Independent Risk Factors for the Dynamic Development of COVID-19: A Retrospective Study

Abstract

Objective To identify the risk factors for predicting the dynamic progression of COVID-19. Methods A total of 2321 eligible patients were included in this study from February 4 to April 15, 2020. Two illness conditions, including mild/moderate (M/M) subtype to severe/critical (S/C) and S/C to fatality, were classified. Clinical message was collected and compared, respectively. Kaplan–Meier method, Cox regression model and risk score system were used to predict disease progression in S/C COVID-19. Results A total of 112 of 1761 patients with M/M subtype were progressors (P) and 1649 non-progressors (NP). Increasing disease progression associated with higher levels of neutrophils count (HR=1.958, 95% CI=1.253–3.059, P =0.003), CK (HR=2.203, 95% CI=1.048–4.632, P =0.037), LDH (HR=3.309, 95% CI=2.083–5.256, P <0.001) and CRP (HR=2.575, 95% CI=1.638–4.049, P <0.001), and lower level of lymphocytes count (HR=1.549, 95% CI=1.018–2.355, P =0.041), as well as total lesion volume ratio greater than ≥10% (HR=2.286, 95% CI=1.451–3.601, P <0.001) on admission. In progression to fatality, 56 of the 672 S/C cases died and 616 survived. Increasing fatality associated with lower level of lymphocytes count (HR:2.060, 95% CI:1.000–4.242, P =0.050), higher levels of BUN (HR:2.715, 95% CI:1.539–4.790, P <0.001), CK-MB (HR:3.412, 95% CI:1.760–6.616, P <0.001), LDH (HR:5.578, 95% CI:2.317–13.427, P <0.001), and PT (HR:3.619, 95% CI:2.102–6.231, P <0.001). Furthermore, high risk of neutrophils count, lymphocytes count, CK, LDH, CRP, and total lesion volume ratio was powerfully correlated with the incidence of progression to S/C in patients with NS COVID-19 and high odds of lymphocytes count, BUN, CK-MB, LDH, and PT were significantly associated with death in patients with S/C COVID-19. In addition, the progression and mortality rates increased with increasing risk scores. Conclusion Elevated LDH level and lymphopenia were independent predictors for COVID-19 sustainable management in classifying non-severe patients who progressed to severe condition and identifying S/C patients who deteriorated to fatal outcomes as well. Total lesion volume ratio ≥10% may provide early predictive evidence with COVID-19 patients at high risk of developing into S/C to improve prognosis.

Development and external validation of the DOAT and DOATS scores: simple decision support tools to identify disease progression among nonelderly patients with mild/moderate COVID-19

“…Several studies have demonstrated the association between certain clinical characteristics, such as an older age, male sex, symptoms of COVID-19 (a fever, cough, fatigue, and shortness of breath), and comorbidities (hypertension, diabetes, and CKD) and the disease severity or activity [ 21 – 23 ]. The addition of blood tests may also increase the accuracy of prediction of disease progression [ 11 ]. However, involving blood sampling would make it difficult for medical staff to immediately evaluate patients’ risk while in their presence.…”

“…In addition, some biomarkers have been reported to be associated with disease severity [ 4 , 8 – 12 ]. Using these risk factors, several investigators have reported risk stratification methods [ 9 – 11 , 13 – 16 ].…”

Coronavirus Disease-2019 Pneumonia

“…Leukocytosis has been associated with disease progression and severity 27 , 28 , 29 , and studies have found that lymphopenia is associated with disease severity and with worse outcomes. 29 , 30 , 31 , 32 , 33 Thrombocytopenia has been routinely observed in patients with COVID-19, with lower platelets manifesting in severe and critical illness 34 and being associated with higher mortality. 35 Additionally, worse outcomes have been observed in patients with elevations in numerous, routinely available inflammatory markers: D-dimer, C-reactive protein, lactate dehydrogenase, and ferritin.…”