Aims: To investigate the relationship between steady-state voriconazole trough concentration (Ctrough) and adverse effects (AEs). Methods: We conducted a retrospective study in the Jinling Hospital from January 2015 to June 2020. A total of 140 patients receiving voriconazole were enrolled in this study. The determination and scoring of voriconazole-associated hepatotoxicity were performed according to the Roussel Uclaf Causality Assessment Method scoring scale and the severity of hepatotoxicity was graded according to CTCAE. Results: Compared to the group without any AEs, voriconazole Ctrough was significantly higher in the hepatotoxicity and neurotoxicity groups; however, no differences were observed in other AEs. Receiver operating characteristic (ROC) curves showed that steady-state voriconazole Ctrough >3.61 mg/L was associated with an increased incidence of hepatotoxicity (AUC=0.645, P=0.047). Logistic regression analysis showed that timely voriconazole dose adjustment was a predictor of attenuated hepatotoxicity after adjustment for confounders, but hepatotoxicity was not associated with voriconazole Ctrough measured at a single time point. When gamma-glutamyl transpeptidase (GGT) was included in the assessment of hepatotoxicity severity, its AE was overestimated. Steady-state voriconazole Ctrough and length of treatment were associated with GGT elevation. Conclusions: Despite an increasing trend of hepatotoxicity and neurotoxicity with increasing steady-state voriconazole Ctrough, it may not be sufficient for predicting the probability of hepatotoxicity. Concomitant co-monitoring of liver function parameters for 2 weeks after dosing may provide greater prevention of hepatotoxic events. In patients with long-term voriconazole usage, GGT is not a reliable indicator of hepatotoxicity, but it can be used to assess oxidative stress levels.

Background: Coronavirus disease 2019 (COVID-19) has been highly epidemic in the whole world now. Asymptomatic transmission of severe acute respiratory coronavirus-2 (SARS-CoV-2)might pose challenges for disease control. Little information on its characteristics of asymptomatic COVID-19 carriers is available. This study aimed to clarify the clinical feature and follow-up data of asymptomatic COVID-19 carriers, We hope the information would help the management of asymptomatic COVID-19 carriers. Methods: This retrospective study included all asymptomatic COVID-19 carriers inThe First People’s Hospital of Yueyang(Hunan,China) and Hunan Provincial People’s Hospital (Changsha, China) between January 22 and March 26, 2020. The epidemiology ,clinical characteristic,laboratory data,chest CT and follow-up data of these cases were investigated. Results: 24 asymptomatic COVID-19 carriers were enrolled inThe First People’s Hospital of Yueyang and Hunan Provincial People’s Hospital between Jan 22, 2020 and Mar 26, 2020 . All patients had history of exposure to SARS-CoV-2. During the whole disease course, patients had no symptoms and most of laboratory findings were normal. The median period from contact to diagnosis was 9.6days(1-38days). The median period from diagnosis to discharge was 14.4 days (6-24 days). Following after discharge,all patients continued to be asymptomatic.5(20.83%) patients were admitted again because their specimens(4 throat swab and 1 feces) showed re-positive results in SARS-CoV-2 PCR. The re-positive time away from diagnosis(day) was from 23-53 days; the time from re-positive to re-negative RT-PCR of SARS-CoV-2 was 3-11 days. Conclusion: Asymptomatic COVID-19 carriers have favorable outcomes and should be closely monitored. We suggested post-discharge surveillance of them.