key: cord-0946581-61gkephv
authors: Cen, Yuan; Chen, Xian; Shen, Ye; Zhang, Xiao-Hua; Lei, Yu; Xu, Cheng; Jiang, Wen-Rui; Xu, Hai-Tao; Chen, Yang; Zhu, Jie; Zhang, Li-Li; Liu, Yu-Hui
title: Risk factors for disease progression in mild to moderate COVID-19 patients– a multi-center observational study
date: 2020-06-09
journal: Clin Microbiol Infect
DOI: 10.1016/j.cmi.2020.05.041
sha: bc64689257dff3124c92226bd68bac3380c065f0
doc_id: 946581
cord_uid: 61gkephv

OBJECTIVES: Since December 2019, patients infected with a novel coronavirus disease (COVID-19) emerged in Wuhan city and rapidly spread globally. The risk for poor outcome dramatically increases once a patient progressed to the severe or critical stage. The present study aims to investigate the risk factors for disease progression in mild to moderate cases of COVID-19. METHODS: We conducted a cohort study which included 1007 mild to moderate cases with COVID-19 from 3 hospitals in Wuhan. Clinical characteristics and baseline laboratory findings were collected. Patients had been followed up for 28 days for observation of disease progression. The endpoint was the progression to a more severe disease stage. RESULTS: During a follow up of 28 days, 720 patients (71.50%) had recovered or been symptomatically stable, 222 patients (22.05%) had progressed to the severe stage, 22 patients (2.18%) had progressed to the critically ill stage, 43 patients (4.27%) had deceased. Multivariate Cox proportional hazards models identified that increased age (HR 2.56, 95% CI 1.97 to 3.33), male sex (HR 1.79, 95% CI 1.41 to 2.28), presence of hypertension (HR 1.44, 95% CI 1.11 to 1.88), diabetes (HR 1.82, 95% CI 1.35 to 2.44), chronic obstructive pulmonary disease (HR 2.01, 95% CI 1.38 to 2.93) and coronary artery disease (HR 1.83, 95% CI 1.26 to 2.66) were risk factors for disease progression. History of smoking was protective against disease progression (HR 0.56, 95% CI 0.34 to 0.91). Elevated procalcitonin (HR 1.72, 95% CI 1.02 to 2.90), urea nitrogen (HR 1.72, 95% CI 1.21 to 2.43), α-hydroxybutyrate dehydrogenase (HR 3.02, 95% CI 1.26 to 7.21) and D-dimer (HR 2.01, 95% CI 1.12 to 3.58) at baseline were also associated with risk for disease progression. CONCLUSIONS: This study identified a panel of risk factors for disease progression in mild to moderate cases with COVID-19.

As of May 10, 2020, 4,118,326 confirmed cases with Coronavirus Disease 2019 56 (COVID-19) have been reported globally, with 280,718 deceased. The clinical 57 spectrum of COVID-19 pneumonia ranges from mild to critically ill patients [1] . 58 According to a recent report, the ratio of patients being admitted to intensive care unit 59 (ICU), requiring invasive ventilation and death were 5.00%, 2.18% and 1.36%, Patients recruited in the present study were followed up for 28 days since 86 admission. The endpoint is conversion from mild or moderate stage to severe or 87 critical stage or to death. The study was approved by the institutional board of each 88 participating site. The subjects' written consents were waived in light of reducing 89 exposure possibility and the urgent need to collect clinical data. However, verbal 90 consent from each patient or its legal relatives was obtained. This study aimed to determine the association of clinical characteristics and 216 laboratory findings with short-term outcome of mild to moderate cases with 217 COVID-19 from 3 medical centers in Wuhan. We found that several chronic 218 comorbidities and baseline blood biomarkers were independently associated with risk 219 for disease progression during a follow up of 28 days.

Once a patient advanced to severe disease stage, the risk for poor outcome 221 dramatically increases [3]. Therefore, identification of patients with risk for 222 progressing to severe disease is essential for timely intervention to improve prognosis.

In the present study, we utilized Cox proportional hazards models to assess the 224 association between clinical characteristics, baseline blood biomarkers and short-term 225 outcome of the disease. Age above 65 years and the male sex were found to be 226 significant risk factors for disease progression, which is consistent with previous 

Risk factors for community-acquired 407 pneumonia in adults in Europe: a literature review

Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute 410 respiratory syndrome (SARS)

Diabetes mellitus and immunity

Angiotensin-Converting Enzyme 2 (ACE2) Is a Key Modulator of 413 the Renin Angiotensin System in Health and Disease

Virus-induced exacerbations in asthma and 415 COPD

Brusselle, DPP4, the Middle East Respiratory Syndrome 418

Coronavirus Receptor, is Upregulated in Lungs of Smokers and Chronic Obstructive 419 Pulmonary Disease Patients

where No. is the total number of patients with available data. p values comparing groups are from χ 2 test, Fisher's exact test, or Mann-Whitney U test. COVID-19, coronavirus disease 2019. White blood cells, WBCs. PCT, Procalcitonin. AST, Aspartate aminotransferase. ALT, Alanine aminotransferase. LDH, Lactate dehydrogenase. α-HBDH, α-hydroxybutyrate dehydrogenase

COVID-19, coronavirus disease

 Table 4 . Cox regression analysis of association between baseline laboratory findings and disease progression in patients with COVID-19.

Univariable HRs (95%CI)

HRs (95%CI)