北京地区250例严重急性呼吸综合征患者临床分析

目的　探讨严重急性呼吸综合征 (SARS)的流行病学特征、临床表现、实验室检查、治疗及预后等特点。方法　回顾性分析北京地坛医院 2 50例SARS患者的临床资料。结果　 2 50例患者的平均年龄 (3 6± 16)岁 ,男 110例 (44 0 % ) ,女 14 0例 (56 0 % )。潜伏期平均 (8± 7)天。主要临床表现 :发热 (10 0 0 % )、咳嗽 (72 8% )、乏力 (70 0 % )。外周血白细胞计数降低者占 2 7 2 % ,淋巴细胞比例降低者占 64 2 %。CD+ 4和CD+ 8计数降低者分别占 91 4%、80 6%。动脉血氧饱和度 (SaO2 )低于 97%者162例 (64 8% )。血清丙氨酸转氨酶 (ALT)升高者 45 2 % ,天冬氨酸转氨酶 (AST)升高者 2 9 4% ,乳酸脱氢酶 (LDH)升高者 42 1% ,肌酸激酶 (CK)升高者 18 3 %。恢复期血清SARS病毒特异性抗体IgG阳性率 69 9%。采用综合治疗 ,使用抗生素、抗病毒药物、激素及免疫增强剂。需要呼吸支持者 196例 ,气管插管或切开机械通气支持治疗者 8例 ,重症患者 81例 (3 2 4% ) ,死亡 2 5例。结论　SARS传染性较强 ,中青年人群患病为主 ,有特征性临床表现 ,采用综合治疗 ,多数患者可取得较好疗效     

78例传染性非典型肺炎病例临床分析

目的　分析传染性非典型肺炎 (世界卫生组织又称严重急性呼吸综合征 ,SARS)患者的临床特点 ,并对其诊断标准和治疗方法进行探讨。方法　对广州呼吸疾病研究所 2 0 0 2年 12月 2 2日至 2 0 0 3年 3月 31日收治的 78例SARS患者的临床、实验室、影像学资料进行回顾性分析。结果78例SARS患者 :男 4 2例 ,女 36例 ;年龄 2 0～ 75岁 ,平均 (37 5± 11 6 )岁 ;医务人员 4 4例 (5 6 % )。临床症状包括 :发热 (10 0 % )、咽痛 (17% )、咳嗽 (88% )、气促 (80 % )、畏寒 (5 9% )、肌肉酸痛 (41% )。血常规 :白细胞 (WBC) <4 0× 10 9/L 12例 (15 % ) ,WBC(4 0～ 10 0 )× 10 9/L 4 9例 (6 3% ) ,WBC >10 0× 10 9/L 17例 (2 2 % ) ,平均为 (7 6± 5 0 )× 10 9/L ;中性粒细胞为 0 75± 0 14 ,淋巴细胞 0 18±0 11。胸部X线和CT显示肺部斑片状阴影 ,短期内病灶增多 ,累计单侧 2 3例 (30 % )、双侧 5 2例(6 7% )。分析医护人员被感染途径 ,提示本病具有较强的飞沫近距离传染特性。出现急性肺损伤(ALI) 37例 (47% ) ,其中发展为急性呼吸窘迫综合征 (ARDS) 2 1例。 7例死亡患者均为ARDS合并有多器官功能衰竭综合征 (MODS)。结论　流行病接触史、发热、X线肺炎征及白细胞计数正常或减少是诊断本病的临床依据。     

超敏C-反应蛋白和C-反应蛋白的测定对SARS的诊断价值

目的　研究血清超敏C -反应蛋白 (hs -CRP )和C -反应蛋白 (CRP)对严重急性呼吸综合征 (SARS)的诊断价值。方法　SARS病人 2 0例、细菌性肺炎病人 2 0例、健康对照 2 0例 ,血清hs -CRP和CRP采用胶乳免疫比浊法全自动定量测定。结果　hs -CRP和CRP测定结果分别为 :健康对照组 (0 6 9± 0 6 2 )mg/L和 (4 4± 0 9)mg/L、细菌性肺炎组 (10 79± 1 36 )mg/L和 (98 0± 2 8 9)mg/L、SARS组 (3 16± 3 72 )mg/L和 (11 0± 9 6 )mg/L。三组间差异均有显著意义 (P <0 0 1)。结论　SARS病人和细菌性肺炎病人早期血清hs -CRP和CRP均升高 ,但细菌性肺炎病人升高更加显著 ,比SARS组分别增加 2 4倍和 7 9倍 ,对SARS与细菌性性肺炎的鉴别诊断有重要意义     

干细胞移植后合并巨细胞病毒感染时淋巴细胞亚群变化

目的　研究异基因外周血干细胞移植 (PBSCT)后早期巨细胞病毒 (CMV)活动性感染时淋巴细胞亚群变化及其意义 ,探讨活动性CMV感染对免疫的影响。方法　根据CMV感染情况 ,将 2 7例早期PBSCT受者分为症状性感染、无症状活动性感染以及同期未出现活动性感染 3组 ,5 1例正常人作为对照组 ,用流式细胞仪测定其淋巴细胞表面CD3 、CD4、CD8、CD16、CD56、CD19、CD2 8的表达 ,比较各组间的差异。结果　PBSCT后早期CD+ 4 T和B细胞数量显著低于正常人 (P值均 <0 0 1) ;2 7例受者中无活动性CMV感染 5例、无症状活动性CMV感染 10例和症状性CMV感染 12例。上述 3组病人的平均CD+ 4 T细胞计数 (× 10 6/L)分别为 32 8± 2 0 3、2 39± 2 18和 199± 92 ;CD+ 8T细胞计数 (× 10 6/L)分别为 4 0 0± 380、2 6 7± 2 0 6和 6 0 3± 4 6 1;CD+ 4 CD+ 2 8的功能细胞亚群的比例分别为 (89 2± 8 9) %、(84 2±10 1) %和 (6 3 5± 11 4 ) % ;自然杀伤 (NK)细胞比例分别为 (16 2± 11 1) %、(2 9 3± 9 9) %和 (19 2±10 2 ) %。与无活动性CMV感染者相比 ,无症状CMV活动性感染者除NK细胞升高外 (P <0 0 1) ,其他指标差异无显著性 ;而症状性CMV感染者和无症状CMV感染者相比 ,其CD+ 4 T细胞数量显著减少(P <0 0 1) ,CD+ 8T     

糖皮质激素治疗重症急性呼吸综合征初探

目的　探讨糖皮质激素对重症急性呼吸综合征 (SARS)病情的影响。方法　定期观察我院自 2 0 0 3年 3月 2 6日至 5月初收治的SARS病人 30例 ,病程均为 3周以上。统计激素治疗的时间和剂量 ,观察治疗前后CD+ 4 、CD+ 8、CD+ 3 T淋巴细胞计数 ,以及电解质、血象、血清白蛋白变化。结果　激素治疗前 2 7例患者CD+ 4 、CD+ 8、CD+ 3 T淋巴细胞计数分别为 (个 / μl ) 4 0 1± 2 0 3、340± 187、75 6± 383。30例中 2 9例使用甲泼尼龙治疗 ,2 4例剂量为 80～ 16 0mg/d ,最大剂量为 10 0 0mg/d(入我院前 )。应用激素后血白细胞升高 (P <0 .0 1) ;血K+ 、Na+ 、Cl-无明显变化 (P >0 .0 5 ) ;血糖升高 (P =0 .0 1) ;血清白蛋白明显下降 (P <0 .0 1) ;较大剂量的激素可明显抑制CD+ 4 、CD+ 8、CD+ 3 T淋巴细胞的水平 ;3例重症病例在大剂量激素应用下出现二重感染。结论　SARS病人在病程早期免疫功能已受到抑制 ,大剂量应用糖皮质激素可明显加重这一抑制 ,并使机体处于高代谢状态 (血糖升高、血清白蛋白下降 ) ,进一步导致病情加重 ,病人在后期易出现严重继发感染 ,因此应严格掌握激素适应证 ,不宜大剂量使用。     

93例传染性非典型肺炎患者外周血T淋巴细胞亚群变化及临床意义

目的　了解传染性非典型肺炎 (世界卫生组织又称严重急性呼吸综合征 ,SARS)患者外周血T淋巴细胞亚群的变化。方法　采用流式细胞仪对 93例临床确诊的SARS患者、5 0例获得性免疫缺陷综合征 (AIDS)患者及 6 4例健康体检者外周血T淋巴细胞亚群进行检测。 93例患者中 ,男4 0例、女 5 3例 ;年龄 17～ 88岁 ,平均 4 4岁 ;重型 35例、普通型 5 8例。结果　健康体检者外周血CD+ 3 、CD+ 4 、CD+ 8分别为 (15 2 7± 4 70 )、(787± 2 5 7)、(6 33± 2 80 )个 / μl;93例急性期SARS患者分别为(72 2± 5 33)、(438± 35 3)、(30 7± 2 17)个 / μl,均有不同程度的下降 (P值均 <0 .0 1) ,重症病例下降尤其明显 ,5例死亡患者外周血CD+ 4 均低于 2 0 0个 / μl;SARS患者恢复期CD+ 3 、CD+ 4 、CD+ 8多数恢复正常。而AIDS患者以CD+ 4 降低为主 ,为 (2 96± 2 98)个 / μl;且CD+ 8升高 ,为 (818± 5 6 6 )个 / μl。 结论SARS患者有明显的细胞免疫损伤。     

广州地区严重急性呼吸道综合征的临床特点

目的　探讨当前流行的严重急性呼吸道综合征 (SARS)的若干临床特点。方法　回顾性统计分析广州南方医院收治的 85例SARS患者的临床资料。结果　 85例SARS患者的年龄在 4～ 87岁 ,平均 ( 38.2± 16 .7)岁 ,男 41例 ,女 44例。该病的潜伏期为 2～ 16d ,平均为 ( 7.4± 3 .8)d ;主要临床表现有发热 ( 97.6 %)、咳嗽 ( 81.2 %)、乏力 ( 74.1%)、头痛 ( 6 3 .5 %)、肌肉酸痛 ( 41.2 %) ;热程多为 4～ 12d( 81.9%) ,平均热程为 ( 7.8± 3.5 )d ;外周血白细胞计数正常或降低 ( 82 .4%) ,淋巴细胞计数减少 ( 2 7.1%) ;血液生化示丙氨酸转氨酶升高 ( 44 .7%) ,天门冬氨酸转氨酶升高 ( 5 7.6 %) ,乳酸脱氢酶升高 ( 49.4%) ,肌酸磷酸激酶升高 ( 2 0 %) ;肺部X线摄片主要表现为片状或斑片状炎症渗出( 85 .9%) ,少数表现为间质性炎症改变 ( 14.1%) ;炎症多位于双侧下肺 /中下肺 ( 5 1.8%) ,其次为单侧下肺 /中下肺 ( 36 .5 %) ;发病至肺炎症渗出完全吸收的平均时间为 ( 2 0 .3± 8.4)d ,热退后至肺炎症渗出完全吸收的平均时间为 ( 13 .1± 6 .9)d ;经验性治疗为 :病毒唑、对症支持治疗及应用广谱抗生素。结论　SARS具有传染性 ,发热、咳嗽、胸片示肺部炎症表现及外周血白细胞正常或降低是该综合征的临床特点。     

医院聚集性感染的重症急性呼吸综合征96例临床分析

目的　初步探讨重症急性呼吸综合征 (SARS)的流行规律、发病特点、临床特征、治疗及预防。方法　分析我院聚集性感染的SARS患者的临床资料。结果　SARS患者 96例 ,男 2 0例 ,女76例 ,年龄 16～ 6 2岁 ,其中医务人员 90例 ,占 93 8% ,均受感染于同一社区患者 ,同期发病。潜伏期1～ 2 0d ;初始体温 (38 3± 0 6 )℃ ,最高体温 (39 2± 0 6 )℃ ;持续发热 (9 0± 4 2 )d。主要症状有乏力、咳嗽、少量咳痰、畏寒、头痛、全身酸痛、肌痛。X线胸片显示肺部病变以双侧、中下肺野为主。6 7 7%患者外周血白细胞计数减少。鼻导管吸氧状态下最低脉搏血氧饱和度为 (94 8± 3 1) %。6 8 8%患者使用甲泼尼龙 ,初始剂量为 (6 7 3± 2 8 2 )mg/d ,最大剂量为 (82 4± 30 5 )mg/d ,持续使用时间 (4 9± 2 4 )d。痊愈出院 95例 (99 0 % ) ,住院时间 8～ 4 7d。结论　SARS发病可呈医院聚集性 ,起病急 ,进展迅速 ,X线胸片显示以双侧肺部受累为主 ,适时使用包括糖皮质激素、抗生素、丙种球蛋白、α 干扰素、抗病毒药物等在内的综合治疗可能有助于减轻病情或缩短病程。     

重症传染性非典型肺炎的治疗及死亡危险因素的分析

目的　探讨重症传染性非典型肺炎 (世界卫生组织又称严重急性呼吸综合征 ,SARS)的治疗方法以及预测死亡的可能危险因素。方法以 2 0 0 2年 12月至 2 0 0 3年 3月临床诊断重症SARS37例患者为对象 ,通过回顾性分析 ,比较 33例应用持续气道内正压的方式进行无创通气前后的呼吸频率和脉搏容积血氧饱和度 (SpO2 ) ,并对其中 18例吸氧 5L/min、安静下SpO2 只有 90 %～ 93%的患者 ,进行无创通气前轻微活动、安静状态及无创通气 1h后SpO2 的比较 ;对年龄、基础疾病、血小板减少、白细胞升高、淋巴细胞减少 5个因素预测死亡的可能危险性采用Mantel Haenszelχ2 检验进行统计学分析。结果　 33例患者无创通气 1h后较通气前呼吸频率明显减慢 (P <0 0 1) ,分别为 (2 9 6±10 0 )次 /min和 (34 6± 8 4 )次 /min ;SpO2 明显提高 (P <0 0 1) ,分别为 (96 1± 2 4 ) %和 (89 9±3 5 ) %。 18例吸氧 5L/min、安静下SpO2 只有 90 %～ 93%的患者 ,轻微活动后SpO2 明显下降 ,无创通气 1h后SpO2 明显提高 ,SpO2 分别为 (91 7± 0 9) %、(88 5± 1 4 ) %和 (96 9± 1 8) % (P均 <0 0 1) ;以血小板减少、年龄 >5 0岁、基础疾病、血白细胞升高、淋巴细胞减少 5个因素预测死亡的可能危险性 ,其相对危险度 (RR )分别为 2     

太原地区严重急性呼吸综合征63例临床分析

目的　对太原市严重急性呼吸综合征 (SARS)的流行病学、临床表现及实验室检查、治疗和转归进行探讨 ,为防治SARS提供经验和依据。方法　采用回顾性方法对本院所收治的 6 3例SARS病例进行分析。结果　 6 3例SARS患者中 ,平均年龄 (35 .1± 14 .4 )岁 ,有明显接触史 36例 ,呈聚集发病 2 2例 ,医务人员感染 3例。平均潜伏期 (6 .2± 3.1)d ,太原市 4月份发病人数最多占 73% ,2 0～ 4 0岁年龄段发病者占 5 9.4 %。临床上以发热 (98.4 % )、咳嗽 (80 .95 % )、末梢血白细胞计数正常或低于正常为主 (88.9% ) ,病后 1周内胸片呈渗出性改变者占 92 .3% ,以双肺、双下肺及右下肺受累最多见 (6 6 .7% ) ,平均住院 (11.6± 5 .9)d时胸片显示炎症开始吸收 ;住院 (2 2 .9± 6 .7)d时炎症基本吸收。 6 3例中 ,重型 14例 (2 2 .2 % ) ,死亡 6例 (9.5 % )。结论　SARS呈明显的聚集发病现象 ,以近距离接触飞沫传播方式为主 ,临床以发热、白细胞总数正常或低于正常、胸片渗出性改变为特点。     

Effects of severe acute respiratory syndrome (SARS) coronavirus infection on peripheral blood lymphocytes and their subsets.

INTRODUCTION: Severe acute respiratory syndrome (SARS) caused large outbreaks of atypical pneumonia in 2003, with the largest localized outbreak occurring in Beijing, China. Lymphopenia was prominent amongst the laboratory abnormalities reported in acute SARS. METHODS: The effect of SARS on peripheral blood lymphocytes and their subsets was examined in 271 SARS coronavirus-infected individuals. RESULTS: There was a significant decrease in the CD45+, CD3+, CD4+, CD8+, CD19+ and CD16+/56+ cell counts over the five weeks of the SARS illness although CD4+/CD8+ ratios did not change significantly. The lymphopenia was prolonged, reaching a nadir during days 7-9 in the second week of illness before returning towards normal after five weeks, with the lowest mean CD4+ cell count of 317 cellsx10(6)/L at day 7, and CD8+ cell count of 239 cellsx10(6)/L at day 8. Patients with more severe clinical illness, or patients who died, had significantly more profound CD4+ and CD8+ lymphopenia. DISCUSSION: Lymphopenia is a prominent part of SARS-CoV infection and lymphocyte counts may be useful in predicting the severity and clinical outcomes. Possible reasons for the SARS-associated lymphopenia may be direct infection of lymphocytes by SARS-CoV, lymphocyte sequestration in the lung or cytokine-mediated lymphocyte trafficking. There may also be immune-mediated lymphocyte destruction, bone marrow or thymus suppression, or apoptosis.     

Severe acute respiratory syndrome in Taiwan: analysis of epidemiological characteristics in 29 cases

OBJECTIVES: To describe the clinical characteristics and outcomes of patients with severe acute respiratory syndrome (SARS). METHODS: Between March 28 and June 30 '2003, 29 patients with probable SARS seen at Shin Kong Wu Ho-Su Memorial Hospital, Taipei, were analysed. RESULTS: Presenting symptoms included fever (100%), cough (69.0%), chills or rigor (62.1%), and shortness of breath (41.4%). Mean days to defervescence were 6.8+/-2.9 days, but fever recurred in 15 patients (51.7%) at 10.9+/-3.4 days. Common laboratory features included lymphopenia (72.4%), thrombocytopenia (34.5%) and elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), and aspartate aminotransferase (AST) (93.1, 62.1, 44.8%, respectively). All patients except one had initial abnormal chest radiographs and 20 (69.0%) had radiological worsening at 7.5+/-2.6 days. Nine patients (31.0%) subsequently required mechanical ventilation with four deaths (13.8%). Most patients with clinical deterioration responded to pulse corticosteroid therapy (14 out of 17) but six complicated with nosocomial infections. The risk factors associated with severe disease were presence of diarrhoea, high peak LDH and CRP, high AST and creatine kinase on admission and high peak values. CONCLUSIONS: Prudent corticosteroid use, vigilant microbiological surveillance and appropriate antibiotics coverage are the key to successful treatment.     

An indolent case of severe acute respiratory syndrome

Severe acute respiratory syndrome (SARS) is a highly contagious and typically rapidly progressive form of atypical pneumonia, which spread from Asia to many parts of the world in early 2003. Clinical diagnosis of SARS requires the presence of unremitting fever and progressive pneumonia despite antibiotic therapy, particularly in the presence of lymphopenia and raised transaminase levels. We report the case of a woman who had undergone a successful allogeneic bone marrow transplant for acute myeloid leukemia. She presented initially with fever and a normal chest radiograph. Her indolent clinical course of SARS was punctuated by resolution of fever, but there was progressive radiologic deterioration and increasing serum antibody titer against SARS coronavirus. Treatment with oral prednisolone and ribavirin normalized her lymphopenia, altered transaminases, chest radiograph and high-resolution computed tomography appearances rapidly. Our experience should alert other clinicians in recognizing this atypical indolent presentation of SARS, to protect health care workers and the community at large and to ensure that these patients are properly treated.     

A comparative study of markers of inflammation for the assessment of cardiovascular risk in patients presenting to the emergency department with acute chest pain suggestive of acute coronary syndrome

BACKGROUND: The role of inflammation in the pathogenesis of acute coronary syndrome (ACS) is established. Little is known however, regarding the use of inflammatory markers as predictors of future cardiovascular events in patients presenting to the emergency department (ED) with suspected ACS. HYPOTHESIS: To assess whether biomarkers that predict cardiovascular risk in apparently healthy individuals and coronary artery disease patients are useful predictors of future cardiovascular events in patients presenting to the ED with chest pain suggestive of ACS. METHODS: We compared the abilities of serum C-reactive protein (hs-CRP), albumin and leukocyte count to identify subjects with ACS and those who are at high risk of developing events during a 30-day follow-up. RESULTS: 144 patients (mean age 62+/-13 years, 45 female) presenting to the ED <3 h after the onset of symptoms suggestive of ACS were evaluated. Final hospital diagnoses were non-ischemic chest pain in 43 (30%) and ACS in 101 (70%) patients. Patients with ACS had significantly higher leukocyte count (p<0.0001) and hs-CRP levels (p<0.02) and lower albumin concentrations, compared to patients with NICP (p<0.0001). Lower albumin concentrations (p=0.03) and hs-CRP (p=0.049) were predictors of recurrent events at 30 days. On multivariate analysis, however, only leukocyte count was a predictor of ACS (OR 20.9; 95% CI: 3.7-19.5; p=0.01) and high hs-CRP levels were a predictor of clinical outcome (OR 2.8; 95% CI: 1.5-5.2; p=0.001). CONCLUSIONS: Leukocyte count is an independent predictor of ACS in patients presenting to the ED with chest pain suggestive of ACS and high hs-CRP levels are an independent predictor of clinical outcome in ACS patients.     

106例重症急性呼吸综合征患者的临床特征与治疗总结

目的　了解重症急性呼吸综合征 (SARS)的临床特点以及探索临床有效的治疗方法。方法　用前瞻性的方法对入院的 10 6例SARS病例临床资料进行总结。结果　 10 6例患者男 5 6例 ,女5 0例 ;年龄 15～ 81岁 ,平均 (36± 10 )岁 ;多数病人都有发热 (98 1% )、畏寒 (75 5 % )、咳嗽 (71 7% )、头痛和胸闷憋气 (4 3 4 % )、腹泻 (2 4 5 % ) ,肺部有音者较少 (11 2 % )。WBC计数降低者占 34 0 % ,淋巴细胞计数减少者占 81 1% ,CD+ 4 T细胞减少者为 98 1% ,ALT增高者占 7 6 % ,血小板降低者少见(3 8% ) ;几乎所有病人在入院时或次日都有血氧分压下降 [<90mmHg(1mmHg =0 133kPa)者90 2 % ,<70mmHg者 2 8 6 % ];X线胸片表现为单侧局部肺部斑片状浸润者 34 0 % ,单侧多发肺部斑片状浸润者 11 3% ,双肺斑片状浸润者 4 6 2 %。临床治疗采取综合治疗的原则 ,包括以小剂量糖皮质激素 (甲泼尼龙 4 0～ 80mg,12h 1次 ) ,第二代头孢菌素、大环内酯类以及抗病毒药物为主 ,同时强调氧疗、对症及其基础病等的治疗。结论　SARS临床表现和实验室多样化 ,CD+ 4 T细胞测定有助于早期诊断 ,临床治疗以综合治疗为主 ,早期氧疗及小剂量激素治疗有较好的治疗效果。     

Value of initial chest radiographs for predicting clinical outcomes in patients with severe acute respiratory syndrome

PURPOSE: To determine whether the initial chest radiograph is helpful in predicting the clinical outcome of patients with severe acute respiratory syndrome (SARS). METHODS: Of 343 patients who met the World Health Organization's case definition of probable SARS and who had been admitted to a regional hospital in Hong Kong, 201 patients had laboratory evidence of SARS coronavirus infection. The initial frontal chest radiographs of these 201 patients were assessed in a blinded fashion by 3 radiologists; individual findings were accepted if at least 2 of the radiologists concurred. Independent predictors of an adverse outcome, defined as the need for assisted ventilation, death, or both, were identified by multivariate analysis. RESULTS: Bilateral disease and involvement of more than two zones on the initial chest radiograph were associated with a higher risk of liver impairment and poor clinical outcome. Forty-two patients (21%) developed an adverse outcome. Multivariate analysis showed that lung involvement of more than two zones (odds ratio [OR] = 7.0; 95% confidence interval [CI]: 2.7 to 17.9), older age (OR for each decade of life = 1.5; 95% CI: 1.1 to 2.0), and shortness of breath on admission (OR = 2.8; 95% CI: 1.1 to 7.4) were independent predictors of an adverse outcome. CONCLUSION: Frontal chest radiographs on presentation may have prognostic value in patients with SARS.     

Patterns of cardiovascular diseases in COVID-19 patients admitted to tertiary cardiac care centre

ObjectivesTo analyse the pattern of cardiovascular diseases (CVDs) in COVID-19 patients admitted to tertiary cardiac care centre.MethodsWe retrospectively analysed 511 adult patients admitted between July 1, 2020, and November 30, 2020, with COVID-19 infection and having either new onset or pre-existing CVDs. Clinical features, electrocardiogram (ECG), echocardiography, chest X-ray, biomarkers, haematological and biochemical parameters were analysed.ResultsThe mean age of the patients was 56.62 ± 14.74 years. Male: Female ratio was 2.78:1. Pre-existing CVDs were present in 258 patients (50.5%). The most common cardiovascular manifestation was acute coronary syndrome (ACS), seen in 259 patients (50.7%). ST-segment elevation myocardial infarction (STEMI) was more common than non-ST-segment elevation ACS (NSTE-ACS). Possible myocarditis was seen in 52 patients (10.1%). Rhythm and conduction abnormalities were noted in 144 patients (28.2%), the most common being QT prolongation, seen in 51 patients (10%). In-hospital mortality occurred in 97 patients (18.9%). Age, serum Ferritin level, D-dimer, NT-pro-BNP and total leukocyte count were significantly higher among patients with in-hospital mortality compared to survival group. Blood lymphocyte count and Haemoglobin level were significantly lower in mortality-group, compared to survival-group. Incidence of pre-existing CVDs, cardiogenic shock, heart failure, atrial fibrillation (AF), and renal failure were significantly higher in mortality-group compared to survival-group.ConclusionThe most common CVD in COVID-19 patients in our study was ACS. STEMI was more common than NSTE-ACS. Advanced age, elevated serum ferritin, D-dimer, NT pro-BNP, leucocytosis, lymphopenia, lower haemoglobin, pre-existing CVDs heart failure, cardiogenic shock, AF and renal failure were associated with increased mortality in these patients.     

Haematological abnormalities in patients of sarcoidosis

OBJECTIVE: To study the presence and pattern of haematological abnormalities in patients with sarcoidosis in India. METHODS: Haematological investigations including complete blood cell counts, ESR and peripheral smear examination were carried out in 30 consecutive freshly diagnosed cases of sarcoidosis and compared with equal number of age and sex matched healthy controls. Coagulation parameters such as prothrombin time (PT), prothrombin index (PTI), partial thromboplastin time (PTTK) and fibrinogen levels were also studied. RESULTS: There were 15 men (mean age 40.4 +/- 10.15 years) and equal number of women (mean age 38.6 +/- 12.14 years) in the study group. Haematological abnormalities were present in 11 (36.66%) of the patients. Four cases (13.33%, all females) were found to have anaemia and in three of them no other cause for this was evident. Lymphopenia (lymphocyte count <1500/cu mm) was present in eight (26.66%) patients and three (10%) controls (P<0.05). Only one patient (3.3%) had leucopenia. Number of subjects with raised ESR and the mean ESR was higher in the study group as compared to the controls. No coagulation abnormalities were encountered. CONCLUSIONS: Different haematological manifestations in total are common in Indian patients, leucopenia is relatively rare while anaemia, lymphopenia and raised ESR are common     

Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention

The neutrophil to lymphocyte (N/L) ratio is a recently described independent predictor of death/myocardial infarction in patients who have undergone coronary angiography. We hypothesized that an elevated N/L ratio would be a predictor of long-term mortality in patients undergoing percutaneous coronary intervention (PCI). A total of 1,046 patients who underwent PCI were divided into tertiles based on their preprocedural N/L ratio (mean N/L ratio, tertile 1, 1.7 +/- 0.5; tertile 2: 3.2 +/- 0.6; tertile 3, 11.2 +/- 12.9). Vital status was assessed using the Social Security Death Index. There were a total of 144 deaths over a mean follow-up of 32 months. The best survival was seen in tertile 1, with an increase in long-term mortality seen in tertiles 2 and 3 (p <0.0001). In multivariable modeling, after adjusting for age, chronic obstructive pulmonary disease, left ventricular ejection fraction, serum hemoglobin, serum creatinine, and lesion severity, the log N/L, but not the white blood cell count, was an independent significant predictor of long-term mortality (hazard ratio 1.85, 95% confidence interval 1.3, to 3.04, p = 0.01). The risk persisted when patients with an acute myocardial infarction were excluded from the analysis (hazard ratio 2.46, 95% confidence interval 1.4 to 4.4, p = 0.002). In conclusion, an elevated preprocedural N/L ratio in patients undergoing PCI is associated with an increased risk of long-term mortality.