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Research article
Jianbo Tian
Huazhong University of Science and Technology Tongji Medical College School of Public Health
Corresponding Author
Ying Wang
Wuhan Centers for Disease Prevention and Control
Corresponding Author
Zhihua Wang
Huazhong University of Science and Technology Tongji Medical College
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5155-1457
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background:
The COVID-19 pandemic has been considered a great threat to global public health. We aimed to clarify the risk factors associated with the development of acute respiratory distress syndrome (ARDS) and progression from ARDS to death and construct a risk prediction model.
Methods:
In this single-centered, retrospective, and observational study, 796 COVID-19 patients developed ARDS and 735 COVID-19 patients without ARDS were matched by propensity score at an approximate ratio of 1:1 based on age, sex and comorbidities. Demographic data, symptoms, radiological findings, laboratory examinations, and clinical outcomes were compared between those with or without ARDS. Univariable and multivariable logistic regression models were applied to explore the risk factors for development of ARDS and progression from ARDS to death and establish a comprehensive risk model.
Results:
Higher SOFA, qSOFA, APACHE II and SIRS scores, elevated inflammatory cytokines, dysregulated multi-organ damage biomarkers, decreased immune cell subsets were associated with higher proportion of death (34.17% vs 1.22%; P<0.001) and increased risk odds of death (OR=57.216, 95%CI=28.373-115.378; P<0.001) in COVID-19 patients with ARDS. In addition to previous reported risk factors related to ARDS development and death, such as neutrophils, IL-6, D-Dimer, leukocytes and platelet, we identified elevated TNF-α (OR=1.146, 95%CI=1.100-1.194; P<0.001), CK-MB (OR=1.350, 95%CI=1.180-1.545; P<0.001), declined ALB (OR=0.834, 95%CI=0.799-0.872; P<0.001), CD8+ T cells (OR=0.983, 95%CI=0.976-0.990; P<0.001) and CD3-CD19+ B cells (OR=0.992, 95%CI=0.988-0.997; P=0.003) as novel risk factors. Most importantly, the predictive accuracy of the combined model integrating four score systems and these risk factors demonstrated highest among all models for the development of ARDS (AUC= 0.904) and the progression from ARDS to death (AUC= 0.959).
Conclusion:
COVID-19 patients with ARDS were more likely to develop into death. The potential risk factors and the comprehensive prediction model could be helpful to identify patients that are at risk of developing ARDS with poor prognosis at an early stage, which might help physicians to formulate a timely therapeutic strategy.
Keywords
COVID-19, ARDS, prediction model
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
- Graphicabstract.pdf
- Additionalfile1.docx
Additional file 1.docx Supplementary methods
- Additionalfile2.docx
Additional file 2.docx Table S1. Laboratory findings, complications, and treatments of ARDS and non-ARDS patients with COVID-19
- Additionalfile3.docx
Additional file 3.docx Table S2. Laboratory findings and complications, and treatments of survivors and non-survivors in COVID-19 patients with ARDS
- Additionalfile4.pdf
Additional file 4.pdf Figure S1. Temporal changes in laboratory prognostic parameters among COVID-19 patients with ARDS and those without ARDS after admission
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CURRENT STATUS: Under Review
Version 2
Posted 12 Jan, 2021
No community comments so far
Reviewer #2 agreed
On 19 Jan, 2021
Reviewer #1 agreed
On 11 Jan, 2021
Editor assigned
On 10 Jan, 2021
Reviewers invited
Invitations sent on 10 Jan, 2021
Editor invited
On 10 Jan, 2021
Submission checks complete
On 02 Jan, 2021
No comments provided
Editorial decision: Major revision
On 15 Dec, 2020
Review #2 received
Received 12 Nov, 2020
Reviewer #3 agreed
On 29 Oct, 2020
Reviewer #1 agreed
On 05 Aug, 2020
Reviewer #2 agreed
On 05 Aug, 2020
Review #1 received
Received 05 Aug, 2020
Reviewers invited
Invitations sent on 21 Jul, 2020
Editor assigned
On 01 Jul, 2020
Submission checks complete
On 30 Jun, 2020
Editor invited
On 30 Jun, 2020
First submitted
On 29 Jun, 2020
Metrics
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PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
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
Jianbo Tian
Huazhong University of Science and Technology Tongji Medical College School of Public Health
Corresponding Author
Ying Wang
Wuhan Centers for Disease Prevention and Control
Corresponding Author
Zhihua Wang
Huazhong University of Science and Technology Tongji Medical College
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5155-1457
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: Under Review
Version 2
Posted 12 Jan, 2021
No community comments so far
Reviewer #2 agreed
On 19 Jan, 2021
Reviewer #1 agreed
On 11 Jan, 2021
Editor assigned
On 10 Jan, 2021
Reviewers invited
Invitations sent on 10 Jan, 2021
Editor invited
On 10 Jan, 2021
Submission checks complete
On 02 Jan, 2021
No comments provided
Editorial decision: Major revision
On 15 Dec, 2020
Review #2 received
Received 12 Nov, 2020
Reviewer #3 agreed
On 29 Oct, 2020
Reviewer #1 agreed
On 05 Aug, 2020
Reviewer #2 agreed
On 05 Aug, 2020
Review #1 received
Received 05 Aug, 2020
Reviewers invited
Invitations sent on 21 Jul, 2020
Editor assigned
On 01 Jul, 2020
Submission checks complete
On 30 Jun, 2020
Editor invited
On 30 Jun, 2020
First submitted
On 29 Jun, 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
Background:
The COVID-19 pandemic has been considered a great threat to global public health. We aimed to clarify the risk factors associated with the development of acute respiratory distress syndrome (ARDS) and progression from ARDS to death and construct a risk prediction model.
Methods:
In this single-centered, retrospective, and observational study, 796 COVID-19 patients developed ARDS and 735 COVID-19 patients without ARDS were matched by propensity score at an approximate ratio of 1:1 based on age, sex and comorbidities. Demographic data, symptoms, radiological findings, laboratory examinations, and clinical outcomes were compared between those with or without ARDS. Univariable and multivariable logistic regression models were applied to explore the risk factors for development of ARDS and progression from ARDS to death and establish a comprehensive risk model.
Results:
Higher SOFA, qSOFA, APACHE II and SIRS scores, elevated inflammatory cytokines, dysregulated multi-organ damage biomarkers, decreased immune cell subsets were associated with higher proportion of death (34.17% vs 1.22%; P<0.001) and increased risk odds of death (OR=57.216, 95%CI=28.373-115.378; P<0.001) in COVID-19 patients with ARDS. In addition to previous reported risk factors related to ARDS development and death, such as neutrophils, IL-6, D-Dimer, leukocytes and platelet, we identified elevated TNF-α (OR=1.146, 95%CI=1.100-1.194; P<0.001), CK-MB (OR=1.350, 95%CI=1.180-1.545; P<0.001), declined ALB (OR=0.834, 95%CI=0.799-0.872; P<0.001), CD8+ T cells (OR=0.983, 95%CI=0.976-0.990; P<0.001) and CD3-CD19+ B cells (OR=0.992, 95%CI=0.988-0.997; P=0.003) as novel risk factors. Most importantly, the predictive accuracy of the combined model integrating four score systems and these risk factors demonstrated highest among all models for the development of ARDS (AUC= 0.904) and the progression from ARDS to death (AUC= 0.959).
Conclusion:
COVID-19 patients with ARDS were more likely to develop into death. The potential risk factors and the comprehensive prediction model could be helpful to identify patients that are at risk of developing ARDS with poor prognosis at an early stage, which might help physicians to formulate a timely therapeutic strategy.
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
- Graphicabstract.pdf
- Additionalfile1.docx
Additional file 1.docx Supplementary methods
- Additionalfile2.docx
Additional file 2.docx Table S1. Laboratory findings, complications, and treatments of ARDS and non-ARDS patients with COVID-19
- Additionalfile3.docx
Additional file 3.docx Table S2. Laboratory findings and complications, and treatments of survivors and non-survivors in COVID-19 patients with ARDS
- Additionalfile4.pdf
Additional file 4.pdf Figure S1. Temporal changes in laboratory prognostic parameters among COVID-19 patients with ARDS and those without ARDS after admission
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