Risk factors for severe COVID-19: Evidence from 167 hospitalized patients in Anhui, China

Yuan, Wei; Wang, Rui Rui; Zhang, Da Wei; Tu, You Hui; Chen, Chang Shan; Ji, Shuang; Li, Chun Xi; Li, Xiu Yong; Zhou, Meng; Cao, Wen; Han, Ming; Fei, Guanghe

doi:10.1016/j.jinf.2020.04.010

Cited by 67 publications

(63 citation statements)

References 7 publications

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“…Being one of the first study aimed at investigating the association between autoimmune diseases and COVID-19, the present study is scarcely comparable to previously published results. The prevalence of RA subjects found in a cohort of 2154 SARS-CoV-2 positive subjects in a large healthcare system in Massachusetts was similar [14], while smaller proportions of autoimmune conditions (with no specification) were found in literature compared to our study [29][30][31][32].…”

Section: Discussionsupporting

confidence: 64%

Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case–control and population case–control design

Murtas¹,

Andreano²,

Gervasi³

et al. 2020

Autoimmun Highlights

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Background COVID-19 epidemic has paralleled with the so called infodemic, where countless pieces of information have been disseminated on putative risk factors for COVID-19. Among those, emerged the notion that people suffering from autoimmune diseases (AIDs) have a higher risk of SARS-CoV-2 infection. Methods The cohort included all COVID-19 cases residents in the Agency for Health Protection (AHP) of Milan that, from the beginning of the outbreak, developed a web-based platform that traced positive and negative cases as well as related contacts. AIDs subjects were defined ad having one the following autoimmune disease: rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjogren disease, ankylosing spondylitis, myasthenia gravis, Hashimoto’s disease, acquired autoimmune hemolytic anemia, and psoriatic arthritis. To investigate whether AID subjects are at increased risk of SARS-CoV-2 infection, and whether they have worse prognosis than AIDs-free subjects once infected, we performed a combined analysis of a test-negative design case–control study, a case–control with test-positive as cases, and one with test-negative as cases (CC-NEG). Results During the outbreak, the Milan AHP endured, up to April 27th 2020, 20,364 test-positive and 34,697 test-negative subjects. We found no association between AIDs and being positive to COVID-19, but a statistically significant association between AIDs and being negative to COVID-19 in the CC-NEG. If, as likely, test-negative subjects underwent testing because of respiratory infection symptoms, these results imply that autoimmune diseases may be a risk factor for respiratory infections in general (including COVID-19), but they are not a specific risk factor for COVID-19. Furthermore, when infected by SARS-CoV-2, AIDs subjects did not have a worse prognosis compared to non-AIDs subjects. Results highlighted a potential unbalance in the testing campaign, which may be correlated to the characteristics of the tested person, leading specific frail population to be particularly tested. Conclusions Lack of availability of sound scientific knowledge inevitably lead unreliable news to spread over the population, preventing people to disentangle them form reliable information. Even if additional studies are needed to replicate and strengthen our results, these findings represent initial evidence to derive recommendations based on actual data for subjects with autoimmune diseases.

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Section: Discussionsupporting

confidence: 64%

Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case–control and population case–control design

Murtas¹,

Andreano²,

Gervasi³

et al. 2020

Autoimmun Highlights

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“…Lower O 2 saturation was linked to a one-third lower risk for developing critical disease. In line with our ndings, a recent study on 167 patients in Anhui, China, reported that ngertip oxygen saturation and decreased CD4 cell count were the only independent risk factors for severe COVID-19 (24).…”

Section: Discussionsupporting

confidence: 91%

Clinical features and disease severity in an Iranian population of COVID-19 patients

Nabavi

Javidarabshahi

Allahyari

et al. 2020

Preprint

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Objectives: Coronavirus disease 2019 (COVID-19) can present with a variety of symptoms. Severity of the disease may be associated with several factors. Here, we review clinical features of COVID-19 patients with different severities.Methods: This cross-sectional study was performed in Imam Reza hospital, Mashhad, Iran, during February-April 2020. COVID-19 patients with typical computed tomography (CT) patterns and/or positive reverse-transcriptase polymerase chain reaction (RT-PCR) were included. The patients were classified into three groups of moderate, severe, and critical based on disease severity. Demographic, clinical, laboratory, and radiologic findings were collected and compared. P<0.05 was considered statistically significant.Results: Overall, 200 patients with mean age of 69.75±6.39 years, of whom 82 (41%) were female were studied. Disease was severe/critical in the majority of patients (167, 83.5%). Disease severity was significantly associated with age, malignant comorbidities, dyspnea, nausea/vomiting, confusion, respiratory rate, pulse rate, O2 saturation, extent of CT involvement, serum C-reactive protein (CRP), pH, pO2, and aspartate transaminase (P<0.05). Moreover, complications including shock, coagulopathy, acidosis, sepsis, acute respiratory distress syndrome (ARDS), intensive care unit (ICU) admission, and intubation were significantly higher in patients with higher severities. O2 saturation, nausea/vomiting, and extent of lung CT involvement were independent predictors of severe/critical COVID-19 (OR=0.342, 45.93, and 25.48, respectively; P<0.05).Conclusions: Our results indicate O2 saturation, nausea/vomiting, and extent of lung CT involvement as independent predictors of severe COVID-19 conditions. Serum CRP levels and pO2 were also considerably higher patients with higher severity and can be used along with other factors as possible predictors of severe disease in COVID-19 patients.

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“…A total of 3,508 patients, with 946 in severe COVID-19 group and 2,561 in non-severe, were included. Clinical demographics are outlined in Table 1 [ [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The criteria for severe and non-severe disease varied between each study, but most studies considered respiratory distress and care in intensive units as severe disease.…”

Section: Resultsmentioning

confidence: 99%

Use of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in COVID-19

2020

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Background: As the pandemic of coronavirus disease 2019 (COV-ID-19) continues, prognostic markers are now being identified. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are easily accessible values that have been known to correlate with inflammation and prognosis in several conditions. We used the available data to identify the association of NLR and PLR with the severity of COVID-19. Methods: A literature search using EMBASE, MEDLINE, and Google Scholar for studies reporting the use of NLR and PLR in COVID-19 published until April 28, 2020, was performed. Random effects meta-analysis was done to estimate standard mean difference (SMD) of NLR and PLR values with 95% confidence interval (CI) between severe and non-severe COVID-19 cases. Results: A total of 20 studies with 3,508 patients were included. Nineteen studies reported NLR values, while five studies reported PLR values between severe and non-severe COVID-19 patients. Higher levels of NLR (SMD: 2.80, 95% CI: 2.12-3.48, P < 0.00001) and PLR (SMD: 1.82, 95% CI: 1.03-2.61, P < 0.00001)) were seen in patients with severe disease compared to non-severe disease. Conclusions: NLR and PLR can be used as independent prognostic markers of disease severity in COVID-19.

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Risk factors for severe COVID-19: Evidence from 167 hospitalized patients in Anhui, China

Cited by 67 publications

References 7 publications

Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case–control and population case–control design

Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case–control and population case–control design

Clinical features and disease severity in an Iranian population of COVID-19 patients

Use of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in COVID-19

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