Abstract
Approximately 15–20% of COVID-19 patients will develop severe pneumonia, and about 10% of these will die if not properly managed. Earlier discrimination of potentially severe patients basing on routine clinical and laboratory changes and commencement of prophylactical management will not only save lives but also mitigate the otherwise overwhelming healthcare burden. In this retrospective investigation, the clinical and laboratory features were collected from 125 COVID-19 patients who were classified into mild (93 cases) or severe (32 cases) groups according to their clinical outcomes after 3–7 days post-admission. The subsequent analysis with single-factor and multivariate logistic regression methods indicated that 17 factors on admission differed significantly between mild and severe groups but that only comorbidity with underlying diseases, increased respiratory rate (>24/min), elevated C-reactive protein (CRP >10 mg/L), and lactate dehydrogenase (LDH >250 U/L) were independently associated with the later disease development. Finally, we evaluated their prognostic values with receiver operating characteristic curve (ROC) analysis and found that the above four factors could not confidently predict the occurrence of severe pneumonia individually, though a combination of fast respiratory rate and elevated LDH significantly increased the predictive confidence (AUC = 0.944, sensitivity = 0.941, and specificity = 0.902). A combination consisting of three or four factors could further increase the prognostic value. Additionally, measurable serum viral RNA post-admission independently predicted the severe illness occurrence. In conclusion, a combination of general clinical characteristics and laboratory tests could provide a highly confident prognostic value for identifying potentially severe COVID-19 pneumonia patients.
Highlights
The novel coronavirus (SARS-CoV-2) has seemed to sweep across the globe ever since its first successful jump from bat to human being through a still unknown intermediate(s) in approximately late Nov 2019; it still shows a tendency toward significant surges in incidence worldwide (1–3)
With our successful experience of treating COVID-19 patients, we retrospectively found that routine clinical features could reliably predict severe pneumonia development and could provide quick and affordable references for physicians to save patients with otherwise fatal COVID-19 using their limited medical resource
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors
Summary
The novel coronavirus (SARS-CoV-2) has seemed to sweep across the globe ever since its first successful jump from bat to human being through a still unknown intermediate(s) in approximately late Nov 2019; it still shows a tendency toward significant surges in incidence worldwide (1–3). COVID-19 pneumonia within 3 months, which was about 15 times that of the total SARS cases (8,000 in 7 months) (4). The surging increase in COVID-19 patients within a short time window will severely impact the limited medical resources, including physicians, nurses, protective suits, masks, and goggles. Data from the Chinese mainland showed that the majority of total infected patients will recover under simple supervision management, such as quarantine in a compartment hospital isolation ward, but that the overall case fatality rate was 2.3% (5). The clinical presentation of COVID-19 patients differs substantially, and this can include asymptomatic infection, mild upper respiratory tract illness, and severe viral pneumonia (2, 6–8). The most crucial issue is to identify these patients and prioritize their treatment strategy by applying prophylactic medical treatment and management before they progress to the severe stage
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