Clinical Features and Risk Factors Associated with Severe COVID-19 Patients in China
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide, posing a significant global health threat. This study aimed to identify the risk factors associated with severe COVID-19 to improve treatment guidelines and patient outcomes. The research was conducted as a multicenter, cross-sectional study involving 313 hospitalized COVID-19 patients in China. Patients were classified into two groups based on disease severity: nonsevere and severe. The study analyzed laboratory test results, epidemiological data, and clinical characteristics to identify factors contributing to severe COVID-19.
The study included 289 patients, with 197 classified as nonsevere and 92 as severe cases. The median age of the patients was 45.0 years, with 53.3% being male. The most common symptoms observed were fever (67.1%) and cough (58.8%), followed by sore throat (17.0%). Multivariate logistic regression analysis identified several risk factors associated with severe COVID-19, including age ≥ 65 years, male gender, comorbid diabetes, and the presence of cough or diarrhea on admission. Stratification analysis further indicated that male patients with diabetes were more likely to develop severe COVID-19.
The demographic and clinical characteristics of the patients revealed significant differences between the severe and nonsevere groups. Severe cases were older, with a median age of 60.0 years compared to 40.0 years in nonsevere cases. Severe cases also had a higher prevalence of comorbidities, including diabetes, chronic cardiac disease, chronic kidney disease, and chronic hematologic disease. Symptoms such as cough, shortness of breath, and diarrhea were more common in severe cases. Additionally, severe cases exhibited more prominent laboratory abnormalities, including reduced hemoglobin levels, lymphopenia, and elevated levels of creatinine, blood urea nitrogen, glucose, procalcitonin, and C-reactive protein.
The study also examined the radiological findings of COVID-19 patients. The most common patterns observed on chest CT were ground-glass opacities (87.2%) and infiltration (73.9%), followed by air bronchogram (32.1%) and interlobular septal thickening (30.8%). Although there were no statistically significant differences in chest CT or radiography results between the severe and nonsevere groups, these findings highlight the typical radiological features of COVID-19.
In terms of treatments, antiviral drugs were used in 95.8% of patients, antibiotics in 62.2%, and antifungal agents in 8.1%. Antibiotics were more commonly used in nonsevere cases, while antifungal agents were more frequently used in severe cases. Noninvasive and invasive mechanical ventilation, renal replacement therapy, inotropes/vasopressors, neuromuscular blocking agents, and extracorporeal membrane oxygenation (ECMO) were only used in severe cases. As of March 29, 2020, five patients had died during hospitalization, 154 were discharged, 51 were still hospitalized, and eight were transferred to other designated hospitals.
The univariate analysis identified several factors associated with severe COVID-19, including older age, smoking history, and the presence of chronic cardiac disease or diabetes. Patients with higher levels of glucose, blood urea nitrogen, creatinine, procalcitonin, and C-reactive protein were also more likely to develop severe COVID-19. The multivariate regression models confirmed that age ≥ 65 years, male gender, comorbid diabetes, and the presence of cough or diarrhea on admission were significant risk factors for severe COVID-19.
The study concluded that fever and cough were the most common symptoms in COVID-19 patients, with cough being more likely associated with severe cases. Elevated procalcitonin and C-reactive protein levels were potential risk factors for severe COVID-19. Patients with diabetes, particularly men, were more likely to develop severe COVID-19, leading to poorer clinical outcomes. The findings suggest that close monitoring and comprehensive therapies are necessary for patients with severe COVID-19 to improve their prognosis.
The study also highlighted the importance of early identification and timely treatment of severe COVID-19 cases. The use of antiviral drugs, antibiotics, and antifungal agents, along with supportive therapies such as mechanical ventilation and ECMO, were crucial in managing severe cases. The research underscores the need for further investigations and rigorous observations to better understand the clinical features and risk factors associated with severe COVID-19.
In summary, this multicenter study provides valuable insights into the clinical characteristics and risk factors associated with severe COVID-19 in China. The findings emphasize the importance of early diagnosis, close monitoring, and comprehensive treatment strategies to improve outcomes for patients with severe COVID-19. The study also highlights the need for ongoing research to further elucidate the natural history and clinical course of COVID-19, particularly in diverse populations and settings.
doi.org/10.1097/CM9.0000000000001466
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