Risk factors for illness severity in patients with COVID-19 pneumonia: a prospective cohort study

Zhang, Nannan; Zhang, Hairong; Tang, Yanhua; Zhang, Hao; Ma, Aiying; Xu, Fang; Sun, Yu; Jiang, Luning; Shan, Fangzhen

doi:10.7150/ijms.51205

Cited by 8 publications

(5 citation statements)

References 42 publications

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“…Patients with elevated NLR should be given more attention to avoid further deterioration or even death. Decreased albumin was demonstrated the predictor of disease severity in COVID-19 pneumonia (17), which was consistent with this study. Literature has also demonstrated that decreasing albumin levels are associated with poor outcomes and mortality in COVID-19 patients (39).…”

Section: Discussionsupporting

confidence: 92%

“…In this study, the median age of severely ill patients was higher than that in previous studies (15)(16)(17)(18)23). Based on robust studies, increasing age was an uncontested risk factor for disease severity (2,15,23,28,29).…”

Section: Discussioncontrasting

confidence: 49%

“…Elevated NLR levels reflected enhancing inflammatory processes and could indicate a poor prognosis (34). This study had shown that elevated NLR was an independent risk factor (17,28,(34)(35)(36)(37). Literature also demonstrates that NLR is an independent risk factor for mortality in hospitalized patients with .…”

Section: Discussionmentioning

confidence: 97%

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Differences in the severity and mortality risk factors for patients hospitalized for COVID-19 pneumonia between the early wave and the very late stage of the pandemic

Li,

Jia,

Wang

et al. 2023

Front. Med.

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BackgroundSince China’s dynamic zero-COVID policy is cancelled on December 7, 2022, the rapidly growing number of patients has brought a major public health challenge. This study aimed to assess whether there were differences in the severity and mortality risk factors for patients hospitalized for COVID-19 pneumonia between the early wave and the very late stage of the pandemic.MethodsA retrospective cross-sectional study was carried out using data from 223 hospitalized patients diagnosed with COVID-19 pneumonia during the Omicron surge in Xi’an People’s Hospital (Xi’an Fourth Hospital) from December 8, 2022, to January 31, 2023. Univariable and multivariable logistic regression analyses were used to identify potential risk factors associated with the severity and mortality of COVID-19 pneumonia during the first wave of the pandemic after the dynamic zero-COVID policy was retracted. Differences in the severity and mortality risk factors were assessed at different stages of the pandemic, mainly from demographic, clinical manifestation, laboratory tests and radiological findings of patients on admission.ResultsThe mean age of the 223 participants was 71.2 ± 17.4. Compared with the patients in the initial stage of the pandemic, the most common manifestation among patients in this study was cough (90.6%), rather than fever (79.4%). Different from the initial stage of the pandemic, older age, chest tightness, elevated neutrophil-to-lymphocyte ratio (NLR), decreased albumin (ALB) level and ground glass opacification (GGO) in radiological finding were identified as severity risk factors, instead of mortality risk factors for COVID-19 patients in the very late stage of the pandemic. Arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ≤300 mmHg, cardiovascular disease and laboratory findings including elevated levels of D-dimer, α-hydroxybutyrate dehydrogenase (α-HBDH), total bilirubin (TBIL), alanine aminotransferase (ALT), urea nitrogen (BUN), creatinine (CR), fasting blood glucose (FBG) and decreased platelet count (PLT) were still associated with mortality in the very late stage of the pandemic.ConclusionMonitoring continuously differences in the severity and mortality risk factors for COVID-19 patients between different stages of the pandemic could provide evidence for exploring uncharted territory in the coming post-pandemic era.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 49%

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Differences in the severity and mortality risk factors for patients hospitalized for COVID-19 pneumonia between the early wave and the very late stage of the pandemic

Li,

Jia,

Wang

et al. 2023

Front. Med.

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“…Other significant outcomes included coronary heart disease (OR: 2.87, 95% CI: 2.22-3.71; I 2 = 59.9%)[11-15, 17, 20, 22-38, 41-45, 47, 49-51], malignancy (OR = 2.60, 95% CI: 2.00-3.40; I 2 = 11.9%)[11, 13, 15, 17, 20, 22-26, 28, 30-32, 34-38, 41, 43], cerebrovascular disease (OR = 2.47, 95% CI: 1.54-3.97; I 2 = 28.4%)[11,13,14,20,22,24,25,34,38,40,42,44,50,51], hypertension (OR = 2.42, 95% CI: 2.03-2.88; I 2 = 67.9%)[11-18, 20, 22-51], diabetes…”

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confidence: 99%

Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis

et al. 2021

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Objective We aimed to systematically identify the possible risk factors responsible for severe cases. Methods We searched PubMed, Embase, Web of science and Cochrane Library for epidemiological studies of confirmed COVID-19, which include information about clinical characteristics and severity of patients’ disease. We analyzed the potential associations between clinical characteristics and severe cases. Results We identified a total of 41 eligible studies including 21060 patients with COVID-19. Severe cases were potentially associated with advanced age (Standard Mean Difference (SMD) = 1.73, 95% CI: 1.34–2.12), male gender (Odds Ratio (OR) = 1.51, 95% CI:1.33–1.71), obesity (OR = 1.89, 95% CI: 1.44–2.46), history of smoking (OR = 1.40, 95% CI:1.06–1.85), hypertension (OR = 2.42, 95% CI: 2.03–2.88), diabetes (OR = 2.40, 95% CI: 1.98–2.91), coronary heart disease (OR: 2.87, 95% CI: 2.22–3.71), chronic kidney disease (CKD) (OR = 2.97, 95% CI: 1.63–5.41), cerebrovascular disease (OR = 2.47, 95% CI: 1.54–3.97), chronic obstructive pulmonary disease (COPD) (OR = 2.88, 95% CI: 1.89–4.38), malignancy (OR = 2.60, 95% CI: 2.00–3.40), and chronic liver disease (OR = 1.51, 95% CI: 1.06–2.17). Acute respiratory distress syndrome (ARDS) (OR = 39.59, 95% CI: 19.99–78.41), shock (OR = 21.50, 95% CI: 10.49–44.06) and acute kidney injury (AKI) (OR = 8.84, 95% CI: 4.34–18.00) were most likely to prevent recovery. In summary, patients with severe conditions had a higher rate of comorbidities and complications than patients with non-severe conditions. Conclusion Patients who were male, with advanced age, obesity, a history of smoking, hypertension, diabetes, malignancy, coronary heart disease, hypertension, chronic liver disease, COPD, or CKD are more likely to develop severe COVID-19 symptoms. ARDS, shock and AKI were thought to be the main hinderances to recovery.

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“…Lung diseases across all ages have become one of the major public health issues worldwide with increased human activities, environmental changes, indoor and outdoor air pollution, long-term smoking, occupational exposures, and various pathogens 1 . Acute and chronic lung diseases have high morbidity and mortality 2 , 3 . While these diverse conditions require different specific therapeutic approaches (e.g., antimicrobial medications, inhaled corticosteroids, anti-inflammatory drugs, antifibrotic drugs, specific cytokine inhibitors, bronchodilators, respiratory support, mechanical ventilation, and restricted fluid input), persistent alleviation of clinical symptoms cannot be offered to most patients affected to date.…”

Section: Introductionmentioning

confidence: 99%

Clinical applications of mesenchymal stromal cell-based therapies for pulmonary diseases: An Update and Concise Review

Chen¹,

Wang

Huang

et al. 2021

Int. J. Med. Sci.

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Lung disorders are a leading cause of morbidity and death worldwide. For many disease conditions, no effective and curative treatment options are available. Mesenchymal stromal cell (MSC)-based therapy is one of the cutting-edge topics in medical research today. It offers a novel and promising therapeutic option for various acute and chronic lung diseases due to its potent and broad-ranging immunomodulatory activities, bacterial clearance, tissue regeneration, and proangiogenic and antifibrotic properties, which rely on both cell-to-cell contact and paracrine mechanisms. This review covers the sources and therapeutic potential of MSCs. In particular, a total of 110 MSC-based clinical applications, either completed clinical trials with safety and early efficacy results reported or ongoing worldwide clinical trials of pulmonary diseases, are systematically summarized following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, including acute/viral pulmonary disease, community-acquired pneumonia (CAP), chronic obstructive pulmonary disease (COPD), bronchopulmonary dysplasia (BPD), interstitial lung diseases (ILD), chronic pulmonary fibrosis, bronchiolitis obliterans syndrome (BOS) and lung cancer. The results of recent clinical studies suggest that MSCs are a promising therapeutic approach for the treatment of lung diseases. Nevertheless, large-scale clinical trials and evaluation of long-term effects are necessary in further studies.

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Risk factors for illness severity in patients with COVID-19 pneumonia: a prospective cohort study

Cited by 8 publications

References 42 publications

Differences in the severity and mortality risk factors for patients hospitalized for COVID-19 pneumonia between the early wave and the very late stage of the pandemic

Differences in the severity and mortality risk factors for patients hospitalized for COVID-19 pneumonia between the early wave and the very late stage of the pandemic

Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis

Clinical applications of mesenchymal stromal cell-based therapies for pulmonary diseases: An Update and Concise Review

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