Abstract
Corona Virus Disease 2019 (COVID-19) has presented an unprecedented challenge to the health-care system across the world. The current study aims to identify the determinants of illness severity of COVID-19 based on ordinal responses. A retrospective cohort of COVID-19 patients from four hospitals in three provinces in China was established, and 598 patients were included from 1 January to 8 March 2020, and divided into moderate, severe and critical illness group. Relative variables were retrieved from electronic medical records. The univariate and multivariate ordinal logistic regression models were fitted to identify the independent predictors of illness severity. The cohort included 400 (66.89%) moderate cases, 85 (14.21%) severe and 113 (18.90%) critical cases, of whom 79 died during hospitalisation as of 28 April. Patients in the age group of 70+ years (OR = 3.419, 95% CI: 1.596-7.323), age of 40-69 years (OR = 1.586, 95% CI: 0.824-3.053), hypertension (OR = 3.372, 95% CI: 2.185-5.202), ALT >50 μ/l (OR = 3.304, 95% CI: 2.107-5.180), cTnI >0.04 ng/ml (OR = 7.464, 95% CI: 4.292-12.980), myohaemoglobin>48.8 ng/ml (OR = 2.214, 95% CI: 1.42-3.453) had greater risk of developing worse severity of illness. The interval between illness onset and diagnosis (OR = 1.056, 95% CI: 1.012-1.101) and interval between illness onset and admission (OR = 1.048, 95% CI: 1.009-1.087) were independent significant predictors of illness severity. Patients of critical illness suffered from inferior survival, as compared with patients in the severe group (HR = 14.309, 95% CI: 5.585-36.659) and in the moderate group (HR = 41.021, 95% CI: 17.588-95.678). Our findings highlight that the identified determinants may help to predict the risk of developing more severe illness among COVID-19 patients and contribute to optimising arrangement of health resources.
Highlights
The pandemic of the novel corona virus disease 2019 (COVID-19), which originally emerged in Wuhan, China in December 2019 has spread around the world [1, 2]
Accumulated evidences have indicated that older age, male, smoking, comorbidity, neutrophilia, coagulopathy, elevated D-dimer level and organ dysfunction were associated with increased risk of death from COVID-19 [5,6,7,8,9,10]
As of 28 April 2020, data from 598 COVID-19 cases admitted to these four hospitals, including 400 (66.89%) moderate cases, 85 (14.21%) severe cases and 113 (18.90%) critical cases, had been collected to be incorporated into this study, of whom 79 cases had died during hospitalisation, with an average mortality of 13.21%, and 457 cases had recovered and been discharged
Summary
The pandemic of the novel corona virus disease 2019 (COVID-19), which originally emerged in Wuhan, China in December 2019 has spread around the world [1, 2]. The clinical spectrum of COVID-19 appears to be wide, ranging from asymptomatic infection to mildly, severely, critically ill cases. Most confirmed patients (81%) were classified as mild or moderate, 14% were severe and 5% were critical according to the largest investigation of 72 314 cases to date [5]. Investigations of determinants of severity of COVID-19 are scarce. Liang et al developed a clinical risk score to predict the occurrence of critical COVID-19 based on severe or non-severe [11]. No previous studies have been conducted to investigate the risk factors of severity of COVID-19 based on ordinal response, namely moderate, severe and critical illness. The estimation of risk factors of disease severity is not very robust
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