Early risk markers for severe clinical course and fatal outcome in German patients with COVID-19.

Paul Balfanz,Robert Stöhr,Michael Kleines,Christian Cornelissen,Dennis Häckl,Nikolaus Marx,Dirk Müller-Wieland,Johannes Bickenbach,Bojan Hartmann,Tobias Müller,Gernot Marx,Ayham Daher,Michael Dreher,Alexander Kersten,Nils Kossack,Wisit Cheungpasitporn

doi:10.1371/journal.pone.0246182

Abstract

BackgroundSome patients with Corona Virus Disease 2019 (COVID-19) develop a severe clinical course with acute respiratory distress syndrome (ARDS) and fatal outcome. Clinical manifestations and biomarkers in early stages of disease with relevant predictive impact for outcomes remain largely unexplored. We aimed to identify parameters which are significantly different between subgroups.Design125 patients with COVID-19 were analysed. Patients with ARDS (N = 59) or non-ARDS (N = 66) were compared, as well as fatal outcome versus survival in the two groups.Key resultsARDS and non-ARDS patients did not differ with respect to comorbidities or medication on developing a fatal outcome versus survival. Body mass index was higher in patients with ARDS versus non-ARDS (p = 0.01), but not different within the groups in survivors versus non-survivors. Interleukin-6 levels on admission were higher in patients with ARDS compared to non-ARDS as well as in patients with fatal outcome versus survivors, whereas lymphocyte levels were lower in the different subgroups (all p<0.05). There was a highly significant 3.5-fold difference in fever load in non-survivors compared to survivors (p<0.0001). Extrapulmonary viral spread was detected more often in patients with fatal outcome compared to survivors (P = 0.01). Further the detection of SARS-CoV-2 in serum showed a significantly more severe course and an increased risk of death (both p<0.05).ConclusionsWe have identified early risk markers for a severe clinical course, like ARDS or fatal outcome. This data might help develop a strategy to address new therapeutic options early in patients with COVID-19 and at high risk for fatal outcome.

Highlights

A new type of Coronavirus, SARS-CoV (Severe Acute Respiratory Syndrome Corona Virus)-2, led to a worldwide pandemic outbreak of an infectious disease, called COVID-19 (Corona Virus Disease 2019)
We have identified early risk markers for a severe clinical course, like acute respiratory distress syndrome (ARDS) or fatal outcome
A decrease in kidney function and need for mechanical ventilation have been described as prognostic factors for fatal outcome in 5,700 patients hospitalized with COVID-19 in the New York City area [5]

Summary

Introduction

A new type of Coronavirus, SARS-CoV (Severe Acute Respiratory Syndrome Corona Virus)-2, led to a worldwide pandemic outbreak of an infectious disease, called COVID-19 (Corona Virus Disease 2019). The clinical manifestation of this disease is very broad and variable, ranging from asymptomatic carriers to symptoms of acute infection of the upper airways and occasionally severe acute respiratory insufficiency and death [1,2,3]. Beside possible regional differences in health care, an age-related increase in mortality has consistently been observed. Mechanical ventilation and higher PEEP level requirements, were associated with increased mortality in 1,591 COVID-19 patients admitted to the ICU departments in the Lombardy Region in Italy [6]. Some patients with Corona Virus Disease 2019 (COVID-19) develop a severe clinical course with acute respiratory distress syndrome (ARDS) and fatal outcome. We aimed to identify parameters which are significantly different between subgroups

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