Predictors of progression from moderate to severe coronavirus disease 2019: a retrospective cohort

Abstract

Objective: Most cases of coronavirus disease 2019 (COVID-19) are identified as moderate, which is defined as having a fever or dry cough and lung imaging with ground-glass opacities. The risk factors and predictors of prognosis in such cohorts remain uncertain. Methods: All adults with COVID-19 of moderate severity diagnosed using quantitative RT-PCR and hospitalized at the Central Hospital of Wuhan, China, from 1 January to 20 March 2020 were enrolled in this retrospective study. The main outcomes were progression from moderate to severe or critical condition or death. Results: Among the 456 enrolled patients with moderate COVID-19, 251/456 (55.0%) had poor prognosis. Multivariate logistic regression analysis identified higher neutrophil count: lymphocyte count ratio (NLR) on admission (OR 1.032, 95% CI 1.042e1.230, p 0.004) and higher C-reactive protein (CRP) on admission (OR 3.017, 95% CI 1.941e4.690, p < 0.001) were associated with increased OR of poor prognosis. The area under the receiver operating characteristic curve (AUC) for NLR and CRP in predicting progression to critical condition was 0.77 (95% CI 0.694e0.846, p < 0.001) and 0.84 (95% CI 0.780e0.905, p < 0.001), with a cutoff value of 2.79 and 25.95 mg/L, respectively. The AUC of NLR and CRP in predicting death was 0.81 (95% CI 0.732e0.878, p < 0.001) and 0.89 (95% CI 0.825e0.946, p < 0.001), with a cutoff value of 3.19 and 33.4 mg/L, respectively. Conclusions: Higher levels of NLR and CRP at admission were associated with poor prognosis of individuals with moderate COVID-19. NLR and CRP were good predictors of progression to critical condition and death.

Bacterial and Fungal Growth in Sputum Cultures from 165 COVID-19 Pneumonia Patients Requiring Intubation: Evidence for Antimicrobial Resistance Development and Analysis of Risk Factors

“…Our study does suggest that following admission and intubation, COVID-19 pneumonia patients have the same predisposition to colonization and infections due to nosocomial pathogens wellknown in hospital-acquired and ventilator-associated pneumonias. The literature on bacterial sputum cultures in COVID-19 report high rates of antibiotic use [28,29]. We observed this as well and demonstrated antimicrobial resistance development in over 10% of bacterial isolates late in patients' hospitalisations; this had been predicted [30] but also has been a topic of considerable debate [31,32,33,34].…”

Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

“…The remaining 42 studies were further scrutinized by reading the full text. Finally, only 19 studies were included in this meta-analysis, of which 9 reported the predictive value on disease severity [26][27][28][29][30][31][32][33][34], 6 reported the predictive value on mortality [35][36][37][38][39][40], and 4 reported the predictive value on both disease severity and mortality [41][42][43][44].…”

“…The methodological quality of the included studies was presented in Additional File 2. One study only included patients classi ed as moderate [36], one only included severe patients [35], and one only included elderly patients [40]. Therefore, these three studies were considered to have a high risk of patient selection.…”

Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

“…Finally, only 19 studies were included in this meta-analysis, of which 9 reported the predictive value on disease severity [26][27][28][29][30][31][32][33][34], 6 reported the predictive value on mortality [35][36][37][38][39][40], and 4 reported the predictive value on both disease severity and mortality [41][42][43][44].…”

“…The methodological quality of the included studies is presented in Additional File 2. One study only included patients classi ed as moderate [36], one included only severe patients [35], and another included only elderly patients [40]. Therefore, these three studies were considered to have a high risk of patient selection bias.…”