Clinical course and risk factors of disease deterioration in critically ill patients with COVID-19

Link to article at PubMed

Hum Gene Ther. 2021 Jan 7. doi: 10.1089/hum.2020.255. Online ahead of print.


BACKGROUND: The severe acute respiratory coronavirus 2 (SARS-CoV-2) began in December 2019, and rapidly spread to other provinces in China as well as other countries.

METHODS: In this study, 262 patients diagnosed of moderate to severe SARS-CoV-2 pneumonia in Wuhan, China, were analyzed. Data were compared between survivors and non-survivors.

RESULTS: Of all the 262 patients, 23 (8.8%) patients died and 239 (91.2%) discharged. The median age was 63.5 years old and 46.9% patients were male. The main complains were fever (83.6%), cough (63.4%), and fatigue (49.2%) in the surviving group, while there were more complains of dyspnea (39.1%) and short of breath (56.5%) in the non-surviving group. The main comorbidities were hypertension (35.5%), diabetes mellitus (16.4%), and coronary artery disease (9.9%). The morbidity is higher in patients with elder age and more comorbidites. Patients were mainly treated by high flow nasal cannula (93.9%), while the non-surviving group received more invasive mechanical ventilation (39.1%). Abigail (80.9%), ribavirin (36.6%), oseltamivir (38.9%), interferon (16.4%), and ganciclovir (14.5%) were used for the anti-viral treatment. In the non-surviving group, the number of white blood cells (WBC) was significantly increased and lymphocytes were decreased, and the lymphopenia was more common. The levels of aspartate transaminase (AST), brain natriuretic peptide (BNP), creatine kinase isoenzyme MB (CK-MB), lactate dehydrogenase (LDH), and C-reactive protein (CRP) were also significantly increased in the non-surviving group. The adjusted hazard rations (HR) for association of known variables for all-cause mortality due to the coronavirus disease 2019 (COVID-19) were 2.467 (95%CI, 1.007-6.044; P=0.048) for short of breath, 1.025 (95%CI, 1.001-1.049; P=0.042) for AST.

CONCLUSIONS: Elderly patients with more comorbidities and complaints of dyspnea and short of breath had increased risk of death. Patients with lymphopenia, and high level of WBC, AST, BNP, CK-MB, LDH, and CRP may be more likely to deteriorate.

PMID:33412996 | DOI:10.1089/hum.2020.255

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