Abstract
ObjectivesWe aimed to identify high-risk factors for disease progression and fatality for coronavirus disease 2019 (COVID-19) patients.MethodsWe enrolled 2433 COVID-19 patients and used LASSO regression and multivariable cause-specific Cox proportional hazard models to identify the risk factors for disease progression and fatality.ResultsThe median time for progression from mild-to-moderate, moderate-to-severe, severe-to-critical, and critical-to-death were 3.0 (interquartile range: 1.8–5.5), 3.0 (1.0–7.0), 3.0 (1.0–8.0), and 6.5 (4.0–16.3) days, respectively. Among 1,758 mild or moderate patients at admission, 474 (27.0%) progressed to a severe or critical stage. Age above 60 years, elevated levels of blood glucose, respiratory rate, fever, chest tightness, c-reaction protein, lactate dehydrogenase, direct bilirubin, and low albumin and lymphocyte count were significant risk factors for progression. Of 675 severe or critical patients at admission, 41 (6.1%) died. Age above 74 years, elevated levels of blood glucose, fibrinogen and creatine kinase-MB, and low plateleta count were significant risk factors for fatality. Patients with elevated blood glucose level were 58% more likely to progress and 3.22 times more likely to die of COVID-19.ConclusionsOlder age, elevated glucose level, and clinical indicators related to systemic inflammatory responses and multiple organ failures, predict both the disease progression and the fatality of COVID-19 patients.
Highlights
In December 2019, an outbreak of novel coronavirus pneumonia (COVID-19) caused by SARS-CoV-2 was reported in Wuhan city, China
Our study provides unique progression and outcome data on a cohort of 2,433 COVID-19 patients admitted to Huoshenshan hospital, a hospital designed and built solely to provide care to patients with COVID-19
The risk factors we identified for death and disease progression are similar to previous studies with older age, poor systematic immune and inflammatory responses, and multiple organ damages [14,15,16, 18, 24,25,26,27,28,29,30,31,32]
Summary
In December 2019, an outbreak of novel coronavirus pneumonia (COVID-19) caused by SARS-CoV-2 was reported in Wuhan city, China. Wang et al BMC Pulm Med (2021) 21:64 people infected with SARS-CoV-2, inspired by the prefab hospital erected in Beijing during the 2003 SARS outbreak This emergency hospital, Huoshenshan hospital, was constructed within ten days and the first hospital specialized in treating patients with COVID-19 in the world [7,8,9]. A systematic review and meta-analysis examine risk factors associated with adverse clinical outcomes in patients with COVID-19 [19]. Most of these studies were limited by their relatively small sample sizes, and many patients had not progressed to the study endpoints by the time the study was conducted, leading to bias and unreliable prediction for disease progression and fatality. Some analyses of risk factors were not adjusted for potential confounding effects, leading to false associations
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