Background: COVID-19 outbreak has spread around the world. Liver dysfunction (LD) was related with high mortality in COVID-19. Methods: Retrospective, single-center study case series of 425 consecutive hospitalized COVID-19 patients were enrolled. Demographic, clinical, laboratory, and treatment data were collected. Results: A total of 425 patients were included in this study, 145 of whom had LD. The overall mortality rate was 8.9%, while 17.9% in the LD group and 4.3% in the nonliver dysfunction (NLD) group. Age, sex, and hypertension were the independent risk factors of LD. LD was an independent risk factor for incidence of severe illness, acute respiratory distress syndrome, and death. The survival rate of patients in LD group was lower than that in NLD group (P < 0.001). A similar trend was observed by the multivariate regression analysis (adjusted hazard ratio, 3.52; 95% confidence interval [CI], 1.69–7.33; P = 0.001). Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers had effect to reduce LD (odds ratio of 0.48 [95% CI, 0.232–0.989; P = 0.045]). Conclusions: LD is one of the main features of hospitalized patients of COVID-19, with a worse prognosis. Patients of COVID-19 with LD on admission should be more cautions.

Background and Objectives: To explore the superiority of flipping-classroom lended learning in which the stay-home e-learning and traditional internship complements each other in resident training of endcorinology during coronavirus disease 2019 restriction period. Materials and Methods: A total of 44 residents were randomized as the study population. In the endocrine-rotation training, we reformed the clinical learning by unified online-teaching led by teachers' combination with individual guidance by residents. Moreover, the final implementation assessment was conducted by standard double-blind examinations. Results: After 4–8 weeks training, the 44 residents were assessed for clinical skills from six dimensions, including medical history collection, physical examination, history report and inpatient record writing, case analysis, and overviewing capability. Compared with the mean scores of 68 residents rotated in internal medicine in 2019, the mean scores on physical examination, inpatient record writing, and overviewing capability in 2020 group were higher with significance ([85.72 ± 8.33] vs.[79.22 ± 10.12], P = 0.0006), ([90.28 ± 10.70] vs. [81.82 ± 8.03], P < 0.0001), ([80.31 ± 8.70] vs. [73.04 ± 12.74], P = 0.0012), whereas scores on skills of medical history collection and history report were slightly lower ([82.11 ± 9.02] vs. [85.06 ± 7.23], P = 0.0586), ([79.30 ± 8.17] vs. [83.21 ± 5.01], P = 0.0022), while scores on case analysis did not show huge gap but with polarized performance in 2020 group ([74.38 ± 10.29] vs. [78.13 ± 8.53], P = 0.0386). Conclusions: Providing the novel pattern of unified online-teaching combined with individual-guidance at the bedside to the front-line residents can reduce the risk of cluster epidemics and effectively ensure the training effect on them but still with shortcomings. The future online teaching reform is better for focus more on how to make up for or reduce the actual problem of disconnection between theory and practice in the process of online clinical skills training for residents and teachers.

Introduction: The diagnostic and prognostic value of thromboelastogram (TEG) in sepsis has not been determined. This study aimed to assess whether TEG is an early predictor of coagulopathy and is associated with mortality in patients with sepsis. Methods: In total, 518 patients with sepsis on the intensive care unit (ICU) admission were prospectively evaluated. We measured TEG and conventional coagulation tests on preadmission to ICU and observed for the development of 1 and 3 days and 1, 3, and 7 days, respectively. Multivariable logistic regression was utilized to determine the odds of ICU/hospital mortality. The parameter of TEG (maximum amplitude, reaction time; MA/R ratio) was calculated to evaluate sepsis-induced coagulopathy. The patients were divided into three groups : MA/R0 group (MA/R = 5–14 mm/min); MA/R1 group (MA/R <5 mm/min); and MA/R2 group (MA/R >14 mm/min). Results: Four hundred and ten patients were included. At enrolment, 10.73%, 65.85%, and 23.41% of the patients had lower, normal, and higher MA/R state, respectively. Compared to MA/R0 group, patients with lower and higher MA/R both had significantly increase risk of hospital mortality (hazards ratio [HR] 2.83 [95% confidence interval [CI] 1.577–5.079], P < 0.01); (HR 1.982 [95% CI 1.073–3.66], P = 0.029), respectively (adjusted with Acute Physiology and Chronic Health Evaluation [APACHEII] score) and ICU mortality (HR 2.512 [95% CI 1.301–4.852], P = 0.006); (HR1.644 [95% CI 1.024–2.639], P = 0.002) (adjusted with APACHEII score). Patients with higher MA/R had significantly increase risk of hospital mortality APACHE II score (HR 1.635 [95% CI 1.016–2.632], P = 0.043). Conclusions: In our cohort of patients with severe sepsis, coagulopathy defined by MA/R ratio was associated with increased risk of ICU/hospital mortality.