Disease progression in patients with COVID-19: a retrospective cohort study in China

Abstract

OBJECTIVE: To evaluate the clinical features of disease progression among patients with COVID-19 to help early identification of patients at high risk.DESIGN: This was a retrospective, multi-centre cohort study. From 10 January to 29 February 2020, all cases diagnosed with COVID-19 at 24 hospitals (with complete medical records) in Jiangsu Province, China were recruited. The primary outcome was deterioration in condition, i.e., the dramatic progression from asymptomatic or mild or moderate status into severe or critically ill status during 14 days´ follow-up.RESULTS: Of the 625 patients in Jiangsu, none died; 597 patients were asymptomatic or had mild or moderate disease on admission, of whom 36 (6%) experienced disease deterioration to become severe or critically ill.CONCLUSION: Disease deterioration to severe or critically ill status was associated with age, pulmonary opacity score, lymphocyte count on admission and exposure to the pandemic centre in Wuhan.

Prone position reduces the risk of patients with mild or moderate COVID-19 progressing to severe or even critical cases: a retrospective study

“…According to the severity of the disease, COVID-19 can be divided into four levels: (1) mild-the clinical symptoms are mild and there is no pneumonia on imaging; (2) moderate-fever, respiratory symptoms, imaging manifestations of pneumonia; (3) severe-adults meet any of the following criteria: a. shortness of breath; respiratory rates ≥ 30 times /min; b. SpO 2 ≤ 93% when inhaling air in resting state; c. arterial partial pressure of oxygen/ oxygen concentration ≤ 300 mmHg; d. clinical symptoms are progressively worse, and lung imaging shows obvious progression (more than 50%) within 24-48 h; (4) critical-meeting one of the following criteria: a. respiratory failure, and the need for mechanical ventilation treatment; b. slip into shock; c. ICU treatment is required for other organ failures [12]. In the course of clinical treatment, it has been found that some patients with mild and moderate COVID-19 can evolve into severe or even critical COVID-19 in a short period of time [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The principles of treatment for patients with different severity vary greatly.…”

“…Therefore, the deterioration rate of control group was obtained through literature review. The results of literature survey showed that the deterioration rate of control group to severe or critical cases was 0% to 45.0%, the average deterioration rate was 22.7%, and the mortality rate was 1.7% [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The results showed that the percentage of patients progressing to severe or critical cases was significantly lower in prone position group than in control group.…”

“…COVID-19 patients can be classified into mild, moderate, severe and critical according to the severity of their illness [11,12]. Studies have found that about 0 to 45.0% of mild or moderate patients can progress to severe or critical patients [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Once progressed to severe or critical patients, the place of treatment needs to be transferred from ordinary wards or Fangcang shelter hospitals to intensive care unit (ICU) wards, which will greatly increase the difficulty of treatment and the medical resources needed.…”