Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease

By Wei Liu, Zha Tao, W. Lei, Yu Ming-li, Liu Kui, Zhou Ling, Wei-Bing Shuang, D. Yan, Liu Jing, Hui-guo Liu and 2 more. Chinese Medical Journal, 2020

968 citations recorded by the source corpus.

Abstract Background Since early December 2019, the 2019 novel coronavirus disease (COVID-19) has caused pneumonia epidemic in Wuhan, Hubei province of China. This study aimed to investigate the factors affecting the progression of pneumonia in COVID-19 patients. Associated results will be used to evaluate the prognosis and to find the optimal treatment regimens for COVID-19 pneumonia. Methods Patients tested positive for the COVID-19 based on nucleic acid detection were included in this study. Patients were admitted to 3 tertiary hospitals in Wuhan between December 30, 2019, and January 15, 2020. Individual data, laboratory indices, imaging characteristics, and clinical data were collected, and statistical analysis was performed. Based on clinical typing results, the patients were divided into a progression group or an improvement/stabilization group. Continuous variables were analyzed using independent samples t-test or Mann-Whitney U test. Categorical variables were analyzed using Chi-squared test or Fisher's exact test. Logistic regression analysis was performed to explore the risk factors for disease progression. Results Seventy-eight patients with COVID-19-induced pneumonia met the inclusion criteria and were included in this study. Efficacy evaluation at 2 weeks after hospitalization indicated that 11 patients (14.1%) had deteriorated, and 67 patients (85.9%) had improved/stabilized. The patients in the progression group were significantly older than those in the disease improvement/stabilization group (66 [51, 70] vs. 37 [32, 41] years, U = 4.932, P = 0.001). The progression group had a significantly higher proportion of patients with a history of smoking than the improvement/stabilization group (27.3% vs. 3.0%, χ2 = 9.291, P = 0.018). For all the 78 patients, fever was the most common initial symptom, and the maximum body temperature at admission was significantly higher in the progression group than in the improvement/stabilization group (38.2 [37.8, 38.6] vs. 37.5 [37.0, 38.4]°C, U = 2.057, P = 0.027). Moreover, the proportion of patients with respiratory failure (54.5% vs. 20.9%, χ2 = 5.611, P = 0.028) and respiratory rate (34 [18, 48] vs. 24 [16, 60] breaths/min, U = 4.030, P = 0.004) were significantly higher in the progression group than in the improvement/stabilization group. C-reactive protein was significantly elevated in the progression group compared to the improvement/stabilization group (38.9 [14.3, 64.8] vs. 10.6 [1.9, 33.1] mg/L, U = 1.315, P = 0.024). Albumin was significantly lower in the progression group than in the improvement/stabilization group (36.62 ± 6.60 vs. 41.27 ± 4.55 g/L, U = 2.843, P = 0.006). Patients in the progression group were more likely to receive high-level respiratory support than in the improvement/stabilization group (χ2 = 16.01, P = 0.001). Multivariate logistic analysis indicated that age (odds ratio [OR], 8.546; 95% confidence interval [CI]: 1.628–44.864; P = 0.011), history of smoking (OR, 14.285; 95% CI: 1.577–25.000; P = 0.018), maximum body temperature at admission (OR, 8.999; 95% CI: 1.036–78.147, P = 0.046), respiratory failure (OR, 8.772, 95% CI: 1.942–40.000; P = 0.016), albumin (OR, 7.353, 95% CI: 1.098–50.000; P = 0.003), and C-reactive protein (OR, 10.530; 95% CI: 1.224−34.701, P = 0.028) were risk factors for disease progression. Conclusions Several factors that led to the progression of COVID-19 pneumonia were identified, including age, history of smoking, maximum body temperature at admission, respiratory failure, albumin, and C-reactive protein. These results can be used to further enhance the ability of management of COVID-19 pneumonia.

Subfields: Infectious Diseases, Neurology

View Paper: https://www.semanticscholar.org/paper/590085c586b3393faf9330ca7873530b693447af

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Infectious Diseases

In Neurology

Citations in the corpus

Smoking Is Associated With COVID-19 Progression: A Meta-analysis (2020, neutral): “Outcome is progression of COVID-19 to more severe or critical conditions or death (Table 1).”
COVID-19 and comorbidities: Deleterious impact on infected patients (2020, background): “3% of the total ICU admitted COVID-19 cases, lead to high mortality among these patients with increased mucous production and blockage of air passages [21].”
Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis (2020, neutral): “The clinical severity was defined as the composite of ICU admission, use of mechanical ventilation or death in two studies [11,13], ICU admission in two studies [12,16], progression towards ARDS in one study [14], death in three studies [15,17,19], and need of mechanical ventilation in the remaining”
Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis (2020, neutral): “47 (median) NR NR NR Liu et al. 2020 [21] Prospective Beijing, China 61 31/61 (50.8) 40 (median) 1.6 19.7 8.2 Tabata et al. 2020 [22] Retrospective Tokyo, Japan 104 47/104 (45”
COVID-19 and smoking: A systematic review of the evidence (2020, background): “Finally, Liu et al.(13) found among their population of 78 patients with COVID-19 that the adverse outcome group had a significantly higher proportion of patients with a history of smoking (27.”
Assessing nitrogen dioxide (NO2) levels as a contributing factor to coronavirus (COVID-19) fatality (2020, background): “, 2020), history of smoking (Liu et al., 2020), hypertension and heart disease (Chen et al.”
Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis (2020, background): “Six studies [1, 4–8] reported that hypertension, diabetes, and COPD, five covered liver disease [1, 4–7], four investigated malignancy [1, 4, 5, 8], renal disease [4–7], and cardiovascular disease [4–7], and three [4, 5, 7] researched cerebrovascular disease.”
Depression, Anxiety and Stress during COVID-19: Associations with Changes in Physical Activity, Sleep, Tobacco and Alcohol Use in Australian Adults (2020, background): “Indeed, early indications suggest the proportion of current and former smokers is higher among those with severe disease and among those admitted to intensive care and requiring ventilation [10,11].”