OBJECTIVE: This retrospective cohort study aimed to investigate the association between chronic obstructive pulmonary disease (COPD) and the prognosis of COVID-19 patients infected with the Omicron variant. The primary objective was to determine if COVID-19 patients with COPD had higher mortality rates compared to those without COPD. Secondary objectives included assessing the risk of respiratory failure, hospital stay length, intensive care unit (ICU) admission, and oxygen requirements in COPD patients with COVID-19.
METHODS: The study included 2761 COVID-19 patients admitted to the Princess Margaret Hospital, Hong Kong, between January 1 and June 30, 2022. Among them, 7.4% (n = 205) had COPD. Demographic and clinical data, including vaccination status and comorbidities, were collected. The primary outcome was 30-day mortality, and secondary outcomes included respiratory support requirement, hospital stay length, and ICU admission. Logistic regression analyses were conducted, adjusting for potential confounders.
RESULTS: COPD did not independently increase the risk of COVID-19 mortality after adjusting for confounders. Instead, older age, male sex, incomplete vaccination, long-term oxygen therapy use, and specific comorbidities were identified as significant predictors of 30-day mortality. COPD patients were more likely to require oxygen and noninvasive ventilation, but there were no significant differences in other secondary outcomes compared to non-COPD patients.
CONCLUSIONS: COPD itself was not an independent risk factor for COVID-19 mortality. Age, sex, vaccination status, comorbidities, and long-term oxygen therapy use were important predictors of mortality. These findings underscore the importance of considering multiple factors when assessing the impact of COPD on COVID-19 prognosis, particularly with the Omicron variant.

On December 7, 2022, China switched from dynamic zeroing strategy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to reopening. A nationwide SARS-CoV-2 epidemic emerged rapidly. The effect of smoking on SARS-CoV-2 infection remains unclear. We aimed to retrospectively investigate the relationship between smoking and coronavirus disease 2019 (COVID-19) using a community-based cohort of smokers and non-smokers. We included participants from a pre-pandemic cohort with a prolonged follow-up period. Data on smoking status, body mass index, and history of other diseases were collected from health examination and consultation clinic records. Cox regression analysis was used to identify the relationship between groups and SARS-CoV-2 infection over time. We analysed 218 male patients with varied smoking statuses (46.3% current or ex-smokers; average age 68.63 ± 9.81 years). Two peaks in the epidemic were observed following the December 2022 outbreak. At the end of the second peak, non-smokers, current smokers, and ex-smokers had primary infection rates increase to 88.0%, 65.1%, and 81.0%, respectively, with a significant difference between the groups. Current smoking significantly protected against SARS-CoV-2 infection (HR 0.625, 95% CI 0.402-0.970, p = 0.036). Further analyses showed that the prevalence of pneumonia in the unvaccinated, older, diabetic, and non-smoking groups was significantly higher than that in the other groups (p < 0.05). Our study suggests a potential association between smoking and a reduced risk of SARS-CoV-2 infection and pneumonia. This indicates that nicotine and ACE2 play important roles in preventing COVID-19 and its progression. We suggest smokers use nicotine replacement therapy during hospitalization for COVID-19.

The COVID-19 pandemic has increased germ aversion, an aversive affective response to a high likelihood of pathogen transmission. While psychological factors are associated with chronic pain, the relationship between germ aversion and chronic pain remains unexplored. This study aimed to examine the relationship between germ aversion and new-onset and prognosis of chronic pain using longitudinal data collected during the COVID-19 pandemic. We conducted web-based surveys of full-time workers at baseline and after three months. Data were collected on demographic characteristics, psychological factors, and chronic pain. Germ aversion was assessed using a modified Perceived Vulnerability to Disease scale. We analyzed responses from 1265 panelists who completed the survey twice. The prevalence of chronic low back pain (CLBP) and chronic neck and shoulder pain (CNSP) was associated with sex, short sleep duration, psychological distress, loneliness, and germ aversion. Stratified analyses showed that germ aversion was a risk factor for CLBP at three months in both individuals with and without CLBP at baseline, and for CNSP at three months in those with CNSP at baseline, even after adjustment for confounders. In conclusion, this preliminary study suggests that high germ aversion is a risk factor for CLBP and CNSP in young and middle-aged workers.

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common cause of hospital admissions. Coronavirus disease 2019 (COVID-19) has large impact on patients with pulmonary diseases. The purpose of the study is to evaluate the impact of COVID-19 on patients with AECOPD.
UNASSIGNED: Retrospective study with two cohorts, the first period included patients with AECOPD before COVID-19 pandemic; the second period included patients with AECOPD since the beginning of COVID-19 pandemic. The length of stay (LOS), number of patients requiring mechanical ventilation, and allcause mortality were calculated.
UNASSIGNED: There was a total of 55 (44.72%) patients in the pre-COVID period compared to 68 (55.28%) patients in the COVID period. In the pre-COVID period: 14 (19.44%) had hypertension, 26(36.11%) had diabetes, 27(37.50%) had ischemic heart disease, 3(4.17%) had myocardial infarction; in the COVID period: 20 (29.41%) had hypertension, 24(35.29%) had diabetes, 27(39.71%) had ischemic heart disease, 1(1.47) had myocardial infarction. The LOS was shorter in pre-COVID period compared to COVID period, 6.51(SD 5.02) days vs 8.91(SD7.88) days with P-value of 0.042 respectively. The total number of patients needing mechanical ventilation in pre-COVID period was similar to the COVID period with P-value of 0.555. All-cause mortality number was 2 (3.64%) in the pre-COVID period compared to 6 (8.82%) in COVID period with P-value of 0.217.
UNASSIGNED: Study results revealed significant difference in length of stay for patients with AECOPD, patient in COVID period had increased LOS compared to pre-COVID period. There was no significant difference in the other parameters.

UNASSIGNED: Inflammatory bowel disease (IBD) patients use a wide variety of immunosuppressive drugs, including biologics, but their effect on SARS-CoV-2 vaccine antibody levels remains a mystery.
UNASSIGNED: We analysed whether the drugs used in the treatment of IBD patients could affect the concentration of SARS-CoV-2 antibodies.
UNASSIGNED: This is a prospective, single-centre evaluation of the persistence of SARS-CoV-2 antibodies after vaccination at various time points: every 2 months throughout the 6th month after the first dose.
UNASSIGNED: We included a total of 346 vaccinated IBD patients in the study. A negative correlation between antibody level and time from full vaccination was confirmed for the following types of therapy: infliximab (rho = -0.32, p < 0.001), adalimumab (rho = -0.35, p = 0.025), and vedolizumab (rho = -0.50, p < 0.001). In the case of other, long-term drug administration, a negative correlation between antibody level and time from full vaccination was confirmed for mesalazine (rho = -0.35, p < 0.001), budesonide (rho = -0.58, p = 0.004), systemic glucocorticoids (rho = -0.58, p < 0.001), and azathioprine (rho = -0.44, p < 0.001).
UNASSIGNED: Due to the immunosuppressive and biological treatment, IBD patients are exposed to a shorter persistence of SARS-CoV-2 antibodies and require booster doses. The role of gastroenterologists in educating patients about the need to continue SARS-CoV-2 vaccination remains crucial.

(1) Background/Objectives: Dexmedetomidine is a sedative for patients receiving invasive mechanical ventilation (IMV) that previous single-site studies have found to be associated with improved survival in patients with COVID-19. The reported clinical benefits include dampened inflammatory response, reduced respiratory depression, reduced agitation and delirium, improved preservation of responsiveness and arousability, and improved hypoxic pulmonary vasoconstriction and ventilation-perfusion ratio. Whether improved mortality is evident in large, multi-site COVID-19 data is understudied. (2) Methods: The association between dexmedetomidine use and mortality in patients with COVID-19 receiving IMV was assessed. This retrospective multi-center cohort study utilized patient data in the United States from health systems participating in the National COVID Cohort Collaborative (N3C) from 1 January 2020 to 3 November 2022. The primary outcome was 28-day mortality rate from the initiation of IMV. Propensity score matching adjusted for differences between the group with and without dexmedetomidine use. Adjusted hazard ratios (aHRs) for 28-day mortality were calculated using multivariable Cox proportional hazards models with dexmedetomidine use as a time-varying covariate. (3) Results: Among the 16,357,749 patients screened, 3806 patients across 17 health systems met the study criteria. Mortality was lower with dexmedetomidine use (aHR, 0.81; 95% CI, 0.73-0.90; p < 0.001). On subgroup analysis, mortality was lower with earlier dexmedetomidine use-initiated within the median of 3.5 days from the start of IMV-(aHR, 0.67; 95% CI, 0.60-0.76; p < 0.001) as well as use prior to standard, widespread use of dexamethasone for patients on respiratory support (prior to 30 July 2020) (aHR, 0.54; 95% CI, 0.42-0.69; p < 0.001). In a secondary model that was restricted to 576 patients across six health system sites with available PaO2/FiO2 data, mortality was not lower with dexmedetomidine use (aHR 0.95, 95% CI, 0.72-1.25; p = 0.73); however, on subgroup analysis, mortality was lower with dexmedetomidine use initiated earlier than the median dexmedetomidine start time after IMV (aHR, 0.72; 95% CI, 0.53-0.98; p = 0.04) and use prior to 30 July 2020 (aHR, 0.22; 95% CI, 0.06-0.78; p = 0.02). (4) Conclusions: Dexmedetomidine use was associated with reduced mortality in patients with COVID-19 receiving IMV, particularly when initiated earlier, rather than later, during the course of IMV as well as use prior to the standard, widespread usage of dexamethasone during respiratory support. These particular findings might suggest that the associated mortality benefit with dexmedetomidine use is tied to immunomodulation. However, further research including a large randomized controlled trial is warranted to evaluate the potential mortality benefit of DEX use in COVID-19 and evaluate the physiologic changes influenced by DEX that may enhance survival.

BACKGROUND: Following the short-term outbreak of coronavirus disease 2019 (COVID-19) in December 2022 in China, clinical data on kidney transplant recipients (KTRs) with COVID-19 are lacking. METHODS: We conducted a single-center retrospective study to describe the clinical features, complications, and mortality rates of hospitalized KTRs infected with COVID-19 between Dec. 16, 2022 and Jan. 31, 2023. The patients were followed up until Mar. 31, 2023. RESULTS: A total of 324 KTRs with COVID-19 were included. The median age was 49 years. The median time between the onset of symptoms and admission was 13 d. Molnupiravir, azvudine, and nirmatrelvir/ritonavir were administered to 67 (20.7%), 11 (3.4%), and 148 (45.7%) patients, respectively. Twenty-nine (9.0%) patients were treated with more than one antiviral agent. Forty-eight (14.8%) patients were treated with tocilizumab and 53 (16.4%) patients received baricitinib therapy. The acute kidney injury (AKI) occurred in 81 (25.0%) patients and 39 (12.0%) patients were admitted to intensive care units. Fungal infections were observed in 55 (17.0%) patients. Fifty (15.4%) patients lost their graft. The 28-d mortality rate of patients was 9.0% and 42 (13.0%) patients died by the end of follow-up. Multivariate Cox regression analysis identified that cerebrovascular disease, AKI incidence, interleukin (IL)‍-6 level of >6.8 pg/mL, daily dose of corticosteroids of >50 mg, and fungal infection were all associated with an increased risk of death for hospitalized patients. CONCLUSIONS: Our findings demonstrate that hospitalized KTRs with COVID-19 are at high risk of mortality. The administration of immunomodulators or the late application of antiviral drugs does not improve patient survival, while higher doses of corticosteroids may increase the death risk.
2022年12月2019冠状病毒病（COVID-19）在中国出现短期的暴发流行，大量肾移植受者在感染COVID-19后需住院治疗。本研究回顾分析了在2022年12月16日至2023年1月31日期间感染COVID-19并在浙江大学医学院附属第一医院住院治疗的肾移植受者的临床特征和预后，随访截至2023年3月31日。本研究共纳入324名患者，其中位年龄为49岁，从出现症状到入院的中位时间为13天。分别有67例（20.7%）、11例（3.4%）和148例（45.7%）患者接受了莫那匹韦、阿兹夫定和奈玛特韦/利托那韦治疗，29例（9.0%）患者接受了多种抗病毒药物治疗，48例（14.8%）接受了托珠单抗治疗，53例（16.4%）接受了巴瑞替尼治疗。其中，81例（25.0%）发生急性肾损伤（AKI），39例（12.0%）转入ICU治疗，55例（17.0%）发生真菌感染，50例（15.4%）最终发生移植肾失功。患者的28天死亡率为9.0%，截至随访终点时共有42例（13.0%）患者死亡。多因素Cox回归分析显示合并脑血管疾病、AKI出现、白介素-6（IL-6）水平大于6.8 pg/mL、每日平均糖皮质激素剂量大于50 mg以及真菌感染等因素与住院患者死亡风险增加相关。结果表明，感染COVID-19后需住院治疗的肾移植受者死亡率很高。此外，服用免疫调节剂或过迟应用抗病毒药物，并不能提高患者生存率，而且大剂量的糖皮质激素使用则会增加死亡风险。.

BACKGROUND: The clinical manifestations and prognosis of hemodialysis patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during the Omicron wave of the pandemic infection were still unclear. This study investigated the clinical characteristics of patients undergoing maintenance hemodialysis (MHD) infected with it.
METHODS: This retrospective single-center study included 151 patients undergoing MHD. Healthcare workers were selected as control group were assessed from December 1, 2022 to March 31, 2023. Clinical data, laboratory test results, treatment protocols, and prognoses were collected and analyzed.
RESULTS: The study population included 146 patients with MHD, 93 (63.7%) of whom were infected with SARS-CoV-2. The number of non-severe, severe, and critical cases was 84 (90.3%), 4 (4.3%), and 5 (5.3%), respectively. Six patients (6.5%) died during the study period. The main symptoms of SARS-CoV-2 infection, including fever, cough, and fatigue, were less common in patients with MHD than the controls. During SARS-CoV-2 infection, the C-reactive protein (2.9 vs. 11.8 mg/dl, p < 0.0001) and ferritin levels(257.7 vs. 537 ng/l, p < 0.0001) were elevated. The hemoglobin(113vs 111 g/L, p = 0.0001) and albumin levels(39.4 vs. 36.1 g/L, p < 0.0001) decreased. Generally, it took two months for the hemoglobin levels to recover. Positivity rate for SARS-COV-2 serum immunoglobin G (IgG) antibodies and IgG titers were lower in dialysis patients than the controls. Age was positively associated with disease severity, while age and hyponatremia were associated with death.
CONCLUSIONS: Patients with MHD and COVID-19 were primarily classified as non-severe. SARS-CoV-2 infection would soon lead to the increase of inflammation related acute response protein in dialysis patients, and then lead to the decrease of hemoglobin and albumin. About 9.6% in HD patients were severe cases and had poor prognosis. Advanced age and hyponatremia were associated with disease severity and prognosis.

BACKGROUND: Despite vaccines\' effectiveness in reducing COVID-19 infection rates and disease severity, their impact on critical patients presenting with acute respiratory failure is elusive. The aim of this study was to further investigate the influence of vaccination on mortality rates among severely ill COVID-19 patients experiencing acute respiratory failure.
METHODS: This retrospective cohort study was carried out at a tertiary medical center in Taiwan. From April to September 2022, patients who tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through reverse transcription polymerase chain reaction (RT-PCR) and subsequently experienced acute respiratory failure were included in the study. Baseline characteristics, including vaccination history, along with information regarding critical illness and clinical outcomes, were gathered and compared between patients who received the vaccine and those who did not.
RESULTS: A total of 215 patients with COVID-19 exhibiting acute respiratory failure, as confirmed via RT‒PCR, were included in the analysis. Of this cohort, sixty-six (30.7%) patients died within 28 days. Neither administration of the vaccine nor achievement of primary series vaccination status had a significantly different effect on 28 day mortality, number of viral shedding events, acute respiratory distress syndrome (ARDS) incidence or other clinical outcomes. Patients who received the booster vaccine and completed the primary series showed a tendency of increased 28 days of ventilator-free status, though this difference was not statistically significant (p = 0.815).
CONCLUSIONS: Vaccination status did not significantly influence mortality rates, the occurrence of ARDS, or the viral shedding duration in COVID-19 patients with acute respiratory failure.

Coronavirus disease 2019 (COVID-19) is continuously posing high global public health concerns due to its high morbidity and mortality. This study aimed to construct a convenient risk model for predicting in-hospital mortality of COVID-19 Omicron variant. A total of 1324 hospitalized patients with Omicron variant were enrolled from Beijing Anzhen Hospital. During hospitalization, the Omicron variant mortality rate was found to be 24.4%. Using the datasets of clinical demographics and laboratory tests, three machine learning algorithms, including best subset selection, stepwise selection, and least absolute shrinkage and selection operator regression analyses were employed to identify the potential predictors of in-hospital mortality. The results found that a panel of twenty-four clinical variables (including age, hyperlipemia, stroke, tumor, and several cardiovascular markers) identified by stepwise selection model exhibited significant performances in predicting the in-hospital mortality of COVID-19. The resultant nomogram showed good discrimination, highlighted by the areas under the curve values of 0.88 for 10 days, 0.81 for 20 days, and 0.82 for 30 days, respectively. Furthermore, decision curve analysis showed a significant reliability and precision for the established stepwise selection model. Collectively, this study developed an accurate and convenience risk model for predicting the in-hospital mortality of COVID-19 Omicron.