Clinical characteristics and risk factors of patients with severe COVID-19 in Jiangsu province, China: a retrospective multicentre cohort study

Abstract

Background: Coronavirus Disease-2019 (COVID-19) has become a major health event that endangers people health throughout China and the world. Understanding the factors associated with COVID-19 disease severity could support the early identification of patients with high risk for disease progression, inform prevention and control activities, and potentially reduce mortality. This study aims to describe the characteristics of patients with COVID-19 and factors associated with severe or critically ill presentation.Methods: Multicentre retrospective cohort study of all individuals with confirmed Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infections diagnosed at 24 COVID-19-designated hospitals in Jiangsu province between the 10th January and 15th March 2020. Demographic, clinical, laboratory, and radiological data were collected at hospital admission and data on disease severity were collected at from admission. Patients were categorised as asymptomatic/mild/moderate, and severe/critically ill according to the worst level of COVID-19 recorded during hospitalisation.Results: A total of 625 patients, 64 (10.2%) were severe/critically ill and 561 (89.8%) were asymptomatic/mild/moderate. All patients were discharged and no patients died. Patients with severe/critically ill COVID-19 were more likely to be older, to be single onset (i.e. not to a cluster of cases in family/community), to have a medical history of hypertension and diabetes; had higher temperature, faster respiratory rates, lower peripheral capillary oxygen saturation (SpO2), and higher CT image quadrant scores and pulmonary opacity percentage; had increased C-reactive protein, fibrinogen, and D-dimer on admission; and had lower white blood cells, lymphocyte, and platelet counts and albumin on admission than asymptomatic/mild/moderate cases. Multivariable regression showed that odds of being a severe/critically ill case were associated with age (year) (OR 1.06, 95%CI 1.03-1.09), lymphocyte count (109/L) (OR 0.25, 95%CI 0.08-0.74), and pulmonary opacity in CT (per 5%) on admission (OR 1.31, 95%CI 1.15-1.51).Conclusions: Severe or critically ill patients with COVID-19 is about one-tenths of patients in Jiangsu. Age, lymphocyte count, and pulmonary opacity in CT on admission were associated with risk of severe or critically ill COVID-19.

Nervous system diseases are associated with the severity and mortality of patients with COVID-19: a systematic review and meta-analysis

“…As for specific nervous system diseases, our meta-analysis showed that stroke was associated with severe COVID-19 disease (8 studies [17, 38, 50, 57, 64, 65, 71, 80], 3178 patients; OR = 1.95, 95%CI: 1.11 to 3.42, P = 0.020; I 2 = 30.2%) (Fig. 6A).…”

“…The sample size per study ranged from 27 to 1590 (total 17 879; 9686 males). Considering methodological quality in items of NOS scale, 23 studies [4, 17, 19, 21, 24, 27–29, 33, 34, 37, 46, 49, 55, 58, 61, 65, 67–69, 73, 75, 76] were rated as high quality (>7 stars) and 46 studies [18, 20, 22, 23, 25, 26, 30–32, 35, 36, 38–45, 47, 48, 50–54, 56, 57, 59, 60, 62–64, 66, 70–72, 74, 77–84] were rated as moderate quality (5−7 stars). The detailed characteristics and quality of the included studies are summarised in Table 1.…”

“…As for specific nervous system diseases, our meta-analysis showed that stroke was associated with severe COVID-19 disease (8 studies [17,38,50,57,65,66,72,81], 3,178 patients; OR = 1.95, 95%CI: 1.11 to 3.42, P = 0.020; I 2 = 30.2%) ( Figure 6A). There were no significant differences in the prevalence of epilepsy (2 studies [41, 57], 1,003 patients; OR = 1.00, 95%CI: 0.42 to 2.35, P = 0.994; I 2 = 0.0%) and dementia (3 studies [44, 54, 66], 1,041 patients; OR = 2.39, 95%CI: 0.55 to 10.48, P = 0.247; I 2 = 61.9%) between severe and non-severe patients ( Figure 6B I 2 = 92.0%) between non-survival and survival patients ( Figure 7).…”

Potential Predictors of Poor Prognosis among Severe COVID-19 Patients: A Single-Center Study

“…Generally, older individuals have more health issues and comorbidities and are more susceptible to COVID-19; thus, they may develop a more severe disease than the younger population. Comorbidities, such as DM and hypertension, associated with old age, predispose them to immunological vulnerabilities [ 18 ]. Patients with severe disease are at a high risk of developing acute respiratory distress syndrome (ARDS) and being admitted to the ICU [ 17 ].…”

From Skirmishes to Protracted Battles: A Bibliometric Analysis About Human Beings and Coronaviruses From 1991 to 2020

“…Based on clinical and epidemiological analyses, older age, male and preexisting comorbidity were identi ed as important risk factors for the development of severe or lethal disease in COVID-19, which were similar to SARS and MERS [22][23][24]. The ve most common comorbidities were hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease and tumor, while higher D-dimer, higher neutrophil/lymphocyte ratio, higher level of Creactive protein, lymphopenia, thrombocytopenia and obesity were the independent risk factors of death in COVID-19 patients [25][26][27]. According to epidemiology and large scale data, diabetes has been identi ed as an important risk factor for mortality and rates of progression to acute respiratory distress syndrome (ARDS) in hospitalized patients with COVID-19 [28,29].…”