Analysis of Factors Associated with Disease Outcomes in Hospitalized Patients with 2019 Novel Coronavirus Disease
Since December 2019, the 2019 novel coronavirus disease (COVID-19) has caused a pneumonia epidemic in Wuhan, Hubei Province, China. This study aimed to investigate the factors affecting the progression of pneumonia in COVID-19 patients, with the goal of evaluating prognosis and identifying optimal treatment regimens. The study included 78 patients who tested positive for COVID-19 based on nucleic acid detection and were admitted to three tertiary hospitals in Wuhan between December 30, 2019, and January 15, 2020. Data collected included individual demographics, laboratory indices, imaging characteristics, and clinical outcomes. Patients were divided into two groups based on clinical typing results after two weeks of hospitalization: a progression group (deterioration or death) and an improvement/stabilization group.
The progression group consisted of 11 patients (14.1%), while the improvement/stabilization group included 67 patients (85.9%). The progression group was significantly older than the improvement/stabilization group, with a median age of 66 years compared to 37 years. Additionally, a higher proportion of patients in the progression group had a history of smoking (27.3% vs. 3.0%). Fever was the most common initial symptom, and the maximum body temperature at admission was significantly higher in the progression group (38.2°C vs. 37.5°C). Respiratory failure was more prevalent in the progression group (54.5% vs. 20.9%), and the respiratory rate was significantly higher (34 breaths/min vs. 24 breaths/min). Laboratory findings revealed that C-reactive protein levels were significantly elevated in the progression group (38.9 mg/L vs. 10.6 mg/L), while albumin levels were significantly lower (36.62 g/L vs. 41.27 g/L). Patients in the progression group were also more likely to require high-level respiratory support.
Multivariate logistic regression analysis identified several risk factors for disease progression, including age (odds ratio [OR], 8.546), history of smoking (OR, 14.285), maximum body temperature at admission (OR, 8.999), respiratory failure (OR, 8.772), albumin levels (OR, 7.353), and C-reactive protein levels (OR, 10.530). These findings suggest that older age, smoking history, higher body temperature, respiratory failure, lower albumin, and elevated C-reactive protein are associated with worse outcomes in COVID-19 patients.
The study also examined treatment protocols for COVID-19 pneumonia. The most common treatment was a combination of antivirals, antibacterials, and glucocorticoids (57.7%). Ribavirin was the most frequently used antiviral, while cephalosporins or quinolone antibiotics were the most common antibacterials. Glucocorticoid doses were similar between the two groups, with no significant difference in the proportion of patients receiving different drug protocols. Respiratory support was essential for all patients, with nasal cannula being the most common form (91.0%). The progression group was more likely to require higher levels of respiratory support.
Imaging characteristics, including the extent and features of lung lesions on computed tomography (CT) scans, were analyzed. However, no significant differences were found between the progression and improvement/stabilization groups. This suggests that while CT scans are valuable for early diagnosis, they may not be as useful for predicting disease outcomes.
The study highlights the importance of monitoring vital signs, particularly respiratory indices, in COVID-19 patients. Elevated respiratory rates and the presence of respiratory failure were strongly associated with disease progression. Laboratory indices such as C-reactive protein and albumin levels were also critical indicators of prognosis. These findings underscore the need for close monitoring of these parameters to identify patients at risk of deterioration.
The use of glucocorticoids in COVID-19 treatment remains controversial. While some studies suggest that glucocorticoids can exacerbate the disease and increase the risk of secondary infections, others argue that early and appropriate use can mitigate excessive immune responses and prevent lung injury. In this study, the combination of antivirals, antibacterials, and glucocorticoids was the most commonly used treatment protocol, but no significant difference in efficacy was observed between different drug regimens.
Respiratory support is a cornerstone of treatment for severe COVID-19 cases. The majority of patients in this study received nasal cannula oxygen, while a smaller proportion required continuous non-invasive positive pressure ventilation. The progression group was more likely to need higher levels of respiratory support, emphasizing the importance of timely and appropriate respiratory interventions.
The study also explored the role of comorbidities in COVID-19 outcomes. While hypertension was the most common comorbidity, no significant differences were found between the progression and improvement/stabilization groups. This may be due to the small sample size, and further research is needed to clarify the impact of comorbidities on COVID-19 prognosis.
In conclusion, this study identifies several factors associated with disease progression in COVID-19 patients, including older age, smoking history, higher body temperature, respiratory failure, lower albumin levels, and elevated C-reactive protein. These findings can help clinicians better assess prognosis and tailor treatment strategies for COVID-19 pneumonia. Early diagnosis, close monitoring of vital signs and laboratory indices, and timely respiratory support are essential for improving outcomes in COVID-19 patients.
The study has some limitations, including the small sample size and the delayed timing of CT scans, which may have introduced bias. Larger, multi-center studies are needed to confirm these findings and further refine diagnostic and treatment protocols for COVID-19.
doi.org/10.1097/CM9.0000000000000775
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