Abstract
BackgroundThe challenge in treating severe COVID-19 in the absence of targeted medication is enforcing physicians to search carefully for clinical predictors of severity.AimTo define the profile of patients at risk of severe COVID-19 and to assess for certain predictors.MethodsConfirmed COVID-19 cases were classified into the following: group A: mild/moderate cases and group B: severe/critical cases according to the selected criteria. History, radiological assessment, complete blood count, lactate dehydrogenase (LDH), myocardial enzymes, serum ferritin, and D dimer were assessed. Patients were followed for the need of ICU and mechanical ventilation. Duration till conversion, length of stay, and mortality were recorded.ResultsA total of 202 patients were analyzed. Group B had higher age (53.2 ± 12.6 vs 40.3 ± 10.3, P < 0.001), more prevalence of DM (60.61% vs 16.57% P < 0.001), hypertension (51.52% vs 20.12%, P < 0.001), ischemic heart (27.27% vs 3.55%, P < 0.001), bronchial asthma (36.36% vs 3.55%, P < 0.001), COPD (9.09% vs 1.18%, P = 0.03), higher mean platelet volume (MPV) (12.76 ± 7.13 vs 10.51 ± 7.78 (fL), P < 0.001), higher serum ferritin (954 ± 138 vs 447 ± 166 ng/ml, P < 0.001), higher LDH (604 ± 220 vs 384 ± 183 U/L, P-value < 0.001), higher creatine phosphokinase (24.27 ± 5.82 vs 16.4 ± 4.87 IU/L, P < 0.001), and higher mortality (30.3% vs 0.6%, P < 0.001). Multivariate regression of predictors of severity identified three predictors; age, MPV, serum ferritin, and IHD.ConclusionsThe current study places of interest the characteristic host-related features of severe COVID-19 and draws attention to potential predictors.
Highlights
An outbreak of pneumonia of unidentified etiology was discovered in Wuhan city, China, in December 2019; the scientist succeeded in early January 2020 to isolate a novel virus which seems to belong to the genus Betacoronavirus, Coronaviridae family
Group B had higher age (53.2 ± 12.6 vs 40.3 ± 10.3, P < 0.001), more prevalence of DM (60.61% vs 16.57% P < 0.001), hypertension (51.52% vs 20.12%, P < 0.001), ischemic heart (27.27% vs 3.55%, P < 0.001), bronchial asthma (36.36% vs 3.55%, P < 0.001), COPD (9.09% vs 1.18%, P = 0.03), higher mean platelet volume (MPV) (12.76 ± 7.13 vs 10.51 ± 7.78, P < 0.001), higher serum ferritin (954 ± 138 vs 447 ± 166 ng/ ml, P < 0.001), higher lactate dehydrogenase (LDH) (604 ± 220 vs 384 ± 183 U/L, P-value < 0.001), higher creatine phosphokinase (24.27 ± 5.82 vs 16.4 ± 4.87 IU/L, P < 0.001), and higher mortality (30.3% vs 0.6%, P < 0.001)
The accuracy of MPV and ferritin were assessed using receiver operating curve analysis; assuming that the area under the ROC curve of 0.9 for this study was significant with margin of type I error 0.05 and type II error 0.1, the sample size calculated with a minimum total number of 70 and the minimum number of cases with severe COVID-19 was 35 using SigmaPlot software 12.5.0.38 for Windows
Summary
An outbreak of pneumonia of unidentified etiology was discovered in Wuhan city, China, in December 2019; the scientist succeeded in early January 2020 to isolate a novel virus which seems to belong to the genus Betacoronavirus, Coronaviridae family They gave them a name, SARS-CoV-2 [1,2,3,4]. The challenge in treating severe and critically ill cases with COVID-19 especially with the absence of specific and targeted medication enforcing the physician to search carefully for clinical characteristics of severe COVID19 pneumonia and subsequent predictors in order to start the optimum standard of care as early as possible. The challenge in treating severe COVID-19 in the absence of targeted medication is enforcing physicians to search carefully for clinical predictors of severity
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