Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan - 22/07/20

Doi : 10.1016/j.jaci.2020.04.006

Xiaochen Li, MD ^a,^b,^{^{∗
These authors contributed equally to this work.}}, Shuyun Xu, MD ^a,^b,^{^{∗
These authors contributed equally to this work.}}, Muqing Yu, MD ^a,^b,^{^{∗
These authors contributed equally to this work.}}, Ke Wang, MD ^a,^b,^{^{∗
These authors contributed equally to this work.}}, Yu Tao, MD ^a,^b,^{^{∗
These authors contributed equally to this work.}}, Ying Zhou, MD ^a,^b,^{^{∗
These authors contributed equally to this work.}}, Jing Shi, MD ^a,^b,^{^{∗
These authors contributed equally to this work.}}, Min Zhou, MD ^a,^b,^{^{∗
These authors contributed equally to this work.}}, Bo Wu, PhD ^c,^{^{∗
These authors contributed equally to this work.}}, Zhenyu Yang, MD ^a,^b,^{^{∗
These authors contributed equally to this work.}}, Cong Zhang, MD ^a,^b, Junqing Yue, MD ^a,^b,^{^{∗
These authors contributed equally to this work.}}, Zhiguo Zhang, PhD ^d,^{^{∗
These authors contributed equally to this work.}}, Harald Renz, MD ^e, Xiansheng Liu, MD ^a,^b, Jungang Xie, MD ^a,^b, Min Xie, MD ^a,^b,^⁎ , Jianping Zhao, MD ^a,^b,^⁎
^a Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
^b Key Laboratory of Respiratory Diseases, National Ministry of Health of the People’s Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
^c United Imaging Healthcare Co Ltd, Wuhan, China
^d School of Medicine and Health Management, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
^e Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg University Hospital Giessen and Marburg GmbH, Marburg, Germany

^∗Corresponding author: Jianping Zhao, MD, or Min Xie, MD, Tongji Hospital, 1095 Jiefang Ave, Wuhan 430030, China.Tongji Hospital1095 Jiefang AveWuhan430030China

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Abstract

Background

In December 2019, the coronavirus disease 2019 (COVID-19) outbreak occurred in Wuhan. Data on the clinical characteristics and outcomes of patients with severe COVID-19 are limited.

Objective

We sought to evaluate the severity on admission, complications, treatment, and outcomes of patients with COVID-19.

Methods

Patients with COVID-19 admitted to Tongji Hospital from January 26, 2020, to February 5, 2020, were retrospectively enrolled and followed-up until March 3, 2020. Potential risk factors for severe COVID-19 were analyzed by a multivariable binary logistic model. Cox proportional hazard regression model was used for survival analysis in severe patients.

Results

We identified 269 (49.1%) of 548 patients as severe cases on admission. Older age, underlying hypertension, high cytokine levels (IL-2R, IL-6, IL-10, and TNF-α), and high lactate dehydrogenase level were significantly associated with severe COVID-19 on admission. The prevalence of asthma in patients with COVID-19 was 0.9%, markedly lower than that in the adult population of Wuhan. The estimated mortality was 1.1% in nonsevere patients and 32.5% in severe cases during the average 32 days of follow-up period. Survival analysis revealed that male sex, older age, leukocytosis, high lactate dehydrogenase level, cardiac injury, hyperglycemia, and high-dose corticosteroid use were associated with death in patients with severe COVID-19.

Conclusions

Patients with older age, hypertension, and high lactate dehydrogenase level need careful observation and early intervention to prevent the potential development of severe COVID-19. Severe male patients with heart injury, hyperglycemia, and high-dose corticosteroid use may have a high risk of death.

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Key words : COVID-19, SARS-CoV-2, risk factors, severity, mortality

Abbreviations used : ACE 2, ARDS, COVID-19, CT, HR, LDH, OR, SARS-CoV-2

Plan

Epidemiologic and demographic characteristics

Clinical characteristics on admission

Radiographic and laboratory findings on admission

Subgroup analysis

Risk factors for severe cases on admission

Complications, treatment, and clinical outcomes during hospitalization and follow-up

Factors associated with death in severe cases

Discussion

Conclusions

	This project was supported by grants from the Science and Technology Program of Hubei Province (grant no. 2020FCA026).
	Disclosure of potential conflict of interest: H. Renz is a member of and receives funding from the German Lung Centre (Deutsches Zentrum für Lungenforschung [DZL]) and of the Universities Giessen and Marburg Lung Centre. The rest of the authors declare that they have no relevant conflicts of interest.

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Vol 146 - N° 1

P. 110-118 - juillet 2020 Retour au numéro

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Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan - 22/07/20

Abstract

Background

Objective

Methods

Results

Conclusions

Plan

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