Abstract
BackgroundDue to the latent onset of novel coronavirus disease 2019 (COVID-19), it is important to identify patients with increased probabilities for disease progression early in order to implement timely medical strategies. This study aimed to identify the factors associated with increased COVID-19 severity and evaluate the current antiviral drugs, especially in severe patients.MethodsThis was a retrospective observational study performed at the No. 7 Hospital of Wuhan (Wuhan, China) with hospitalized patients confirmed with COVID-19 from January 11 to March 13, 2020. Multivariable logistic regression analysis was used to identify the associated factors of severe COVID. Treatments of antivirus drugs were collected and evaluated.ResultsOf the 550 patients, 292 (53.1%) were female and 277 (50.4%) were > 60 years old. The most common symptom was fever (n = 372, 67.7%), followed by dry cough (n = 257, 46.7%), and dyspnea (n = 237, 43.1%), and fatigue (n = 224, 40.7%). Among the severe patients, 20.2% required invasive ventilator support and 18.0% required non-invasive ventilator. The identified risk factors for severe cases were: age ≥ 60 years (odds ratio (OR) =3.02, 95% confidence interval (CI): 1.13–8.08, P = 0.028), D-dimer > 0.243 μg/ml (OR = 2.734, 95%CI: 1.012–7.387, P = 0.047), and low oxygenation index (OR = 0.984, 95%CI: 0.980–0.989, P < 0.001). In severe cases, the benefits (relief of clinical symptoms, clinical outcome, and discharge rate) of arbidol alone was 73.3%, which was better than ribavirin (7/17, 41.2%, P = 0.029).ConclusionsAge > 60 years, D-dimer > 0.243 μg/ml, and lower oxygenation index were associated with severe COVID-19. Arbidol might provide more clinical benefits in treating patients with severe COVID-19 compared with ribavirin.
Highlights
Due to the latent onset of novel coronavirus disease 2019 (COVID-19), it is important to identify patients with increased probabilities for disease progression early in order to implement timely medical strategies
The results indicated that 23.7% of the patients (119/502) had leukopenia, which was more frequently seen in severe patients (P < 0.001)
The results suggest that age ≥ 60 years, D-dimer > 0.243 μg/ml, and lower oxygenation index were associated with severe COVID-19
Summary
Due to the latent onset of novel coronavirus disease 2019 (COVID-19), it is important to identify patients with increased probabilities for disease progression early in order to implement timely medical strategies. This study aimed to identify the factors associated with increased COVID-19 severity and evaluate the current antiviral drugs, especially in severe patients. Many patients are asymptomatic, most of those with symptoms have a good prognosis, and about 20% of symptomatic patients may experience disease progression and reach a critical condition [10]. Such patients will quickly progress to acute respiratory distress syndrome (ARDS), respiratory failure, multiple organ failure (MODS), or even death [1,2,3,4,5]. Suspected risk factors for severe COVID-19 include age > 65 years, residence in long-term care facilities, and underlying conditions such as chronic lung disease, a serious heart condition, severe obesity, diabetes, chronic kidney disease, liver disease, and immunocompromising conditions [11]
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