Risk factors for disease progression in patients with mild to moderate coronavirus disease 2019—a multi-centre observational study

Abstract

the novel coronavirus disease 2019 (COVID-19) that emerged in Wuhan city has spread rapidly around the world. The risk for poor outcome dramatically increases once a patient progresses to the severe or critical stage. The present study aims to investigate the risk factors for disease progression in individuals with mild to moderate COVID-19. Methods: We conducted a cohort study that included 1007 individuals with mild to moderate COVID-19 from three hospitals in Wuhan. Clinical characteristics and baseline laboratory findings were collected. Patients were followed up for 28 days for observation of disease progression. The end point was the progression to a more severe disease stage. Results: During a follow up of 28 days, 720 patients (71.50%) had recovered or were symptomatically stable, 222 patients (22.05%) had progressed to severe disease, 22 patients (2.18%) had progressed to the critically ill stage and 43 patients (4.27%) had died. Multivariate Cox proportional hazards models identified that increased age (hazard ratio (HR) 2.56, 95% CI 1.97e3.33), male sex (HR 1.79, 95% CI 1.41 e2.28), presence of hypertension (HR 1.44, 95% CI 1.11e1.88), diabetes (HR 1.82, 95% CI 1.35e2.44), chronic obstructive pulmonary disease (HR 2.01, 95% CI 1.38e2.93) and coronary artery disease (HR 1.83, 95% CI 1.26e2.66) were risk factors for disease progression. History of smoking was protective against disease progression (HR 0.56, 95% CI 0.34e0.91). Elevated procalcitonin (HR 1.72, 95% CI 1.02e2.90), urea nitrogen (HR 1.72, 95% CI 1.21e2.43), a-hydroxybutyrate dehydrogenase (HR 3.02, 95% CI 1.26e7.21) and D-dimer (HR 2.01, 95% CI 1.12e3.58) at baseline were also associated with risk for disease progression. Conclusions: This study identified a panel of risk factors for disease progression in individuals with mild to moderate COVID-19.

Predictive criteria of severe cases in COVID‐19 patients of early stage: A retrospective observational study

“…The presence of chronic comorbidity is a key risk factor of developing into severe state. Recent study demonstrated that presence of hypertension, diabetes, COPD, and coronary artery disease were risk factors of disease progression in mild or moderate COVID‐19 patients, which is in accordance with our result 6 . Moreover, patients with two or more comorbidities are prone to poor prognosis compared with those with no or single 7 .…”

Predictive criteria of severe cases in COVID-19 patients of early stage

“…The presence of chronic comorbidity is a key risk factor of developing into severe state. Recent study demonstrated that presence of hypertension, diabetes, COPD and coronary artery disease were risk factors of disease progression in mild or moderate COVID-19 patients, which is in accordance with our result (Cen et al, 2020). Moreover, patients with two or more comorbidities are prone to poor prognosis compared with those with no or single (Guan et al, 2020).…”

Association of Initial Symptoms or Comorbidities With Pneumonia Lesions in COVID-19 Patients: Based on Artificial Intelligence-Enabled CT Quantitation

“…However, adjusted by multivariate linear regression model, we found that only the plasma brinogen level, plasma D-dimer level, serum albumin level, serum α-hydroxybutyrate dehydrogenase level, and peripheral blood leukocyte count were independently correlated with the lesion ratio of the whole lung. This observation shares the same perspective with previous researches that reported elevated plasma D-dimer or serum α-hydroxybutyrate dehydrogenase were associated with poor clinical outcomes in COVID-19 patients (17,18). Laboratory ndings and postmortem ndings in COVID-19 patients revealed activation of coagulation pathways and in ammation responses in the COVID-19 (19)(20)(21).…”