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Impaired immune and coagulation systems may be early risk factors for COVID-19 patients: A retrospective study of 118 inpatients from Wuhan, China.
Medicine (Baltimore). 2020 Aug 28; 99(35):e21700.M

Abstract

The coronavirus disease 2019 (COVID-19) outbreak has become a global health threat and will likely be one of the greatest global challenges in the near future. The battle between clinicians and the COVID-19 outbreak may be a "protracted war."The objective of this study was to investigate the risk factors for in-hospital mortality in patients with COVID-19, so as to provide a reference for the early diagnosis and treatment.This study retrospectively enrolled 118 patients diagnosed with COVID-19, who were admitted to Eastern District of Renmin Hospital of Wuhan University from February 04, 2020 to March 04, 2020. The demographics and laboratory data were collected and compared between survivors and nonsurvivors. The risk factors of in-hospital mortality were explored by univariable and multivariable logistic regression to construct a clinical prediction model, the prediction efficiency of which was verified by receiver-operating characteristic (ROC) curve.A total of 118 patients (49 males and 69 females) were included in this study; the results revealed that the following factors associated with in-hospital mortality: older age (odds ratio [OR] 1.175, 95% confidence interval [CI] 1.073-1.287, P = .001), neutrophil count greater than 6.3 × 10 cells/L (OR 7.174, (95% CI 2.295-22.432, P = .001), lymphocytopenia (OR 0.069, 95% CI 0.007-0.722, P = .026), prothrombin time >13 seconds (OR 11.869, 95% CI 1.433-98.278, P = .022), D-dimer >1 mg/L (OR 22.811, 95% CI 2.224-233.910, P = .008) and procalcitonin (PCT) >0.1 ng/mL (OR 23.022, 95% CI 3.108-170.532, P = .002). The area under the ROC curve (AUC) of the above indicators for predicting in-hospital mortality were 0.808 (95% CI 0.715-0.901), 0.809 (95% CI 0.710-0.907), 0.811 (95% CI 0.724-0.898), 0.745 (95% CI 0.643-0.847), 0.872 (95% CI 0.804-0.940), 0.881 (95% CI 0.809-0.953), respectively. The AUC of combined diagnosis of these aforementioned factors were 0.992 (95% CI 0.981-1.000).In conclusion, older age, increased neutrophil count, prothrombin time, D-dimer, PCT, and decreased lymphocyte count at admission were risk factors associated with in-hospital mortality of COVID-19. The prediction model combined of these factors could improve the early identification of mortality risk in COVID-19 patients.

Authors+Show Affiliations

Department of Intensive Care Unit.Department of Infection Management, Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan.Department of Intensive Care Unit.Department of Intensive Care Unit.Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei.Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei.Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32871887

Citation

Qin, Zhi-Jun, et al. "Impaired Immune and Coagulation Systems May Be Early Risk Factors for COVID-19 Patients: a Retrospective Study of 118 Inpatients From Wuhan, China." Medicine, vol. 99, no. 35, 2020, pp. e21700.
Qin ZJ, Liu L, Sun Q, et al. Impaired immune and coagulation systems may be early risk factors for COVID-19 patients: A retrospective study of 118 inpatients from Wuhan, China. Medicine (Baltimore). 2020;99(35):e21700.
Qin, Z. J., Liu, L., Sun, Q., Li, X., Luo, J. F., Liu, J. S., & Liu, D. (2020). Impaired immune and coagulation systems may be early risk factors for COVID-19 patients: A retrospective study of 118 inpatients from Wuhan, China. Medicine, 99(35), e21700. https://doi.org/10.1097/MD.0000000000021700
Qin ZJ, et al. Impaired Immune and Coagulation Systems May Be Early Risk Factors for COVID-19 Patients: a Retrospective Study of 118 Inpatients From Wuhan, China. Medicine (Baltimore). 2020 Aug 28;99(35):e21700. PubMed PMID: 32871887.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impaired immune and coagulation systems may be early risk factors for COVID-19 patients: A retrospective study of 118 inpatients from Wuhan, China. AU - Qin,Zhi-Jun, AU - Liu,Lei, AU - Sun,Qun, AU - Li,Xia, AU - Luo,Jian-Fei, AU - Liu,Jia-Sheng, AU - Liu,Dan, PY - 2020/9/3/entrez PY - 2020/9/3/pubmed PY - 2020/9/9/medline SP - e21700 EP - e21700 JF - Medicine JO - Medicine (Baltimore) VL - 99 IS - 35 N2 - The coronavirus disease 2019 (COVID-19) outbreak has become a global health threat and will likely be one of the greatest global challenges in the near future. The battle between clinicians and the COVID-19 outbreak may be a "protracted war."The objective of this study was to investigate the risk factors for in-hospital mortality in patients with COVID-19, so as to provide a reference for the early diagnosis and treatment.This study retrospectively enrolled 118 patients diagnosed with COVID-19, who were admitted to Eastern District of Renmin Hospital of Wuhan University from February 04, 2020 to March 04, 2020. The demographics and laboratory data were collected and compared between survivors and nonsurvivors. The risk factors of in-hospital mortality were explored by univariable and multivariable logistic regression to construct a clinical prediction model, the prediction efficiency of which was verified by receiver-operating characteristic (ROC) curve.A total of 118 patients (49 males and 69 females) were included in this study; the results revealed that the following factors associated with in-hospital mortality: older age (odds ratio [OR] 1.175, 95% confidence interval [CI] 1.073-1.287, P = .001), neutrophil count greater than 6.3 × 10 cells/L (OR 7.174, (95% CI 2.295-22.432, P = .001), lymphocytopenia (OR 0.069, 95% CI 0.007-0.722, P = .026), prothrombin time >13 seconds (OR 11.869, 95% CI 1.433-98.278, P = .022), D-dimer >1 mg/L (OR 22.811, 95% CI 2.224-233.910, P = .008) and procalcitonin (PCT) >0.1 ng/mL (OR 23.022, 95% CI 3.108-170.532, P = .002). The area under the ROC curve (AUC) of the above indicators for predicting in-hospital mortality were 0.808 (95% CI 0.715-0.901), 0.809 (95% CI 0.710-0.907), 0.811 (95% CI 0.724-0.898), 0.745 (95% CI 0.643-0.847), 0.872 (95% CI 0.804-0.940), 0.881 (95% CI 0.809-0.953), respectively. The AUC of combined diagnosis of these aforementioned factors were 0.992 (95% CI 0.981-1.000).In conclusion, older age, increased neutrophil count, prothrombin time, D-dimer, PCT, and decreased lymphocyte count at admission were risk factors associated with in-hospital mortality of COVID-19. The prediction model combined of these factors could improve the early identification of mortality risk in COVID-19 patients. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/32871887/Impaired_immune_and_coagulation_systems_may_be_early_risk_factors_for_COVID_19_patients:_A_retrospective_study_of_118_inpatients_from_Wuhan_China_ DB - PRIME DP - Unbound Medicine ER -