χ2 test (or Fisher exact test) and multivariate logistic regression analysis were used to analyze the sequelae and influencing factors. Results: A total of 175 patients participated in at least 1 follow-up visit, and 120 completed all 3 follow-up visits. Patients diagnosed with severe and critically ill COVID-19 had worse mental conditions (χ2 = 7.653, P = 0.022) than those with the nonsevere type (not severe or critical) and were more likely to feel fatigued (χ2 = 4.836, P = 0.028). Female patients had a higher risk of sleep disturbance (χ2 = 10.026, P = 0.002) and dyspnea (χ2 = 5.672, P = 0.017) and had more difficulty returning to their original work and life (χ2 = 8.922, P = 0.003) than male patients. Patients with diabetes had a worse appetite (χ2 = 4.669, P = 0.031) and were more prone to sleep disturbance (χ2 = 4.417, P = 0.036) after discharge. The proportion of patients with at least 1 sequela increased from 29.76% (50/168) at 6 months to 51.11% (69/135) at 9 months (χ2 = 14.305, P < 0.001). Compared with the nonsevere type, patients diagnosed with severe and critically ill COVID-19 had an odds ratio (OR) of 4.325 (95% confidence interval [CI], 1.215-15.401) for memory decline. Female patients had an OR of 4.632 (95% CI, 1.716-12.501) for joint or muscle pain. Patients with hypertension had an OR of 3.014 (95% CI, 1.193-7.615) for joint or muscle pain. Conclusion: One year after discharge, there were still some patients with varying degrees of decline in QoL and sequelae, which occurred in all follow-up visits. Moreover, QoL and sequelae after discharge were related to sex, clinical classification of COVID-19, and underlying diseases.

Background: The coronavirus disease 2019 (COVID-19) cases continue to rise, and the demand for medical treatment and resources in healthcare systems surges. Assessing the viral shedding time (VST) of patients with COVID-19 can facilitate clinical decision making. Although some studies have been conducted on the factors affecting the VST of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), few prediction models are currently available. Methods: This retrospective study included the consecutive patients with COVID-19 admitted to Xi’an Chest Hospital in Shaanxi, China, for treatment between December 19, 2021 and February 5, 2022. The clinical data of the patients were extracted from their electronic medical records. Combining significant factors affecting the VST, a nomogram was developed to predict the VST of the SARS-CoV-2 Delta variant in patients with COVID-19. Results: We included 332 patients in this study. The average VST was 21 d. VST was significantly prolonged in patients with severe clinical symptoms, sore throat, old age, long time from onset to diagnosis, and an abnormal white blood cell count. Consequently, we developed a nomogram prediction model using these 5 variables. The concordance index (C-index) of this nomogram was 0.762, and after internal validation using bootstrapping (1000 resamples), the adjusted C-index was 0.762. The area under the nomogram’s receiver operator characteristic curve showed good discriminative ability (0.965). The calibration curve showed high consistency. The VST was prolonged in the group with lower model fitting scores according to the Kaplan-Meier curve (χ2=286, log-rank P < 0.001). Conclusions: We developed a nomogram for predicting VST based on 5 easily accessible factors. It can effectively estimate the appropriate isolation period, control viral transmission, and optimize clinical strategies.

Background: Delta and Omicron are two main variants that have been prevalent since 2021. However, the Omicron variant of severe acute respiratory syndrome coronavirus 2 shows a less severe clinical presentation and high transmissibility. Therefore, we carried out this retrospective study to evaluate Omicron severity compared with the Delta variant and further comprehend the differences in clinical characteristics in patients with the Omicron variant. Methods: We extracted clinical data and compared clinical severity, symptoms, vaccination status, laboratory parameters, viral shedding time, and computed tomography (CT) imaging between the two groups of patients, which included 109 COVID-19 cases with the Delta variant and 183 cases with the Omicron variant, from January 19 to April 1, 2022, in Beijing Ditan Hospital. In addition, the Beijing Center for Disease Prevention and Control conducted whole-genome sequencing. Results: We obtained 94 strains of variants of concern/Delta and 110 strains of variants of concern/Omicron. For the 110 Omicron strains, three were assigned as BA.1.1, 53 as BA.2, and 54 as BA.2.2. Among patients with the Delta variant, 54% (59/109) were moderate, which was significantly higher than that of patients with the Omicron variant (7% (12/183), P < 0.001). The number of patients with mild symptoms in the Omicron group was significantly higher than in the Delta group (80% vs. 35%, P < 0.001). Compared with the Omicron group, patients with underlying diseases or obesity, 60 years or older, or unvaccinated in the Delta group had more severe disease, and there was a significant difference between the two groups. The viral shedding time in the Omicron group was shorter than in the Delta group ((11.9 ± 5.9) vs. (14.0 ± 5.8) days, P = 0.003). Among the 183 patients in the Omicron group, 104 (57%) had dry or sore throat symptoms, more than those in the Delta group (34% (37/109); P < 0.001). In the Delta group, patients in the moderate group had more fever and cough symptoms than those in the mild group. The remission time of CT imaging in the Omicron group was shorter than in the Delta group ((9.0 ± 5.2) vs. (13.2 ± 4.2) days, P = 0.018). Conclusions: Patients with Delta variants are more likely to have pneumonia, mainly with fever and cough symptoms, while patients with the Omicron variant are mostly mild, with more prominent dry or sore throat symptoms. In addition, patients with the Omicron variant have a short viral shedding time and rapid absorption of pneumonia.

Background: The global spread of coronavirus disease 2019 (COVID-19) continues to threaten human health security, exerting considerable pressure on healthcare systems worldwide. While prognostic models for COVID-19 hospitalized or intensive care patients are currently available, prognostic models developed for large cohorts of thousands of individuals are still lacking. Methods: Between February 4 and April 16, 2020, we enrolled 3,974 patients admitted with COVID-19 disease in the Wuhan Huo-Shen-Shan Hospital and the Maternal and Child Hospital, Hubei Province, China. (1) Screening of key prognostic factors: A univariate Cox regression analysis was performed on 2,649 patients in the training set, and factors affecting prognosis were initially screened. Subsequently, a random survival forest model was established through machine analysis to further screen for factors that are important for prognosis. Finally, multivariate Cox regression analysis was used to determine the synergy among various factors related to prognosis. (2) Establishment of a scoring system: The nomogram algorithm established a COVID-19 patient death risk assessment scoring system for the nine selected key prognostic factors, calculated the C index, drew calibration curves and drew training set patient survival curves. (3) Verification of the scoring system: The scoring system assessed 1,325 patients in the test set, splitting them into high- and low-risk groups, calculated the C-index, and drew calibration and survival curves. Results: The cross-sectional study found that age, clinical classification, sex, pulmonary insufficiency, hypoproteinemia, and four other factors (underlying diseases: blood diseases, malignant tumor; complications: digestive tract bleeding, heart dysfunction) have important significance for the prognosis of the enrolled patients with COVID-19. Herein, we report the discovery of the effects of hypoproteinemia and hematological diseases on the prognosis of COVID-19. Meanwhile, the scoring system established here can effectively evaluate objective scores for the early prognoses of patients with COVID-19 and can divide them into high- and low-risk groups (using a scoring threshold of 117.77, a score below which is considered low risk). The efficacy of the system was better than that of clinical classification using the current COVID-19 guidelines (C indexes, 0.95 vs. 0.89). Conclusions: Age, clinical typing, sex, pulmonary insufficiency, hypoproteinemia, and four other factors were important for COVID-19 survival. Compared with general statistical methods, this method can quickly and accurately screen out the relevant factors affecting prognosis, provide an order of importance, and establish a scoring system based on the nomogram model, which is of great clinical significance.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in numerous confirmed cases and deaths worldwide. Recent studies have shown that people living with HIV (PLWH) are prone to develop severe illness and poor outcomes if they experience coronavirus disease 2019 (COVID-19), especially those with uncontrolled viremia and low CD4 T-cell count. Therefore, many countries prioritized PLWH for COVID-19 vaccination. However, lower magnitude or faster waning humoral immune responses elicited by other vaccines have been documented in PLWH, raising concerns regarding the efficacy of the COVID-19 vaccine in these specific populations. Here, we summarize the current progress in the immunogenicity and efficacy of different types of SARS-CoV-2 vaccinations in PLWH and highlight several challenges faced by PLWH in the current COVID-19 pandemics.