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Predictive role of clinical features in patients with coronavirus disease 2019 for severe disease.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2020 May 28; 45(5):536-541.ZN

Abstract

OBJECTIVES

Since the outbreak of coronavirus disease 2019 (COVID-19), it has spread rapidly in China and many other countries. The rapid increase in the number of cases has caused widespread panic among people and has become the main public health problem in the world. Severe patients often have difficult breathing and/or hypoxemia after 1 week of onset. A few critically ill patients may not only rapidly develop into acute respiratory distress syndrome, but also may cause coagulopathy, as well as multiple organs failure (such as heart, liver and kidney) or even death. This article is to analyze the predictive role of clinical features in patients with COVID-19 for severe disease, so as to help doctor monitor the severity-related features, restrain the disease progress, and provide a reference for improvement of medical treatment.

METHODS

The clinical data of 208 patients with COVID-19 who were isolated and treated in Changsha Public Health Treatment Center from January 17, 2020 to March 14, 2020 were collected. All patients were the mild and ordinary adult patients on admission, including 105 males and 103 females from 19 to 84 (median age 44) years old. According to the "Program for the diagnosis and treatment of novel coronavirus (COVID-19) infected pneumonia (Trial version 7)" issued by the General Office of National Health Committee and Office of State Administration of Traditional Chinese Medicine as the diagnostic and typing criteria. According to progression from mild to severe disease during hospitalization, the patients were divided into a mild group (n=183) and a severe transformation group (n=25). The clinical features such as age, underlying disease, blood routine, coagulation function, blood biochemistry, oxygenation index, and so on were analyzed. Among them, laboratory tests included white blood cell (WBC), lymphocytes (LYM), neutrophil (NEU), hemoglobin (Hb), platelet (PLT), prothrombin time (PT), plasma fibrinogen (Fib), activated partial prothrombin time (APTT), thrombin time (TT), D-dimer, total bilirubin (TBIL), albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (Cr), creatine kinase (CK), creatine kinase isoenzyme-MB (CK-MB), lactate dehydrogenase (LDH), C-reactive protein (CRP), and oxygen partial pressure in arterial blood. Partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO2/FiO2) was calculated. The variables with statistical significance were analyzed by logistic regression analysis.

RESULTS

Patients in the severe transformation group had more combined underlying diseases than those in the mild group (P<0.05). From the perspective of disease distribution, patients in the severe transformation group had more combined hypertension (P<0.05). In the severe transformation group, PT was significantly longer, the levels of Fib, ALT, AST, CK, LDH, and CRP were significantly higher than those in the mild group (P<0.05 or P<0.001), while LYM, ALB, and PaO2/FiO2 were significantly lower than those in the mild group (P<0.05 or P<0.001). Logistic regression analysis was performed on clinical features with statistically significant differences. Combined with hypertension, LYM, PT, Fib, ALB, ALT, AST, CK, LDH, and CRP as independent variables, and having severe disease or not was the dependent variable. The results show that combined hypertension, decreased LYM, longer PT, and increased CK level were independent risk factors that affected the severity of COVID-19 (P<0.05).

CONCLUSIONS

The patients with mild COVID-19 who are apt to develop severe diseases may be related to combined hypertension, decreased LYM, and longer PT, and increased CK level. For the mild patients with these clinical features, early intervention may effectively prevent the progression to severe diseases.

Authors+Show Affiliations

Department of Intensive Medicine, First Hospital of Changsha, Changsha 410005. mojuango@163.com.Department of Administrative Office, First Hospital of Changsha, Changsha 410005. 41002978@qq.com.Department of Intensive Medicine, First Hospital of Changsha, Changsha 410005.Department of Intensive Medicine, First Hospital of Changsha, Changsha 410005.Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005.Department of Medical Administration, First Hospital of Changsha, Changsha 410005.Department of Spine Surgery, First Hospital of Changsha, Changsha 410005.Department of Administrative Office, First Hospital of Changsha, Changsha 410005.Department of Information Statistics, First Hospital of Changsha, Changsha 410005.Department of Endocrinology and Metabolism, First Hospital of Changsha, Changsha 410005, China.

Pub Type(s)

Journal Article

Language

eng chi

PubMed ID

32879103

Citation

Mo, Juan, et al. "Predictive Role of Clinical Features in Patients With Coronavirus Disease 2019 for Severe Disease." Zhong Nan Da Xue Xue Bao. Yi Xue Ban = Journal of Central South University. Medical Sciences, vol. 45, no. 5, 2020, pp. 536-541.
Mo J, Liu J, Wu S, et al. Predictive role of clinical features in patients with coronavirus disease 2019 for severe disease. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2020;45(5):536-541.
Mo, J., Liu, J., Wu, S., LÜ, A., Xiao, L., Chen, D., Zhou, Y., Liang, L., Liu, X., & Zhao, J. (2020). Predictive role of clinical features in patients with coronavirus disease 2019 for severe disease. Zhong Nan Da Xue Xue Bao. Yi Xue Ban = Journal of Central South University. Medical Sciences, 45(5), 536-541. https://doi.org/10.11817/j.issn.1672-7347.2020.200384
Mo J, et al. Predictive Role of Clinical Features in Patients With Coronavirus Disease 2019 for Severe Disease. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2020 May 28;45(5):536-541. PubMed PMID: 32879103.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictive role of clinical features in patients with coronavirus disease 2019 for severe disease. AU - Mo,Juan, AU - Liu,Jiyang, AU - Wu,Songbai, AU - LÜ,Ailian, AU - Xiao,Le, AU - Chen,Dong, AU - Zhou,Yun, AU - Liang,Lu, AU - Liu,Xiaofang, AU - Zhao,Jinjin, PY - 2020/9/4/entrez PY - 2020/9/4/pubmed PY - 2020/9/9/medline KW - clinical feature KW - coronavirus disease 2019 KW - pneumonia KW - prediction KW - severity SP - 536 EP - 541 JF - Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences JO - Zhong Nan Da Xue Xue Bao Yi Xue Ban VL - 45 IS - 5 N2 - OBJECTIVES: Since the outbreak of coronavirus disease 2019 (COVID-19), it has spread rapidly in China and many other countries. The rapid increase in the number of cases has caused widespread panic among people and has become the main public health problem in the world. Severe patients often have difficult breathing and/or hypoxemia after 1 week of onset. A few critically ill patients may not only rapidly develop into acute respiratory distress syndrome, but also may cause coagulopathy, as well as multiple organs failure (such as heart, liver and kidney) or even death. This article is to analyze the predictive role of clinical features in patients with COVID-19 for severe disease, so as to help doctor monitor the severity-related features, restrain the disease progress, and provide a reference for improvement of medical treatment. METHODS: The clinical data of 208 patients with COVID-19 who were isolated and treated in Changsha Public Health Treatment Center from January 17, 2020 to March 14, 2020 were collected. All patients were the mild and ordinary adult patients on admission, including 105 males and 103 females from 19 to 84 (median age 44) years old. According to the "Program for the diagnosis and treatment of novel coronavirus (COVID-19) infected pneumonia (Trial version 7)" issued by the General Office of National Health Committee and Office of State Administration of Traditional Chinese Medicine as the diagnostic and typing criteria. According to progression from mild to severe disease during hospitalization, the patients were divided into a mild group (n=183) and a severe transformation group (n=25). The clinical features such as age, underlying disease, blood routine, coagulation function, blood biochemistry, oxygenation index, and so on were analyzed. Among them, laboratory tests included white blood cell (WBC), lymphocytes (LYM), neutrophil (NEU), hemoglobin (Hb), platelet (PLT), prothrombin time (PT), plasma fibrinogen (Fib), activated partial prothrombin time (APTT), thrombin time (TT), D-dimer, total bilirubin (TBIL), albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (Cr), creatine kinase (CK), creatine kinase isoenzyme-MB (CK-MB), lactate dehydrogenase (LDH), C-reactive protein (CRP), and oxygen partial pressure in arterial blood. Partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO2/FiO2) was calculated. The variables with statistical significance were analyzed by logistic regression analysis. RESULTS: Patients in the severe transformation group had more combined underlying diseases than those in the mild group (P<0.05). From the perspective of disease distribution, patients in the severe transformation group had more combined hypertension (P<0.05). In the severe transformation group, PT was significantly longer, the levels of Fib, ALT, AST, CK, LDH, and CRP were significantly higher than those in the mild group (P<0.05 or P<0.001), while LYM, ALB, and PaO2/FiO2 were significantly lower than those in the mild group (P<0.05 or P<0.001). Logistic regression analysis was performed on clinical features with statistically significant differences. Combined with hypertension, LYM, PT, Fib, ALB, ALT, AST, CK, LDH, and CRP as independent variables, and having severe disease or not was the dependent variable. The results show that combined hypertension, decreased LYM, longer PT, and increased CK level were independent risk factors that affected the severity of COVID-19 (P<0.05). CONCLUSIONS: The patients with mild COVID-19 who are apt to develop severe diseases may be related to combined hypertension, decreased LYM, and longer PT, and increased CK level. For the mild patients with these clinical features, early intervention may effectively prevent the progression to severe diseases. SN - 1672-7347 UR - https://www.unboundmedicine.com/medline/citation/32879103/Predictive_role_of_clinical_features_in_patients_with_coronavirus_disease_2019_for_severe_disease_ L2 - http://xbyxb.csu.edu.cn/xbwk/fileup/PDF/202005536.pdf DB - PRIME DP - Unbound Medicine ER -