Predictors of clinical deterioration in non-severe patients with COVID-19: a retrospective cohort study

Abstract

Objective: Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains pandemic with considerable morbidity and mortality around the world. The aim of this study was to identify the predictors for clinical deterioration in patients with COVID-19 who did not show clinical deterioration upon hospital admission. Methods: Two hundred fifty-seven patients with confirmed COVID-19 pneumonia admitted to Guangzhou Eighth People's Hospital between 23 January and 21 March 2020 were retrospectively enrolled. Demographic data, symptoms, laboratory values, comorbidities and treatments were all collected. The study endpoint was clinical deterioration within 20 days from hospital admission. Univariate and multivariable logistic regression methods were used to explore the risk factors associated with clinical deterioration. Results: A total of 49 (19%) patients showed clinical deterioration after admission. Compared with patients that did not experience clinical deterioration, clinically deteriorated patients had more dyspnea, cough and myalgia (65.3% versus 29.3%) symptoms and more had comorbidities (89.8% versus 36.1%). Clinical and laboratory characteristics at admission that were associated with clinical deterioration included senior age, diabetes, hypertension, myalgia, higher temperature, systolic blood pressure, C-reactive protein (CRP), procalcitonin, activated partial thromboplastin time, aspartate aminotransferase, alanine transaminase, direct bilirubin, plasma creatinine, lymphocytopenia, thrombocytopenia, decreased albumin and bicarbonate concentration. Medical history of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, calcium channel blockers and metformin were also risk factors. Conclusion: The four best predictors for clinical deterioration were CRP, procalcitonin, age and albumin. A "best" multivariable prediction model, resulting from using a variable selection procedure, included senior age, presentation with myalgia, and higher level of CRP and serum creatinine (bias-corrected c-statistic ¼ 0.909). Sensitivity and specificity corresponding to a cut point of CRP !18.45 mg/L for predicting clinical deterioration were 85% and 74%, respectively.

Metformin in Patients With COVID-19: A Systematic Review and Meta-Analysis

“…To examine the association between metformin use and other outcomes, we conducted a further meta-analyses of two (33,52), five (35,38,39,41,48,49), and four (29)(30)(31)47) studies estimating the association between metformin use and risk of intubation, deterioration, and hospitalization. The pooled ORs of metformin use with intubation, deterioration, and hospitalization were 0.94 (95% CI, 0.77-1.16; I 2 = 0.0%), 2.04 (95% CI, 0.65-6.34; I 2 = 79.4%), and 0.73 (95% CI, 0.53-1.00; I 2 = 16.8%), respectively (Supplementary Figures 2-4).…”

Metformin in SARS-CoV-2 infection: A hidden path – from altered inflammation to reduced mortality. A review from the literature

“…Opposite to the previous findings, Yitao et al 53 concluded that metformin was associated with greater clinical deterioration (OR 3.961; 95 % CI 1.020–15.368; p = 0.047). Similarly, Gao et al 54 concluded that metformin use was related to increasing probability of severe disease during hospitalization and to a higher risk of disease progression (OR 3.964; 95 % CI 1.034–15.194; p = 0.045).…”

“…, 44. Nevertheless, we cannot ignore the studies that point out an eventual risk association with higher clinical deterioration (Yitao et al 53 ), increased risk of disease progression (Gao et al 54 ), no-association with mortality (Oh et al 18 and Cheng et al 19 ), or even greater chance of death (Singh et al 21 and Do et al 20 ). Moreover, it is important to acknowledge that the vaccination status was not evaluated.…”

Active pulmonary tuberculosis and coronavirus disease 2019: A systematic review and meta-analysis

“…All, except four (20.0%), of these publications were from China [ 35 , 42 , 49 , 58 ]. Severe COVID-19 was defined based on World Health Organization guidance in three (15.0%) studies [ 35 , 49 , 58 ], recommendations from international professional bodies in two (10.0%) studies [ 44 , 70 ], national guidelines in 11 (55.0%) studies [ 38 , 42 , 46 , 47 , 51 , 53 , 56 , 57 , 73 , 74 , 76 ], and institutional policy in four (20.0%) studies [ 54 , 55 , 75 , 77 ]. Only three (15.0%) studies were considered high quality [ 42 , 54 , 58 ].…”