Analysis of clinical features and early warning signs in patients with severe COVID-19: A retrospective cohort study

Abstract

Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, in December 2019. Although previous studies have described the clinical aspects of COVID-19, few studies have focused on the early detection of severe COVID-19. Therefore, this study aimed to identify the predictors of severe COVID-19 and to compare clinical features between patients with severe COVID-19 and those with less severe COVID-19. Patients admitted to designated hospital in the Henan Province of China who were either discharged or died prior to February 15, 2020 were enrolled retrospectively. Additionally, patients who underwent at least one of the following treatments were assigned to the severe group: continuous renal replacement therapy, high-flow oxygen absorption, noninvasive and invasive mechanical ventilation, or extracorporeal membrane oxygenation. The remaining patients were assigned to the non-severe group. Demographic information, initial symptoms, and first visit examination results were collected from the electronic medical records and compared between the groups. Multivariate logistic regression analysis was performed to determine the predictors of severe COVID-19. A receiver operating characteristic curve was used to identify a threshold for each predictor. Altogether,104 patients were enrolled in our study with 30 and 74 patients in the severe and non-severe groups, respectively. Multivariate logistic analysis indicated that patients aged �63 years (odds ratio = 41.0; 95% CI: 2.8, 592.4), with an absolute lymphocyte value of �1.02×10 9 /L (odds ratio = 6.1; 95% CI = 1.5, 25.2) and a C-reactive protein level of �65.08mg/L (odds ratio = 8.9; 95% CI = 1.0, 74.2) were at a higher risk of severe illness. Thus, our results could be helpful in the early detection of patients at risk for severe illness, enabling the implementation of effective interventions and likely lowering the morbidity of COVID-19 patients.

Correlation between hospitalized patients’ demographics, symptoms, comorbidities, and COVID-19 pandemic in Bahia, Brazil

“…Liu et al . [ 21 ], in a research to determine the risk factors for severe COVID-19, report that fever, cough and fatigue appear as the main symptoms among the participants, with fever being the most common initial symptom (92.3%). Rivera-Izquierdo et al .…”

“…It is noteworthy that the fever symptom appears as an important indicator in the screening of suspected or confirmed cases of COVID-19, despite not having, in this study, a strong relationship with the length of hospital stay. Liu et al [21], in a research to determine the risk factors for severe COVID-19, report that fever, cough and fatigue appear as the main symptoms among the participants, with fever being the most common initial symptom (92.3%). Rivera-Izquierdo et al [22] complement that in patients admitted for COVID-19 at Hospital Universitario Clínico San Cecilio, Spain, the most frequent clinical picture was also due to low fever (89.5%) and dry cough (80.7%), followed by general malaise (63.5%), dyspnea (61.3%) and tiredness (59.2%).…”

Is it all in the heart? Myocardial injury as major predictor of mortality among hospitalized COVID‐19 patients

“…In addition, a large number of studies, albeit with small sample sizes, have examined the association between individual co‐morbidities, 20‐23 or laboratory and/or imaging abnormalities 8,24,25 . Several reports have reported predictors of disease severity, unfortunately with widely differing definitions of severe illness 26‐28 . We could find only one larger cohort of hospitalized patients with COVID‐19 from the US reporting independent predictors of mortality among 1304 hospitalized patients with COVID‐19 18 .…”

“…8,24,25 Several reports have reported predictors of disease severity, unfortunately with widely differing definitions of severe illness. [26][27][28] We could find only one Abbreviations: ANC, absolute neutrophil count; ARDS, acute respiratory distress syndrome; BMI, body mass index; CVD, cerebrovascular disease; CHD, coronary heart disease; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; CT, computed tomography; DM, diabetes mellitus; HR, hazard ratio; LDH, lactate dehydrogenase; NSAID, nonsteroidal anti-inflammatory drugs; OR, odds ratio; SOFA, sequential organ failure assessment; Tn, troponin; ULN, upper limits of normal; WCC, white cell count.…”

Atualização sobre a pandemia do COVID-19: uma revisão integrativa / Update on the COVID-19 pandemic: an integrative review

“…Além disso, acredita-se que o vírus possa danificar os linfócitos, prejudicando o sistema imunológico durante o curso da doença. Por fim, concentrações elevadas de PCR estão correlacionadas com um maior risco de falência e morte de órgãos(LIU et al, 2020).…”