key: cord-0769330-z0476b47
authors: Yu, Tao; Cai, Shaohang; Zheng, Zhidan; Cai, Xuejuan; Liu, Yuanyuan; Yin, Sichun; Peng, Jie; Xu, Xuwen
title: Association between clinical manifestations and prognosis in patients with COVID-19
date: 2020-04-27
journal: Clinical therapeutics
DOI: 10.1016/j.clinthera.2020.04.009
sha: 1c6f1888177420011ff0c6e714490bb9216898d9
doc_id: 769330
cord_uid: z0476b47

Abstract Purpose The purpose of this study was to find out risk factors associated with pneumonia, acute respiratory distress syndrome (ARDS) and clinical outcome among patients with 2019 novel coronavirus disease (COVID-19). Methods This was a cross-sectional multicenter clinical study. A total of 95 patients infected with COVID-19 were enrolled. The COVID-19 diagnostic standard was PCR detection of target genes of 2019 novel coronavirus(2019-nCoV). Clinical, laboratory, and radiological results as well as treatment outcome data were obtained. ARDS was defined as oxygenation index (PaO2/FiO2) ≤ 300mmHg. Findings Multivariate analysis showed that older age (OR=1.078, P=0.008) and high BMI (OR=1.327, P=0.024) were independent risk factor associated with patients with pneumonia. For patients with ARDS, multivariate analysis showed that only high systolic blood pressure (SBP) level (OR=1.046, P=0.025) and high lactate dehydrogenase (LDH) level (OR=1.010, P=0.021) were independent risk factors associated with ARDS. A total of 70 patients were conducted CT scan repeatedly after treatment. Patients were divided in disease exacerbation group (n=19) and disease relieve group (n=51). High BMI (OR=1.285, P=0.017) and tobacco smoking (OR=16.13, P=0.032) were independent risk factors associated with disease exacerbation after treatment. Implications Our results help to risk stratification in patients with 2019-nCoV infection. Patients with risk factors should be given timely intervention to avoid disease progression.

been found in many countries worldwide 2,3 . However, until now, the source of the virus and the pathogenesis of the disease are unknown. To better control the epidemic and reduce the 69 spread of the disease, early detection, quarantine and timely treatment are the keys to 70 controlling the disease. 71 Coronaviruses are RNA viruses, and can be divided into four genera according to the This sudden infectious disease mainly manifests as fever, fatigue, and cough [6] [7] [8] . Upper 78 respiratory symptoms such as nasal congestion and runny nose are rare. About one-half of the 79 patients develop dyspnoea after one week 9 . In severe cases, patients progress rapidly to acute 80 respiratory distress syndrome (ARDS), sepsis, and coagulopathy. Some patients have mild 81 symptoms with no fever or without pneumonia and usually recover after one week. However, 82 some patients may suddenly worsen and develop to ARDS 9 . At present, how to stratify 83 high-risk and low-risk patients is an important but unsolved issue. independent risk factor associated with patients developing pneumonia. As shown in Table 2 . 

Patients were divided into an ARDS group (n = 24) and a non-ARDS group (n = 71) as 153 determined by the ARDS definition. As shown in Table 3 . Patients with ARDS were older 154 than those without ARDS (P=0.021). Moreover, systolic blood pressure (SBP) (P=0.038), 155 serum creatinine (P=0.025) and LDH level (p=0.003) were significantly higher in patients 156 with ARDS. However, lymphocyte counts were lower in patients with ARDS than in others exacerbation were significantly older (P=0.021), with higher BMI (P=0.003), and higher proportion of tobacco smoking (P=0.006). As shown in Table 5 . 

In our study, we discussing the evolution of CT findings for patients with COVID-19. The current study has limitations. First, this study involved a cross-sectional including length of stay data in this study is missing because some patients are still in hospital.

For mortality and length of stay data, another study is needed. • Patients infected with 2019-nCoV could progress rapidly to acute respiratory distress syndrome. However, some patients have only some mild symptoms with no fever or without pneumonia and usually recover after one week. At present, how to stratify high-risk and low-risk patients is an important but unsolved issue. • In this study, we found older age, high BMI, low lymphocyte count, low platelet count, high AST and high LDH level to be risk factors associated with patients with pneumonia. However, only older age and high BMI were independent risk factors associated with patients with pneumonia. • Furthermore, high SBP level and high LDH level were independent risk factors associated with ARDS among patients with COVID-19. • High BMI and tobacco smoking were independent risk factors associated with pneumonia exacerbation after treatment in patients with COVID-19. Our results help in the risk stratification of patients with COVID-19. Timely intervention should be initiated in patients with risk factors to avoid disease progression.

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