Risk factors for disease progression in Japanese patients with COVID-19 with no or mild symptoms on admission

Abstract

Background Although the risk factors for coronavirus disease 2019 (COVID-19) mortality have been identified, there is limited information about the risk factors for disease progression after hospitalization among Japanese patients with COVID-19 exhibiting no or mild symptoms. Methods All 302 consecutive patients who were admitted to our institutions and diagnosed with COVID-19 between March and December 2020 were retrospectively assessed. Ultimately, 210 adult patients exhibiting no or mild symptoms on admission were included in the analysis. They were categorized into the stable (no oxygen needed) and worsened (oxygen needed) groups, and their characteristics and laboratory data were compared. Results Among 210 patients, 49 progressed to a severe disease stage, whereas 161 did not. The mean patient age was 52.14 years, and 126 (60.0%) patients were male. The mean body mass index (BMI) was 23.0 kg/m2, and 71 patients were overweight (BMI ≥ 25 kg/m2). Multivariate logistic analysis showed that old age, overweight, diabetes mellitus (DM), and high serum ferritin levels were independent risk factors for disease progression. Conclusions Clinicians should closely observe patients with COVID-19, especially those with risk factors such as old age, overweight, DM, and high serum ferritin levels, regardless of whether they have no or mild symptoms.

Influence of obesity on incidence of thrombosis and disease severity in patients with COVID-19: From the CLOT-COVID study

“…Consistent with a lot of previous reports [1] , [11] , [12] , [14] , [16] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , the present study identified that obesity was independently associated with severe status of COVID-19 during hospitalization. Obesity may lead to an impaired immune system and reduced respiratory function [10] , [34] .…”

Association Between the Development of Thrombosis and Worsening of Disease Severity in Patients With Moderate COVID-19 on Admission ― From the CLOT-COVID Study ―

“…37-39 A Japanese study reported that diabetes is an independent risk factor of disease progression in patients with COVID-19 with no or mild symptoms who do not require oxygen administration. 24 These factors can attenuate the immune response, leading to increased susceptibility to viral infections, and exacerbating the infection. In addition to these potential baseline risk factors, comorbidities, and biomarkers, the development of thrombosis was found to be independently and strongly associated with worsening COVID-19 severity in this study, suggesting that more aggressive pharmacological thromboprophylaxis may be helpful for the prevention of worsening COVID-19 severity.…”

“…23 A recent Japanese study reported that 49/210 patients (23%) exhibiting no or mild COVID-19 symptoms on admission required oxygen supplementation during hospitalization. 24 The nationwide COVID-19 Registry in Japan (COVIREGI-JP) study reported that mechanical ventilation or ECMO was required during hospitalization in 2.0% of patients with non-severe and 26.4% of patients with severe COVID-19. 25 In this study, 19.6% of patients with moderate COVID-19 upon admission had worsening of COVID-19 severity, which is consistent with previous reports.…”

Mortality-associated Risk Factors in Hospitalized COVID-19 Patients in Japan: Findings of the CLOT-COVID Study

“…Several previous reports of the risk factors for the disease severity and progression of COVID-19 in Japan have been published. 31 , 32 A recent large-scale Japanese registry-based study that included 3,829 COVID-19 patients reported that male sex, higher age, hypertension, obesity, cardiovascular disease, and diabetes were independent risk factors for disease progression. 17 However, the mortality-associated risk factors for COVID-19 patients in Japan have not been reported.…”