Abstract
BackgroundOlder age and elevated d-dimer are reported risk factors for coronavirus disease 2019 (COVID-19). However, whether early radiographic change is a predictor of fatality remains unknown.MethodsWe retrospectively reviewed records of all laboratory-confirmed patients admitted to a quarantine unit at Tongji Hospital, a large regional hospital in Wuhan, China, between January 31 and March 5, 2020. Confirmed cases were defined by positive RT-PCR detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in throat-swab specimens. Chest CT images were reviewed independently by two radiologists. The Tongji Hospital ethics committee approved this study.ResultsA total of 102 patients were confirmed to have SARS-CoV-2 infection. As of March 25, 85 confirmed patients were discharged, 15 died, and 2 remained hospitalized. When compared with survivors, non-survivors were older (median age, 69 [interquartile range, 58–77] vs. 55 [44–66], p = 0.003), and more likely to have decreased lymphocyte count (0.5 vs. 0.9 × 109/L, p = 0.006), elevated lactate dehydrogenase (LDH) (569.0 vs. 272.0 U/L, p < 0.001), elevated d-dimer (> 1 μg/mL, 86% vs. 37%, p = 0.002) on admission. Older age and elevated LDH were independent risk factors for fatality in a multivariate regression model included the above variables. In a subset of patients with CT images within the first week, higher total severity score, and more involved lung lobes (5 involved lobes) in CT images within the first week were significantly associated with fatality. Moreover, in this subset of patients, higher total severity score was the only independent risk factor in a multivariate analysis incorporating the above mentioned variables.ConclusionsOlder age, elevated LDH on admission, and higher severity score of CT images within the first week are potential predictors of fatality in adults with COVID-19. These predictors may help clinicians identify patients with a poor prognosis at an early stage.
Highlights
Older age and elevated d-dimer are reported risk factors for coronavirus disease 2019 (COVID-19)
We hypothesized that the extent of the lung lesions in early CT images after symptom onset is a potential predictor of fatality of COVID-19
In a multivariate regression model including older age, lymphocytopenia, elevated lactate dehydrogenase (LDH), and elevated ddimer, older age and elevated LDH were independent risk factors for fatality (Supplementary Table 3)
Summary
Older age and elevated d-dimer are reported risk factors for coronavirus disease 2019 (COVID-19). SARS-CoV-2 shares similarity with the severe acute respiratory syndrome coronavirus (SARS-CoV) in the disease dynamics, the transmission route, and the cell entry receptors angiotensin-converting enzyme 2 (ACE2) [5,6,7]. These two viruses are highly homologic to SARS-like coronaviruses isolated from bats and the genomes of these two virus have 86% identity [5]. We hypothesized that the extent of the lung lesions in early CT images after symptom onset is a potential predictor of fatality of COVID-19
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
