COVID-19 with Different Severities: A Multicenter Study of Clinical Features

Abstract

Rationale: The coronavirus disease (COVID-19) pandemic is now a global health concern. Objectives: We compared the clinical characteristics, laboratory examinations, computed tomography images, and treatments of patients with COVID-19 from three different cities in China. Methods: A total of 476 patients were recruited from January 1, 2020, to February 15, 2020, at three hospitals in Wuhan, Shanghai, and Anhui. The patients were divided into four groups according to age and into three groups (moderate, severe, and critical) according to the fifth edition of the Guidelines on the Diagnosis and Treatment of COVID-19 issued by the National Health Commission of China. Measurements and Main Results: The incidence of comorbidities was higher in the severe (46.3%) and critical (67.1%) groups than in the moderate group (37.8%). More patients were taking angiotensinconverting enzyme inhibitors/angiotensin II receptor blockers in the moderate group than in the severe and critical groups. More patients had multiple lung lobe involvement and pleural effusion in the critical group than in the moderate group. More patients received antiviral agents within the first 4 days in the moderate group than in the severe group, and more patients received antibiotics and corticosteroids in the critical and severe groups. Patients .75 years old had a significantly lower survival rate than younger patients. Conclusions: Multiple organ dysfunction and impaired immune function were the typical characteristics of patients with severe or critical illness. There was a significant difference in the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers among patients with different severities of disease. Involvement of multiple lung lobes and pleural effusion were associated with the severity of COVID-19. Advanced age (>75 yr) was a risk factor for mortality.

A systematic review and meta-analysis to evaluate the clinical outcomes in COVID -19 patients on angiotensin converting enzyme inhibitors or angiotensin receptor blockers

“…Further, abstracts of 98 articles were read and subsequently, the full text of 41 articles were reviewed. Of these, sixteen articles were shortlisted which compared the clinical and/or mortality outcomes of COVID-19 patients on ACEI or ARB with non-users [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Finally, these sixteen studies were included for review and out of these, nine and five studies were included in the meta-analysis of mortality and severity outcomes in COVID-19 patients on ACEI/ARB, respectively.…”

Smoking Is Associated With COVID-19 Progression: A Meta-analysis

“…A total of 907 studies were retrieved through the search, of which 19, 8-26 16 from China, 1 from Korea, and 2 from the United States, included data on smoking behavior and COVID-19 disease progression (Supplementary Table S1). Seventeen studies [9][10][11][12][14][15][16][17][18][19][20][21][22][23][24][25][26] were based on hospitalized patients and two 8,13 included both hospitalized patients and outpatients.…”

“…The exposure group for our analysis were those who had a history of smoking (current smokers or former smokers) and unexposed group was never smokers. Nine studies 10,12,14,18,20,21,23,25,26 assessed whether the patient was a "current smoker," five studies 8,9,13,16,24 assessed whether the patient was a current or former smoker (as separate categories), and five studies 11,15,17,19,22 assessed whether the patient had a "history of smoking" (current or former).…”

“…Outcomes were progression of COVID-19 to more severe or critical conditions or death. Six studies 11,16,20,21,23,24 categorized the outcome as severe or critical (respiratory distress with respiratory rate ≥30/min, or oxygen saturation ≤93% at rest, or oxygenation index ≤300 mm Hg, based on the diagnostic and treatment guideline for SARS-CoV-2 issued by Chinese National Health Committee or the American Thoracic Society guidelines for community acquired pneumonia 23,24 ) or nonsevere, three 10,17,18 categorized the outcome as progression or improvement, two 8,14 categorized the outcome as intensive care unit (ICU) admission or non-ICU admission, one 13 categorized the outcome as the primary composite endpoint (ICU admission, the use of mechanical ventilation, or death) or not, three 9,22,26 categorized the outcome as death or survivor, one 19 categorized the outcome as the occurrence of severe cases (without defining severe) or death or mild, one study 15 categorized the outcome as clinical deterioration during the hospitalization and needed supplemental oxygen therapy, one 12 categorized the outcome as a need of intensive mechanical ventilators, and one 25 categorized the outcome as abnormal chest imaging findings.…”

“…This analysis is based on unadjusted ORs that were either reported in the studies 17 or that we calculated based on counts in the studies. [8][9][10][11][12][13][14][15][16][18][19][20][21][22][23][24][25][26] Only one 17 of the studies reported unadjusted and adjusted ORs using multivariate analysis; after adjusting for confounding by age, maximum temperature at admission, respiratory failure, severe illness, albumin, creatinine, procalcitonin, and C-reactive protein level, the effect of smoking on disease severity increased (unadjusted: OR 12.19, 95% CI 1.76-84.31, p = .011; adjusted: OR 14.29, 95% CI 1.58-25.0, p = .018). Three peer-reviewed meta-analysis papers 6,34,35 on association between smoking and COVID-19 were also based on unadjusted ORs, but with fewer studies included.…”