Clinical Characteristics of Patients With Progressive and Non-progressive Coronavirus Disease 2019: Evidence From 365 Hospitalised Patients in Honghu and Nanchang, China.

Yanpei Zhang,Shan-Shan Liu,Lu-Shan Xiao,Chenyi Hu,Wen-Feng Zhang,Meng-Ying Shen,Qing-Can Sun,Mengchun Gong,Hong Zhu,Han-Yi Zeng,Pu Li,Yu-Lin He,Hongbo Zhu,Li Liu,Wan-Li Zhang

doi:10.3389/fmed.2020.556818

Abstract

Background: Coronavirus disease (COVID-19) has swept around the globe and led to a worldwide catastrophe. Studies examining the disease progression of patients with non-severe disease on admission are scarce but of profound importance in the early identification of patients at a high risk of deterioration.Objectives: To elucidate the differences in clinical characteristics between patients with progressive and non-progressive COVID-19 and to determine the risk factors for disease progression.Study design: Clinical data of 365 patients with non-severe COVID-19 from 1 January 2020 to 18 March 2020 were retrospectively collected. Patients were stratified into progressive and non-progressive disease groups. Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors for disease progression.Results: Compared with patients with non-progressive disease, those who progressed to severe COVID-19 were older and had significantly decreased lymphocyte and eosinophil counts; increased neutrophil and platelet counts; lower albumin levels; higher levels of lactate dehydrogenase, C-reactive protein (CRP), creatinine, creatinine kinase, and urea nitrogen; and longer prothrombin times. Hypertension, fever, fatigue, anorexia, bacterial coinfection, bilateral patchy shadowing, antibiotic and corticosteroid administration, and oxygen support had a significantly higher incidence among patients with progressive disease. A significantly longer duration of hospital stay was also observed in patients with progressive disease. Bilateral patchy shadowing (OR = 4.82, 95% CI: 1.33–17.50; P = 0.017) and elevated levels of creatinine (OR =6.24, 95% CI: 1.42–27.40; P = 0.015), and CRP (OR = 7.28, 95% CI: 2.56–20.74; P < 0.001) were independent predictors for disease progression.Conclusion: The clinical characteristics of patients with progressive and non-progressive COVID-19 were significantly different. Bilateral patchy shadowing and increased levels of creatinine, and CRP were independent predictors of disease progression.

Highlights

Coronavirus disease (COVID-19) has swept around the world, with more than 2.9 million confirmed cases resulting in 204,000 deaths as of 27 April 2020
Patients were diagnosed according to the guidelines of the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 7) [13]
By 18 March 2020, a total of 690 patients with confirmed COVID-19 were recruited, of whom 365 patients from the People’s Hospital of Honghu and the First Affiliated Hospital of Nanchang University with complete medical records and who were diagnosed with mild or moderate COVID-19 on admission were included in this study

Summary

Introduction

Coronavirus disease (COVID-19) has swept around the world, with more than 2.9 million confirmed cases resulting in 204,000 deaths as of 27 April 2020. If the treatment of severely ill patients lies “downstream” to the control of COVID19, it is the “upstream” strategy to identify patients who are at a risk of progressing to severe disease. Identification of these patients coupled with early intervention could save lives and alleviate the burden on the health care system. Studies examining the disease progression of patients with non-severe disease on admission are scarce but of profound importance in the early identification of patients at a high risk of deterioration

Objectives

Methods

Results

Conclusion