Objective:To study the relationship between serum level matrix metalloproteinase-9 (MMP-9) and atrial fibrillation (AF) and to assess its predictive value of AF recurrence in persistent AF patients after cardio-version.
Methods: Our research included in 4 groups: Control group, n=30 healthy subjects, Paroxysmal AF group, n=30, Persistent AF group, n=60 and Permanent AF group, n=30. Serum levels of MMP-9 were examined and compared among different groups. The patients in Persistent AF group received drug therapy or drug+electric cardio-version;with successful cardio-version, antiarrhythmia medication was used to maintain sinus rhythm and the patients were followed-up for prognosis, MMP-9 levels were further compared between the patients with or without AF recurrence to assess the predictive value of MMP-9 for AF recurrence.
Results: Serum levels of MMP-9 were as follows: Control group (151.43±88.14) ng/ml, Paroxysmal AF group (182.66±96.39) ng/ml, Persistent AF group (278.93±89.22) ng/ml and Permanent AF group (336.82±112.35) ng/ml respectively, which indicated that MMP-9 level in Persistent AF group was higher than Paroxysmal AF group and Control group;MMP-9 in Persistent AF group was higher than the other 3 groups, P<0.01. The patients in Permanent AF group were followed-up for (15.4±4.3) months after cardio-version, retrospective analysis found that the patients with AF recurrence had the higher MMP-9 level than those without AF recurrence (315.63±94.52) ng/ml vs (261.92±87.86) ng/ml, P=0.036. Multivariate regression analysis was conducted on age, gender, AF history, left atrial diameter and MMP-9, the consequence showed that serum MMP-9 level was the independent predictor for AF recurrence in persistent AF patients after cardio-version (P=0.035, OR=1.135, 95%CI 1.018-1.321).
Conclusion: Serum MMP-9 level was elevated in persistent and permanent AF patients;MMP-9 was the independent predictor for AF recurrence in persistent AF patients after cardio-version.

Objective:To explore the effect of chitosan hydrogel on the serum levels of tumor necrosis factor (TNF-α),interleukin (IL-10) and intercellular adhesion molecule (ICAM-1) of patients with burns.Methods:96 cases with second degree burns who were treated in our hospital from June 2015 to November 2016 were selected and randomly divided into two groups,with 48 cases in each group.The patients in the observation group were treated with chitosan hydrogel,while the patients in the control group were treated with conventional vaseline gauze wound.Then the wound healing,the serum levels of tumor necrosis factor (TNF-α),interleukin (IL-10) and intercellular adhesion molecule (ICAM-1) and the incidence of adverse reactions were observed and compared between the two groups before and after the treatment.Results:The healing rate of superficial burns at the 7th day in the observation group was significantly higher than that of the control group (P＜0.01).The healing rate of deep burns at the 15th day and 25th day were significantly higher than those of the control group (P＜0.05).The healing time of the superficial burns and deep bums in the observation group were significantly shorter than those of the control group,and the SI score was significantly lower (P＜0.01).After treatment,the serum levels of TNF-α,IL-10 and ICAM-1 of patients with superficial burns significantly decreased in the two groups,and the observation group was lower than that of the control group (P＜0.05).The serum levels of TNF-α,IL-10 and ICAM-1 of patients with deep burns were significantly lower than before,and the observation group was lower than that of the control group (P＜0.01).The incidence of wound infection in the observation group was lower than that of the control group (P＜0.05).Conclusion:Chitosan wound repair membrane gel could accelerate the wound healing,prevent the wound infection,and reduce the inflammation with high safety.

OBJECTIVETo observe the curative effects of platelet-rich plasma (PRP) combined with negative-pressure wound therapy (NPWT) on patients with sternal osteomyelitis and sinus tract after thoracotomy.

METHODSSixty-two patients with sternal osteomyelitis and sinus tract after thoracotomy, hospitalized from March 2011 to June 2015, were retrospectively analyzed. Based on whether receiving PRP or not, patients were divided into two groups, group NPWT ( 22 patients hospitalized from March 2011 to December 2012) and combination treatment group (CT, 40 patients hospitalized from January 2013 to June 2015). After debridement, patients in group NPWT were treated with continuous NPWT (negative pressure values from -15.96 to -13.30 kPa), while those in group CT were treated with PRP gel (blood platelet counts in PRP ranged from 1 450×10(9)/L to 1 800×10(9)/L, with 10-15 mL in each dosage) made on the surgery day to fill the sinus tract and wound, followed by NPWT. Negative pressure materials were changed every 5 days until 20 days after surgery in patients of both groups. PRP gel was replenished before changing of negative pressure materials in patients of group CT. The sinus tract sealing time, wound healing time, number of patients who had secondary repair surgery, number of patients who had recurrence of sinus tract within three months after wound healing, and length of hospital stay were recorded. Data were processed with t test, Fisher's exact test, and chi-square test.

RESULTSThe sinus tract sealing time, wound healing time, and length of hospital stay in patients of group CT were (16±8), (27±13), and (43±13) d respectively, which were all significantly shorter than those in group NPWT [(29±14), (41±17), and (60±20) d, with t values from 3.88 to 4.67, P values below 0.01]. The number of patients who had secondary repair surgery in group CT was less than that in group NPWT (P<0.01). There was no statistically significant difference in the number of patients who had recurrence of sinus tract between two groups (P>0.05).

CONCLUSIONSCompared with NPWT only, PRP combined with NPWT has great curative effects on patients with sternal osteomyelitis and sinus tract after thoracotomy, for it shortens sinus tract sealing time, wound healing time, and length of hospital stay, and avoids the secondary repair surgery. This method is simple and safe with little injury.

Debridement ; Humans ; Length of Stay ; Negative-Pressure Wound Therapy ; Osteomyelitis ; surgery ; therapy ; Paranasal Sinuses ; pathology ; Platelet-Rich Plasma ; Retrospective Studies ; Sternum ; surgery ; Thoracotomy ; Wound Healing

Objective:To investigate the differences and changes in early postoperative visual quality after small incision lenticule extraction (SMILE) and smart pulse technology-assisted transepithelial photorefractive keratectomy (SPT-TransPRK).Methods:A cohort study was performed.A total of 92 patients (92 eyes) who underwent corneal laser refractive surgery were enrolled in Dalian Third People's Hospital Affiliated to Dalian Medical University from February 2021 to May 2021.The data from the right eye were collected for analysis.The patients were divided into SMILE group (40 patients, 40 eyes) and SPT-TransPRK group (52 patients, 52 eyes). Preoperative, 1- and 3-month postoperative visual acuity were measured to calculate the effectiveness, which was defined as the ratio of postoperative uncorrected visual acuity (UCVA) to preoperative best corrected visual acuity.Refraction was measured by an AR-1 autorefractor.Corneal higher-order aberration (HOA) including total HOA, spherical aberration and coma was measured by Sirius corneal topographer.Objective scatter index (OSI), modulation transfer function cut-off frequency (MTF cut-off), Strehl ratio (SR), simulated contrast visual acuity VA100 (day), VA20 (dusk) and VA9 (night) were measured via OQAS II visual quality analysis system.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Dalian Third People's Hospital Affiliated to Dalian Medical University (No.2019-KT-010). Written informed consent was obtained from each subject.Results:There was no significant difference in 3-month postoperative UCVA and effectiveness between the two groups ( Z=0.880, P=0.380; t=0.920, P=0.058). Patients in SPT-TransPRK group showed mild hyperopia 3 months after surgery.Preoperative, 1- and 3-month postoperative total corneal HOA was (0.47±0.18), (0.70±0.22) and (0.74±0.19)μm in SMILE group, and (0.40±0.14), (0.98±0.35) and (0.94±0.22)μm in SPT-TransPRK group respectively, showing statistically significant differences ( Fgroup=13.851, P=0.001; Ftime=29.960, P<0.001). Preoperative, 1- and 3-month postoperative spherical aberration was (-0.20±0.09), (-0.44±0.14) and (-0.44±0.15)μm in SMILE group, and (-0.20±0.10), (-0.71±0.23) and (-0.75±0.20)μm in SPT-TransPRK group respectively, showing statistically significant differences ( Fgroup=31.037, P<0.001; Ftime=48.005, P<0.001). The postoperative total corneal HOA and spherical aberration were increased in both groups compared with before surgery, with statistically significant differences (all at P<0.05). The 1- and 3-month postoperative total corneal HOA and spherical aberrations were smaller in SMILE group than in SPT-TransPRK group, and the differences were statistically significant (all at P<0.05). The 1- and 3-month postoperative coma were increased in both groups compared with before surgery, showing statistically significant differences (all at P<0.05). In SMILE group, 1-month postoperative OSI was higher and 1-month postoperative MTF cut-off, SR, and VA9 were lower than those before surgery, and 3-month postoperative OSI was higher and 3-month postoperative SR and VA9 were lower than those before surgery, showing statistically significant differences (all at P<0.05). In SPT-TransPRK group, 1-month postoperative OSI was higher and 1-month postoperative MTF cut-off, SR, VA100, VA20, and VA9 were lower than those before surgery, showing statistically significant differences (all at P<0.05). There was no significant difference in OSI, MTF cut-off, SR, VA100, VA20, and VA9 between 3 months postoperatively and before surgery in the SPT-TransPRK group (all at P>0.05). There was no significant difference in coma, OSI, MTF cut-off, SR, VA100, VA20, and VA9 between two groups (all at P>0.05). Conclusions:Both SMILE and SPT-TransPRK are effective methods for correcting myopia and they have comparable visual quality.Compared with SPT-TransPRK, corneal total HOA and spherical aberration are smaller after SMILE.

Objective:To investigate the effects of transepithelial photorefractive keratectomy (TransPRK) and femtosecond small incision lenticule extraction (SMILE) on corneal biomechanics measured by the Ocular Response Analyzer in the early postoperative period.Methods:A cohort study was conducted.The right eyes of 56 patients who underwent TransPRK and 52 patients who underwent SMILE in Dalian Medical University Affiliated Dalian Third People's Hospital from November 2020 to June 2021 were continuously included.The postoperative follow-up was 3 months.The central corneal thickness (CCT) and keratometry (Km) were measured 1 month and 3 months after surgery.The corneal-compensated intraocular pressure (IOPcc), corneal resistance factor (CRF), corneal hysteresis (CH), and 19 repeatable mechanical infrared signal waveform parameters measured by the Ocular Response Analyzer were recorded before the surgery, 1 month and 3 months after the surgery, respectively.The measurement indexs at different time points between two groups were compared.This study adhered to the Declaration of Helsinki and the study protocol was approved by the Ethics Committee of Dalian Medical University Affiliated Dalian Third People's Hospital (No.2019-KT-010). Written informed consent was obtained from each patient before surgery.Results:There was no significant difference in CCT, Km, and IOPcc between the two groups at 1 month and 3 months after the surgery (all at P>0.05). In both groups, CRF, CH, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h1, h2, h11, h21, dive1, dive2 and mslew1 were decreased, while path1, path2, path11, and aplhf were increased at 1 month after the surgery compared with before surgery, showing statistically significant differences (all at P<0.05). In both groups, CRF, CH, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h1, h2, h11, h21, dive1 decreased, while path1, path2, path11, and aplhf were increased at 3 months after the surgery in comparison with before surgery, showing statistically significant differences (all at P<0.05). In SMILE group, the dive2 were decreased at 3 months after the surgery compared with before surgery, and the difference was statistically significant ( P<0.01). At 1 month after the surgery, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, dive1 and dive2 were higher, while CH, path1, path2, and path11 were smaller in TransPRK group than in SMILE group, showing statistically significant differences between them (all at P<0.05). At 3 months after the surgery, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h2, h21, dive1 and dive2 were higher, while path1, path2, and path11 were smaller in TransPRK group than in SMILE group, showing statistically significant differences between them (all at P<0.05). Conclusions:Corneal biomechanics are weakened after both TransPRK and SMILE.In the early postoperative period, the mechanical infrared waveform parameters measured by the Ocular Response Analyzer are better after TransPRK than after SMILE.

Objective: To investigate the effects of platelet-rich plasma (PRP) combined with polylactic acid/polycaprolactone (PLA/PCL) on healing of mininature pig deep soft tissue defect caused by fragment injury. Methods: Two male Bama miniature pigs with 11 to 12 months (the same below) were selected by lottery to prepare PRP. The other twenty-seven male Bama miniature pigs were used to reproduce deep soft tissue defect caused by high-explosive ammunition fragment injury on bilateral posterior femoral region. According to the random number table, 27 pigs were divided into control group, material group, and PRP+material group, with 9 pigs in each group. After debridement, wounds of pigs in material group and PRP+material group were filled with PLA/PCL and PLA/PCL+2 mL activated PRP, respectively. Pigs in each group received suture of full-thickness skin to close the wounds. The operative duration was recorded. The length and volume of wounds of pigs in the above groups were measured immediately after surgery. In 1, 2, and 4 weeks after surgery, 3 pigs in each group were sacrificed to collect femoral wounds tissue on two sides, and PLA/PCL were collected from wounds of pigs in material group and PRP+material group for general observation of wounds tissue and degradation of the material. In 2 and 4 weeks after surgery, wounds tissue was obtained to observe the histological changes by hematoxylin-eosin staining, and expressions of transforming growth factor β (TGF-β) and vascular endothelial growth factor (VEGF), and angiogenesis were determined by immunohistochemical method. In 1, 2, and 4 weeks after surgery, wounds tissue was collected to determine mRNA expressions of TGF-β and VEGF by real-time quantitative reverse transcription polymerase chain reaction. Data were processed with analysis of variance of factorial design, one-way analysis of variance, and least significant difference-t test. Results: (1) There were no significantly statistical differences in length and volume of the wounds of pigs among the three groups (F=0.336, 0.282, P>0.05). The operative duration in control group [(30.9±2.1)min] was significantly shorter than that of material group [(39.7±2.2)min] and PRP+material group[(40.0±2.6)min], t=-11.45, -11.88, P<0.01. (2) There were respectively 10, 7, and 5 wounds tissue with infection in pigs of control group, material group, and PRP+material group. In 1, 2, 4 weeks after surgery, all of the wounds tissue of pigs was infected in control group, while none of wounds tissue of pigs was infected in material group and PRP+material group. In pigs of material group and PRP+material group, materials and tissue were easily separated in 1 week after surgery; some materials were integrated with tissue and showed a tendency of degradation in 2 weeks after surgery; materials were completely embedded with tissue in 4 weeks after surgery. (3) In pigs of control group, erythrocytes and inflammatory cells infiltration in wounds tissue were observed in 2 weeks after surgery, and necrotic tissue and inflammatory cells infiltration in wounds tissue were still observed in 4 weeks after surgery. In pigs of material group and PRP+material group, a large number of erythrocytes and inflammatory cells infiltration were observed in 2 weeks after surgery. Compared with that of material group, wounds tissue of pigs in PRP+material group had no inflammatory cells infiltration in 4 weeks after surgery. (4) Protein expressions of TGF-β in fibroblasts and multinuclear macrophagocytes, VEGF in fibroblasts and vascular endothelial cells, and blood vessel formation in wounds tissue of pigs in PRP+material group were significantly more than those of pigs in control group and material group in 2 and 4 weeks after surgery. (5) The mRNA expression of TGF-β in wounds tissue of pigs in material group was significantly higher than that in control group in 4 weeks after surgery (t=-3.93, P<0.01). Compared with those of pigs in control group and material group, the mRNA expression of TGF-β in wounds tissue of pigs in PRP+material group was significantly increased at each time point (t=9.23, 13.81, 11.73, -7.51, -12.04, -7.80, P<0.01). The mRNA expression of VEGF in wounds tissue of pigs increased significantly in material group compared with that of pigs in control group in 4 weeks after surgery (t=-3.94, P<0.01). Compared with those of pigs in control group and material group, the mRNA expression of VEGF in wounds tissue increased significantly in wound tissue of pigs in PRP+material group at each time point (t=12.33, 3.95, 7.97, -11.36, -2.97, -4.04, P<0.01). Conclusions PRP combined with PLA/PCL can accelerate wound healing of deep soft tissue defect of mininature pigs caused by fragment injury by providing physical scaffold for newborn tissue growth, promoting mRNA and protein expressions of TGF-β and VEGF.

OBJECTIVE: To explore the effectiveness of Nice knot technique for wound closure in Gustilo type ⅢA and ⅢB open tibial fractures. METHODS: A retrospective study was performed on 22 patients with Gustilo type ⅢA and ⅢB open tibial fractures, who underwent wound closure using the Nice knot technique and were admitted between June 2021 and June 2022. There were 15 males and 7 females. The age ranged from 18 to 67 years, with an average of 41.9 years. The causes of injury included traffic accident in 11 cases, falling from height in 7 cases, and heavy object injuries in 4 cases. Fractures were located on the left side in 9 cases and on the right side in 13 cases. And 9 cases were type ⅢA fractures and 13 were type ⅢB fractures according to Gustilo classification. All patients had extensive soft tissue injuries, and no vascular or neurological damage was observed. The time from injury to debridement was 3-8 hours (mean, 6.5 hours). The sizes of wounds before operation and at 2 weeks after operation were measured and wound healing rate at 2 weeks after operation were calculated. The wound healing time and wound healing grading were recorded. The Vancouver Scar Scale (VSS) score was used to assess the wound scar after wound healed and the excellent and good rate was calculated. RESULTS: The wound area was 21.0-180.0 cm ² (mean, 57.82 cm ²) before operation, and it was 1.2-27.0 cm ² (mean, 6.57 cm ²) at 2 weeks after operation. The wound healing rate at 2 weeks after operation was 76%-98% (mean, 88.6%). After operation, 2 cases needed to adjust Nice knot due to skin cutting and 1 case occurred soft tissue infection on the wound. The other patient's wounds healed. The average wound healing time was 27.8 days (range, 18-44 days). And the wound healing were grade A in 13 cases and grade B in 9 cases. VSS score was 2-9, with an average of 4.1; 10 cases were rated as excellent, 10 as good, and 2 as poor, with an excellent and good rate of 90.9%. All patients were followed up 9-24 months (mean, 14.6 months). During follow-up, no deep infection or osteomyelitis occurred. Two cases experienced fracture non-union, and were treated with compression fixation and bone grafting. The fractures of the other patients all healed, with a healing time of 85-190 days (mean, 148.2 days). CONCLUSION Nice knot technique can be used in wound closure of Gustilo type ⅢA and ⅢB open tibial fractures effectively, which is easy to operate.
Male ; Female ; Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Cicatrix ; Retrospective Studies ; Treatment Outcome ; Tibial Fractures/surgery* ; Wound Healing ; Fracture Fixation, Internal/methods* ; Fractures, Open/surgery*

OBJECTIVE: To compare the effects of robotic and laparoscopic-assisted radical total gastrectomy on lymph node dissection and short-term outcomes in patients with Siewert type II adenocarcinoma of esophagogastric junction (AEG). METHODS: Inclusion criteria: the tumor center was located between 2 cm above and below the esophagogastric junction and was confirmed as adenocarcinoma by endoscopic biopsy. EXCLUSION CRITERIA: tumor with local invasion of the liver,spleen, pancreas or other organs; intraoperative finding of tumor dissemination or distant metastasis; patients undergoing palliative surgical treatment or preoperative neoadjuvant chemotherapy; patients with serious heart diseases, lung diseases, liver diseases, kidney diseases and other comorbidities; patients with multiple primary cancers;patients receiving emergency surgery. According to the above criteria, 82 patients with Siewert type II AEG who underwent gastrointestinal surgery at the Affiliated Hospital of Qingdao University from October 2014 to October 2018 were enrolled in the study. They were randomly divided into robotic surgery groups (41 cases) and laparoscopic group (41 cases) according to a computer-generated randomized allocation table. Both groups underwent radical total gastrectomy plus D2 lymph node dissection through the transabdominal esophageal hiatus approach. The intraoperative conditions and postoperative short-term outcomes were compared between two groups, including surgery time, intraoperative blood loss, length of esophagectomy, postoperative complications, postoperative gastrointestinal recovery time, length of hospital stay, postoperative unplanned reoperation rate and rehospitalization rate. Mean±SD is used for the measurement data that conforms to the normal distribution, and two independent sample t-tests are used to compare the two groups; the comparison of the count data is performed by the χ² test. RESULTS: There were 35 males (85.4%) with age of (62.3±10.0) years and body mass index of (24.4±3.2) kg/m² in the robotic surgery group. There were 37 males (90.2%) with age of (62.5±10.0) years and body mass index of (23.8±2.6) kg/m² in the laparoscopic group. No significant differences in the baseline data between two groups were found (all P>0.05). All the patients of both groups completed R0 resection successfully without conversion to laparotomy or perioperative death. Compared with the laparoscopic group, the robotic group had less intraoperative blood loss [(70.7±39.9) ml vs. (110.2±70.6) ml, t=3.118, P=0.003], longer resected esophagus [(3.0±0.7) cm vs. (1.9±0.5) cm, t=8.759, P<0.001], but longer setup time [(56.5±7.4) minutes vs. (36.0±6.6) minutes, t=4.241, P<0.001], and higher hospitalization costs [(122 317.31±57 789.33) yuan vs. (99 401.56±39 349.53) yuan, t=2.099, P=0.039], whose differences were statistically significant (all P<0.05). The total number of harvested lymph node in the robotic surgery group was 39.2±15.3,which was significantly higher than that in the laparoscopic group (33.0±12.1) (t=0.733, P=0.047). In the robotic group and the laparoscopic group, the mediastinal lymph node No.110 and No.111 were 3.6±1.2 vs. 1.5±1.0 and 3.7±2.0 vs. 1.8±1.1, respectively, with significant difference (t=10.138, P<0.001, t=8.227, P<0.001); axillary lymph node No.19 and No.20 were 2.3±1.2 vs. 1.1±0.9 and 2.0±1.0 vs. 1.0±0.1, respectively, with significant difference (t=7.082, P<0.001,t=8.672,P<0.001). There were no significant differences in the total number of abdominal lymph node and the number of lymph node in abdominal stations between two group (all P>0.05). The highest lymph node metastasis rate was approximately 20% and observed in No.1, No.2, No.3, and No.7, followed by No.8a, No.9, No.11p, and No.110 with around 5%. The lymph node metastasis rate in other stations (No.4sa, No.4sb, No.4d, No.5, No.6, No.11d, No.12a, No.19, No.20 and No.111) was less than 5%.There were no significant differences in postoperative complication rate, postoperative fever time, postoperative exhaust and defecation time, fluid diet time, and postoperative hospital stay (all P>0.05). There were 2 patients(4.9%) with unplanned reoperation and 1 patient (2.4%) with unplanned re-admission in the laparoscopic group,while 3 patients (7.3%)with unplanned reoperation and 2 patients (4.9%)with unplanned re-admission in the robotic surgery group, whose differences were also not statistically significant (χ²=0.240,P=0.675;χ²=0.346,P=1.000). CONCLUSION Robot-assisted radical total gastrectomy for Siewert II AEG is safe and feasible, which is characterized by more sophisticated operation, less blood loss and higher quality of lymph node dissection, especially for subphrenic and inferior mediastinal lymph nodes.
Adenocarcinoma ; classification ; pathology ; surgery ; Aged ; Esophageal Neoplasms ; classification ; pathology ; surgery ; Esophagectomy ; Esophagogastric Junction ; pathology ; surgery ; Female ; Gastrectomy ; Humans ; Laparoscopy ; Lymph Node Excision ; methods ; Male ; Middle Aged ; Retrospective Studies ; Robotic Surgical Procedures ; Stomach Neoplasms ; classification ; pathology ; surgery ; Treatment Outcome

The Coronavirus disease 2019 (COVID-19) has spread globally. Although mixed liver impairment has been reported in COVID-19 patients, the association of liver injury caused by specific subtype especially chronic hepatitis B (CHB) with COVID-19 has not been elucidated. In this multi-center, retrospective, and observational cohort study, 109 CHB and 327 non-CHB patients with COVID-19 were propensity score matched at an approximate ratio of 3:1 on the basis of age, sex, and comorbidities. Demographic characteristics, laboratory examinations, disease severity, and clinical outcomes were compared. Furthermore, univariable and multivariable logistic and Cox regression models were used to explore the risk factors for disease severity and mortality, respectively. A higher proportion of CHB patients (30 of 109 (27.52%)) developed into severe status than non-CHB patients (17 of 327 (5.20%)). In addition to previously reported liver impairment markers, such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and total bilirubin, we identified several novel risk factors including elevated lactate dehydrogenase (⩾ 245 U/L, hazard ratio (HR) = 8.639, 95% confidence interval (CI) = 2.528-29.523; P < 0.001) and coagulation-related biomarker D-dimer (⩾ 0.5 µg/mL, HR = 4.321, 95% CI = 1.443-12.939; P = 0.009) and decreased albumin (< 35 g/L, HR = 0.131, 95% CI = 0.048-0.361; P < 0.001) and albumin/globulin ratio (< 1.5, HR = 0.123, 95% CI = 0.017-0.918; P = 0.041). In conclusion, COVID-19 patients with CHB were more likely to develop into severe illness and die. The risk factors that we identified may be helpful for early clinical surveillance of critical progression.
COVID-19 ; Cohort Studies ; Hepatitis B, Chronic/epidemiology* ; Humans ; Retrospective Studies ; Risk Factors