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Research article
Risk factors and clinical features of deterioration in COVID-19 patients in Zhejiang, China: a single- centre, retrospective study
Lanjuan Li
Zhejiang University First Affiliated Hospital State Key Laboratory for Diagnosis and Treatment of Infectious Diseases
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2861-2354
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Infectious Diseases.
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection swept through Wuhan and spread across China and overseas beginning in December 2019. To identify predictors associated with disease progression, we evaluated clinical risk factors for exacerbation of SARS-CoV-2 infection.
Methods A retrospective analysis was used for PCR-confirmed COVID-19 (coronavirus disease 2019)-diagnosed hospitalized cases between January 19, 2020, and February 19, 2020, in Zhejiang, China. We systematically analysed the clinical characteristics of the patients and predictors of clinical deterioration.
Results One hundred patients with COVID-19, with a median age of 54 years, were included. Among them, 49 patients (49%) had severe and critical disease. Age ([36-58] vs [51-70], P=0.0001); sex (49% vs 77.6%, P=0.0031); BMI ([21.53-25.51] vs [23.28-27.01], P=0.0339); hypertension (17.6% vs 57.1%, P<0.0001); IL-6 ([6.42-30.46] vs [16.2-81.71], P=0.0001); IL-10 ([2.16-5.82] vs [4.35-9.63], P<0.0001); T lymphocyte count ([305- 1178] vs [167.5-440], P=0.0001); B lymphocyte count ([91-213] vs [54.5-163.5], P=0.0001); white blood cell count ([3.9-7.6] vs [5.5-13.6], P=0.0002); D2 dimer ([172-836] vs [408-953], P=0.005), PCT ([0.03-0.07] vs [0.04-0.15], P=0.0039); CRP ([3.8-27.9] vs [17.3-58.9], P<0.0001); AST ([16, 29] vs [18, 42], P=0.0484); artificial liver therapy (2% vs 16.3%, P=0.0148); and glucocorticoid therapy (64.7% vs 98%, P<0.0001) were associated with the severity of the disease. Age and weight were independent risk factors for disease severity.
Conclusion Deterioration among COVID-19-infected patients occurred rapidly after hospital admission. In our cohort, we found that multiple factors were associated with the severity of COVID19. Early detection and monitoring of these indicators may reduce the progression of the disease. Removing these factors may halt the progression of the disease. In addition, early treatment with low doses of glucocorticoids and liver therapy, when necessary, may help reduce mortality in critically ill patients.
Keywords
coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), predictors, severe illnesses
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On 28 Oct, 2020
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On 12 Oct, 2020
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On 11 Oct, 2020
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On 11 Oct, 2020
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On 17 Aug, 2020
Review #1 received
Received 17 Aug, 2020
Reviewers invited
Invitations sent on 12 Aug, 2020
Editor assigned
On 24 Jun, 2020
Submission checks complete
On 23 Jun, 2020
Editor invited
On 23 Jun, 2020
No comments provided
Editorial decision: Major revision
On 01 Jun, 2020
Review #2 received
Received 28 May, 2020
Review #1 received
Received 21 May, 2020
Reviewer #2 agreed
On 07 May, 2020
Reviewers invited
Invitations sent on 04 May, 2020
Reviewer #1 agreed
On 04 May, 2020
Editor assigned
On 14 Apr, 2020
Submission checks complete
On 13 Apr, 2020
Editor invited
On 13 Apr, 2020
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On 10 Apr, 2020
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This preprint is under consideration at BMC Infectious Diseases. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Risk factors and clinical features of deterioration in COVID-19 patients in Zhejiang, China: a single- centre, retrospective study
Lanjuan Li
Zhejiang University First Affiliated Hospital State Key Laboratory for Diagnosis and Treatment of Infectious Diseases
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2861-2354
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
No comments provided
Review #1 received
Received 25 Nov, 2020
Reviewers invited
Invitations sent on 28 Oct, 2020
Reviewer #1 agreed
On 28 Oct, 2020
Editor assigned
On 12 Oct, 2020
Submission checks complete
On 11 Oct, 2020
Editor invited
On 11 Oct, 2020
Version 2
Posted 26 Jun, 2020
No comments provided
Reviewer #1 agreed
On 17 Aug, 2020
Review #1 received
Received 17 Aug, 2020
Reviewers invited
Invitations sent on 12 Aug, 2020
Editor assigned
On 24 Jun, 2020
Submission checks complete
On 23 Jun, 2020
Editor invited
On 23 Jun, 2020
No comments provided
Editorial decision: Major revision
On 01 Jun, 2020
Review #2 received
Received 28 May, 2020
Review #1 received
Received 21 May, 2020
Reviewer #2 agreed
On 07 May, 2020
Reviewers invited
Invitations sent on 04 May, 2020
Reviewer #1 agreed
On 04 May, 2020
Editor assigned
On 14 Apr, 2020
Submission checks complete
On 13 Apr, 2020
Editor invited
On 13 Apr, 2020
First submitted
On 10 Apr, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Infectious Diseases.
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection swept through Wuhan and spread across China and overseas beginning in December 2019. To identify predictors associated with disease progression, we evaluated clinical risk factors for exacerbation of SARS-CoV-2 infection.
Methods A retrospective analysis was used for PCR-confirmed COVID-19 (coronavirus disease 2019)-diagnosed hospitalized cases between January 19, 2020, and February 19, 2020, in Zhejiang, China. We systematically analysed the clinical characteristics of the patients and predictors of clinical deterioration.
Results One hundred patients with COVID-19, with a median age of 54 years, were included. Among them, 49 patients (49%) had severe and critical disease. Age ([36-58] vs [51-70], P=0.0001); sex (49% vs 77.6%, P=0.0031); BMI ([21.53-25.51] vs [23.28-27.01], P=0.0339); hypertension (17.6% vs 57.1%, P<0.0001); IL-6 ([6.42-30.46] vs [16.2-81.71], P=0.0001); IL-10 ([2.16-5.82] vs [4.35-9.63], P<0.0001); T lymphocyte count ([305- 1178] vs [167.5-440], P=0.0001); B lymphocyte count ([91-213] vs [54.5-163.5], P=0.0001); white blood cell count ([3.9-7.6] vs [5.5-13.6], P=0.0002); D2 dimer ([172-836] vs [408-953], P=0.005), PCT ([0.03-0.07] vs [0.04-0.15], P=0.0039); CRP ([3.8-27.9] vs [17.3-58.9], P<0.0001); AST ([16, 29] vs [18, 42], P=0.0484); artificial liver therapy (2% vs 16.3%, P=0.0148); and glucocorticoid therapy (64.7% vs 98%, P<0.0001) were associated with the severity of the disease. Age and weight were independent risk factors for disease severity.
Conclusion Deterioration among COVID-19-infected patients occurred rapidly after hospital admission. In our cohort, we found that multiple factors were associated with the severity of COVID19. Early detection and monitoring of these indicators may reduce the progression of the disease. Removing these factors may halt the progression of the disease. In addition, early treatment with low doses of glucocorticoids and liver therapy, when necessary, may help reduce mortality in critically ill patients.