Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease

Abstract

Individual data, laboratory indices, imaging characteristics, and clinical data were collected, and statistical analysis was performed. Based on clinical typing results, the patients were divided into a progression group or an improvement/stabilization group. Continuous variables were analyzed using independent samples t-test or Mann-Whitney U test. Categorical variables were analyzed using Chi-squared test or Fisher's exact test. Logistic regression analysis was performed to explore the risk factors for disease progression. Results: Seventy-eight patients with COVID-19-induced pneumonia met the inclusion criteria and were included in this study. Efficacy evaluation at 2 weeks after hospitalization indicated that 11 patients (14.1%) had deteriorated, and 67 patients (85.9%) had improved/stabilized. The patients in the progression group were significantly older than those in the disease improvement/ stabilization group (66 [51, 70] vs. 37 [32, 41] years, U = 4.932, P = 0.001). The progression group had a significantly higher proportion of patients with a history of smoking than the improvement/stabilization group (27.3% vs. 3.0%, x 2 = 9.291, P = 0.018). For all the 78 patients, fever was the most common initial symptom, and the maximum body temperature at admission was significantly higher in the progression group than in the improvement/stabilization group (38.2 [37.8, 38.6] vs. 37.5 [37.0, 38.4]°C, U = 2.057, P = 0.027). Moreover, the proportion of patients with respiratory failure (54.5% vs. 20.9%, x 2 = 5.611, P = 0.028) and respiratory rate (34 [18, 48] vs. 24 [16, 60] breaths/min, U = 4.030, P = 0.004) were significantly higher in the progression group than in the improvement/stabilization group. C-reactive protein was significantly elevated in the progression group compared to the improvement/stabilization group (38.9 [14.3, 64.8] vs. 10.6 [1.9, 33.1] mg/L, U = 1.315, P = 0.024). Albumin was significantly lower in the progression group than in the improvement/stabilization group (36.62 ± 6.60 vs. 41.27 ± 4.55 g/L, U = 2.843, P = 0.006). Patients in the progression group were more likely to receive high-level respiratory support than in the improvement/stabilization group (x 2 = 16.01, P = 0.001). Multivariate logistic analysis indicated that age (odds ratio [OR], 8.546; 95% confidence interval [CI]: 1.628-44.864; P = 0.011), history of smoking (OR, 14.285; 95% CI: 1.577-25.000; P = 0.018), maximum body temperature at admission (OR, 8.999; 95% CI: 1.036-78.147, P = 0.046), respiratory failure (OR, 8.772, 95% CI: 1.942-40.000; P = 0.016), albumin (OR, 7.353, 95% CI: 1.098-50.000; P = 0.003), and C-reactive protein (OR, 10.530; 95% CI: 1.224À34.701, P = 0.028) were risk factors for disease progression. Conclusions: Several factors that led to the progression of COVID-19 pneumonia were identified, including age, history of smoking, maximum body temperature at admission, respiratory failure, albumin, C-reactive protein. These results can be used to further enhance the ability of management of COVID-19 pneumon...

Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis

“…Overall, 98 documents could be initially identified based on our search criteria and from the reference lists, 89 of which were excluded after title, abstract or full text reading, since they were review articles (n=8), commentaries or other editorial materials (n=2), they did not deal with COVID-19 disease (n=71), or did not expressly reported the number of platelets and/or the rate of thrombocytopenia in COVID-19 patients with or without severe disease (n=8). Therefore, 9 studies could finally be included in our metaanalysis, totaling 1779 COVID-19 patients, 399 of whom (22.4%) with severe disease [11][12][13][14][15][16][17][18][19].…”

“…Eight studies included Chinese patients, whilst one was based in Singapore [18]. The clinical severity was defined as the composite of ICU admission, use of mechanical ventilation or death in two studies [11,13], ICU admission in two studies [12,16], progression towards ARDS in one study [14], death in three studies [15,17,19], and need of mechanical ventilation in the remaining study [18]. All eight studies provided data on the platelet count, whilst only four studies provided information on the rate of thrombocytopenia [11,12,14,19], where thrombocytopenia was defined as platelet count <15010 9 /L in two studies [11,14], whilst was set at <10010 9 /L in the other two investigations [12,19].…”

“…The mean difference in platelet count between COVID-19 patients with or without severe disease in the nine individual studies is shown in Figure 1. In seven of the studies, patients with severe COVID-19 displayed a lower platelet count compared to those with milder forms (mean difference ranging between -3 to -5410 9 /L) [11,[13][14][15][16]18,19], whilst in the remaining two studies the platelet count was found to be lower in patients with non-severe forms of COVID-19 (mean difference ranging between 27 to 3110 9 /L) [12,17]. The pooled results of these nine studies revealed that the platelet count was significantly lower in patients with more severe COVID-19 (WMD -3110 9 /L; 95% CI, -35 to -2910 9 /L).…”

Chronic obstructive pulmonary disease is associated with severe coronavirus disease 2019 (COVID-19)

“…With respect to COVID-19, levels of angiotensin converting enzyme 2 (ACE2), the reported host receptor of the virus responsible of COVID-19 (severe acute respiratory syndrome coronavirus 2; SARS-CoV-2), have been observed to be increased in patients with COPD [4,5]. However, early individual COVID-19 studies have not consistently reported a significantly higher rate of severe disease in COPD patients [6,7]. In this article, we analyze if COPD may be associated with increased odds of severe COVID-19…”

“…Overall, 87 articles were initially identified based on our electronic and reference search, which after screening by tile, abstract, and full text, 80 were excluded as not related to COVID-19 (n=27), were review articles (n=7), did not provide relevant data (n=28), were editorials (n=10), did not provide data on severity or comorbidities (n=5), compared patients by mortality not severity (n=2) or compared mild cases to critical cases (n=1). Thus, a total number of 7 studies were finally included in our meta-analysis, totaling 1,592 COVID-19 patients, 314 of which (19.7%) had severe disease [6][7][8][9][10][11][12].…”