Abstract
ObjectiveTo analyze the epidemiological history, clinical symptoms, laboratory testing parameters of patients with mild and severe COVID-19 infection, and provide a reference for timely judgment of changes in the patients’ conditions and the formulation of epidemic prevention and control strategies.MethodsA retrospective study was conducted in this research, a total of 90 patients with COVID-19 infection who received treatment from January 21 to March 31, 2020 in the Ninth People’s Hospital of Dongguan City were selected as study subject. We analyzed the clinical characteristics of laboratory-confirmed patients with COVID-19, used the oversampling method (SMOTE) to solve the imbalance of categories, and established Lasso-logistic regression and random forest models.ResultsAmong the 90 confirmed COVID-19 cases, 79 were mild and 11 were severe. The average age of the patients was 36.1 years old, including 49 males and 41 females. The average age of severe patients is significantly older than that of mild patients (53.2 years old vs 33.7 years old). The average time from illness onset to hospital admission was 4.1 days and the average actual hospital stay was 18.7 days, both of these time actors were longer for severe patients than for mild patients. Forty-eight of the 90 patients (53.3%) had family cluster infections, which was similar among mild and severe patients. Comorbidities of underlying diseases were more common in severe patients, including hypertension, diabetes and other diseases. The most common symptom was cough [45 (50%)], followed by fever [43 (47.8%)], headache [7 (7.8%)], vomiting [3 (3.3%)], diarrhea [3 (3.3%)], and dyspnea [1 (1.1%)]. The laboratory findings of patients also included leukopenia [13(14.4%)] and lymphopenia (17.8%). Severe patients had a low level of creatine kinase (median 40.9) and a high level of D-dimer. The median NLR of severe patients was 2.82, which was higher than that of mild patients. Logistic regression showed that age, phosphocreatine kinase, procalcitonin, the lymphocyte count of the patient on admission, cough, fatigue, and pharynx dryness were independent predictors of COVID-19 severity. The classification of random forest was predicted and the importance of each variable was displayed. The variable importance of random forest indicates that age, D-dimer, NLR (neutrophil to lymphocyte ratio) and other top-ranked variables are risk factors.ConclusionThe clinical symptoms of COVID-19 patients are non-specific and complicated. Age and the time from onset to admission are important factors that determine the severity of the patient’s condition. Patients with mild illness should be closely monitored to identify those who may become severe. Variables such as age and creatine phosphate kinase selected by logistic regression can be used as important indicators to assess the disease severity of COVID-19 patients. The importance of variables in the random forest further complements the variable feature information.
Highlights
Coronavirus disease 2019 (COVID-19) is an ongoing pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Zhu et al, 2020)
Other symptoms included dyspnea [1 (1.1%)], diarrhea [3 (3.3%)], emesis [3 (3.3%)], headache [7 (7.8%)]. (Table 1; Figure 1). This suggested that elderly patients with delayed diagnosis and admission for treatment were more likely to develop severe illnesses after being infected with COVID-19
We need to be wary of the superposition of influenza and COVID-19 in the winter
Summary
Coronavirus disease 2019 (COVID-19) is an ongoing pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Zhu et al, 2020). The virus was isolated and the whole genome sequenced in a short time, and was further found to have high homology with SARS coronavirus and bat coronavirus sequences through phylogenetic analysis (Lu et al, 2020; Wu et al, 2020; Zhou et al, 2020). The emergence of SARS-CoV-2 caused a profound change all over the world. Most severe cases develop dyspnea after one week, and rapidly progress to acute respiratory distress syndrome, septic shock, coagulation dysfunction, and metabolic acidosis that are difficult to correct (Guan et al, 2020; Huang et al, 2020a)
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