Abstract
BackgroundInformation regarding characteristics and risk factors of COVID-19 amongst middle-aged (40–59 years) patients without comorbidities is scarce.MethodsWe therefore conducted this multicentre retrospective study and collected data of middle-aged COVID-19 patients without comorbidities at admission from three designated hospitals in China.ResultsAmong 119 middle-aged patients without comorbidities, 18 (15.1%) developed into severe illness and 5 (3.9%) died in hospital. ARDS (26, 21.8%) and elevated D-dimer (36, 31.3%) were the most common complications, while other organ complications were relatively rare. Multivariable regression showed increasing odds of severe illness associated with neutrophil to lymphocyte ratio (NLR, OR, 11.238; 95% CI 1.110–1.382; p < 0.001) and D-dimer greater than 1 µg/ml (OR, 16.079; 95% CI 3.162–81.775; p = 0.001) on admission. The AUCs for the NLR, D-dimer greater than 1 µg/ml and combined NLR and D-dimer index were 0.862 (95% CI, 0.751–0.973), 0.800 (95% CI 0.684–0.915) and 0.916 (95% CI, 0.855–0.977), respectively. SOFA yielded an AUC of 0.750 (95% CI 0.602–0.987). There was significant difference in the AUC between SOFA and combined index (z = 2.574, p = 0.010).ConclusionsMore attention should be paid to the monitoring and early treatment of respiratory and coagulation abnormalities in middle-aged COVID-19 patients without comorbidities. In addition, the combined NLR and D-dimer higher than 1 μg/ml index might be a potential and reliable predictor for the incidence of severe illness in this specific patient with COVID-19, which could guide clinicians on early classification and management of patients, thereby relieving the shortage of medical resource. However, it is warranted to validate the reliability of the predictor in larger sample COVID-19 patients.
Highlights
Information regarding characteristics and risk factors of COVID-19 amongst middle-aged (40–59 years) patients without comorbidities is scarce
Numerous studies have shown that the hypercoagulable state induced by COVID-19 was associated with poor outcomes of patients [2, 37, 38]. Consistent with these recent studies, we found in this study that D-dimer higher than 1 μg/ml on admission was as much as 16.079 times more likely to develop severe COVID-19 than those with D-dimer lower than 1 μg/ml
We found in our study that the combined NLR and D-dimer index was a good prognostic biomarker for the development of severe COVID-19, even better than Sequential Organ Failure Assessment (SOFA) score
Summary
Information regarding characteristics and risk factors of COVID-19 amongst middle-aged (40–59 years) patients without comorbidities is scarce. Accumulating evidences have shown the risk factors for severe illness and death in COVID-19. Older age has been identified to be associated with an increased risk of death in COVID19, as well as comorbidities [2,3,4,5,6]. The presence of these comorbidities might have increased the risk of mortality independent of SARS-CoV-2 infection. Risk factors and predictors for severe illness in this specific population have not been well described
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