Epidemiology and Clinical Characteristics of Bloodstream Infection in Patients Under Extracorporeal Membranous Oxygenation

Background: Bloodstream infection (BSI) is an important complication of extracorporeal membranous oxygenation (ECMO) and a major cause of mortality. This study evaluated the epidemiological and clinical characteristics of BSI that occur during ECMO application according to microbial etiology. Methods: Adult patients who underwent ECMO from January 2009 to December 2016 were retrospectively analyzed for BSI episodes at a 2,700-bed, tertiary center. Epidemiological and clinical characteristics and outcomes of BSI were evaluated and were compared for etiologic groups (gram-positive cocci, gram-negative rods, and fungi groups). Risk factors for 14-day mortality were analyzed. Results: A total of 1,100 patients underwent ECMO during the study period, and 65 BSI episodes occurred in 61 patients. The BSI incidence was 8.3 episodes/1,000 ECMO days, which significantly decreased over time ( P = 0.03), primarily in gram-positive cocci BSI. Gram-positive cocci, gram-negative rods, and fungi accounted for 38%, 40%, and 22% of the 73 blood isolates, respectively. Baseline characteristics were comparable between groups. Catheter-related infection (CRI) and pneumonia were the most common sources of BSI; 52% of gram-positive cocci BSIs and 79% of fungi BSIs were caused by CRI, and 75% of gram-negative BSIs by pneumonia. Patients with gram-negative rods BSI died more frequently and earlier than those with other BSIs. Independent risk factors for 14-day mortality were older age and gram-negative rods BSI. Conclusions: The decreased BSI incidence during ECMO was mainly because of the decrease of gram-positive cocci BSI. The high early mortality of gram-negative rods BSI makes prevention and adequate treatment necessary.

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Impact of empirical antibiotic regimens on mortality in neutropenic patients with bloodstream infection presenting with septic shock

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01744-21 ◽

2021 ◽

Author(s):

Mariana Chumbita ◽

Pedro Puerta-Alcalde ◽

Carlota Gudiol ◽

Nicole Garcia-Pouton ◽

Júlia Laporte-Amargós ◽

...

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Kidney Injury ◽

Bloodstream Infections ◽

Gram Positive ◽

Gram Negative ◽

Neutropenic Patients ◽

Prospective Cohorts ◽

Independent Risk Factors ◽

The Impact

Objectives: We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. Methods: Multicenter retrospective study (2010-2019) of two prospective cohorts comparing BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Results: Of 1563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% vs 15%, p<0.001). Gram-negative bacilli caused 81% of episodes with septic shock; gram-positive cocci, 22%; and Candida species 5%. Inappropriate empirical antibiotic treatment (IEAT) was administered in 17.5% of septic shock episodes. Empirical β-lactam combined with other active antibiotics was associated with the lowest mortality observed. When amikacin was the only active antibiotic, mortality was 90%. Addition of empirical specific gram-positive coverage had no impact on mortality. Mortality was higher when IEAT was administered (76% vs 51%, p=0.002). Age >70 years (OR 2.3, 95% CI 1.2-4.7), IEAT for Candida spp. or gram-negative bacilli (OR 3.8, 1.3-11.1), acute kidney injury (OR 2.6, 1.4-4.9) and amikacin as the only active antibiotic (OR 15.2, 1.7-134.5) were independent risk factors for mortality, while combination of β-lactam and amikacin was protective (OR 0.32, 0.18-0.57). Conclusions: Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes.

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Bleeding, thrombosis and transfusion in patients on ECMO: A retrospective study in a tertiary center in Hong Kong

The International Journal of Artificial Organs ◽

10.1177/0391398820965584 ◽

2020 ◽

pp. 039139882096558

Author(s):

Ka Man Fong ◽

Shek Yin Au ◽

George Wing Yiu Ng ◽

Anne Kit Hung Leung

Keyword(s):

Risk Factors ◽

Bloodstream Infection ◽

Primary Outcome ◽

Significant Risk ◽

Tertiary Hospital ◽

Chinese Patients ◽

Bleeding Complications ◽

Bleeding Events ◽

Tertiary Center ◽

Independent Risk Factors

Purpose: Use of anticoagulation in patients on ECMO, especially in Chinese, has always been difficult. This study aimed to review the incidence of bleeding, thrombosis, and transfusion requirement in Chinese ECMO patients and to identify risk factors for bleeding complications. Materials and Methods: This was a retrospective observational study of a tertiary hospital from 2010 to 2018. Patients aged ⩾18 years who received ECMO were included. The primary outcome was incidence of bleeding. Secondary outcomes included ICU mortality, hospital mortality, and length of the ICU and hospital stay. Results: Of the 130 patients, 55(42.3%) had at least one bleeding events and thrombosis occurred in 37(28.5%). A lower fibrinogen level (adjusted OR 0.56 (0.36–0.86), p = 0.009), bloodstream infection (adjusted OR 2.76 (1.01–7.53), p = 0.047) and longer duration on ECMO (adjusted OR 1.14 (1.02–1.27), p = 0.018) were independently associated with occurrence of bleeding. APTT (adjusted OR 0.99 (0.97–1.01), p = 0.370) and platelet count (adjusted OR 1.00 (0.98–1.01), p = 0.632) were not statistically significant risk factors for bleeding events. Conclusions: Bleeding and thrombosis were common complications in Chinese patients receiving ECMO. Hypofibrinogenemia and bloodstream infection, but not APTT nor platelet counts, were independent risk factors for bleeding events.

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Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients

Scientific Reports ◽

10.1038/s41598-021-89108-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hyoung Soo Kim ◽

Sunghoon Park ◽

Ho Hyun Ko ◽

Sang Ook Ha ◽

Sun Hee Lee ◽

...

Keyword(s):

Blood Culture ◽

Extracorporeal Membrane Oxygenation ◽

Bloodstream Infection ◽

Clinical Characteristics ◽

Gram Positive ◽

Gram Negative ◽

Membrane Oxygenation ◽

Gram Negative Bacteremia ◽

Va Ecmo ◽

Vv Ecmo

AbstractCurrently, there is scarcity of data on whether differences exist in clinical characteristics and outcomes of bloodstream infection (BSI) between venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) and whether they differ between Candida BSI and bacteremia in adult ECMO patients. We retrospectively reviewed data of patients who required ECMO for > 48 h and had BSIs while receiving ECMO between January 2015 and June 2020. Cases with a positive blood culture result within 24 h of ECMO implantation were excluded. We identified 94 (from 64 of 194 patients) and 38 (from 17 of 56 patients) BSI episodes under VA and VV ECMO, respectively. Fifty nine BSIs of VA ECMO (59/94, 62.8%) occurred in the first 2 weeks after ECMO implantation, whereas 24 BSIs of VV ECMO (24/38, 63.2%) occurred after 3 weeks of ECMO implantation. Gram-negative bacteremia (39/59, 66.1%) and gram-positive bacteremia (10/24, 41.7%) were the most commonly identified BSI types in the first 2 weeks after VA ECMO implantation and after 3 weeks of VV implantation, respectively. Timing of Candida BSI was early (6/11, 54.5% during the first 2 weeks) in VA ECMO and late (6/9, 66.7% after 3 weeks of initiation) in VV ECMO. Compared with bacteremia, Candida BSI showed no differences in clinical characteristics and outcomes during VA and VV ECMO, except the significant association with prior exposure to carbapenem in VA ECMO (vs. gram-negative bacteremia [P = 0.006], vs. gram-positive bacteremia [P = 0.03]). Our results suggest that ECMO modes may affect BSI clinical features and timing. In particular, Candida BSI occurrence during the early course of VA ECMO is not uncommon, especially in patients with prior carbapenem exposure; however, it usually occurs during the prolonged course of VV ECMO. Consequently, routine blood culture surveillance and empiric antifungal therapy might be warranted in targeted populations of adult ECMO patients, regardless of levels of inflammatory markers and severity scores.

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THU0426 CLINICAL CHARACTERISTIC OF INFECTIOUS ULCERATION OVER TOPHI

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.968 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 451.2-452

Author(s):

Z. Huang ◽

T. LI ◽

X. Liu

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Antibiotic Susceptibility ◽

Clinical Characteristics ◽

Albumin Level ◽

Gram Positive ◽

Gram Negative ◽

Antibiotic Susceptibility Patterns ◽

Susceptibility Patterns

Background:Infection in ulceration over tophi is the leading cause of sepsis in patients with gout, which is the main indication for surgery. Additionally, patients with infection will significantly prolonged wound closure time compared with those without infection. Investigation of infection in ulceration over tophi will improve our understanding of this critical issue.Objectives:To describe the microbiological profile in ulceration over tophi, antibiotic susceptibility patterns of causative agents, and to study the prediction of infection in ulceration over tophi among patients with gout.Methods:Patients with ulceration over tophi were prospectively enrolled. The clinical characteristics were recorded and microbiological specimens were taken on admission. Specimens were cultured for aerobic and anaerobic bacteria, and antibiotic susceptibility testing was performed for the culture isolates. Patients were divided into 2 groups according to having infectious ulceration or not and the potential risk factors for infectious ulceration over tophi were examined using univariate and multivariate logistic regression analyses.Results:A total of 82 patients were included for analysis. 46 pathogens were isolated from 39 (47.6%) patients, among which the top 3 wereStaphylococcus aureus(43.5%),Pseudomonas aeruginosa(17.4%) andEnterococcus faecalis(13.0%). Overall, the Gram-positive bacilli were more sensitive to gentamicin (81.5%), amikacin (88.9%), trimethoprim/sulfamethoxazole (92.6%), nitrofurantoin (96.3%), linezolid (100.0%), teicoplanin (100.0%) and vancomycin (100.0%) whereas penicillin, oxacillin and ampicillin were 66.7% to 77.8% resistant. The Gram-negative bacilli were more sensitive to amikacin (84.2%), cefoperazone/sulbactam (84.2%) and meropenem (89.5%) whereas ampicillin, amoxicillin/clavulanate, cefotaxime, cefazolin, piperacillin, trimethoprim/sulfamethoxazole and tetracycline were 68.4% to 100% resistant. Patients with infection had a higher rate of smoking history and type 2 diabetes, with higher levels of erythrocyte sedimentation rate, C-reactive protein and leucocyte, and lower level of albumin. In stepwise logistic regression analysis, type 2 diabetes (adjusted OR 5.064; 95% CI = 1.430 to 17.928) and albumin level (adjusted OR 0.855; 95% CI = 0.782 to 0.935) were independent predictors of infection in ulceration over tophi.Conclusion:Infection is common in ulceration over tophi. Different antibiotic susceptibility patterns were observed in Gram-positive bacilli and Gram-negative bacilli. Type 2 diabetes and low albumin level were associated with an increased risk of infection in ulceration over tophi. The data in this study will be beneficial for tailoring infection control measures in a way that improves outcomes of ulceration over tophi.References:[1]Huang Z, Liu X, Liu Y, et al. Clinical characteristics and risk factors of ulceration over tophi in patients with gout.International journal of rheumatic diseases2019;22:1052-7.[2]Xu J, Zhu Z, Zhang W. Clinical characteristics of infectious ulceration over tophi in patients with gout.The Journal of international medical research2018;46:2258-64.Table 1.Bacteria isolated from initial ulceration specimens taken on the first admission.BacteriaNumber* (n = 46)Proportion (%)Gram-positive bacilli2758.7 Staphylococcus aureus2043.5 Enterococcus faecalis613.0 Streptococcus mutans12.2Gram-negative bacilli1941.3 Pseudomonas aeruginosa817.4 Klebsiella pneumonia48.7 Enterobacter cloacae36.5 Escherichia coli24.3 Acinetobacter baumannii24.3* Number of ulcerationDisclosure of Interests: :None declared

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The Clinical Characteristics of Obese Patients with Acanthosis Nigricans and Its Independent Risk Factors

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0042-123035 ◽

2017 ◽

Vol 125 (03) ◽

pp. 191-195 ◽

Cited By ~ 1

Author(s):

Yueye Huang ◽

Jiaqi Chen ◽

Xingchun Wang ◽

Yan Li ◽

Shezhen Yang ◽

...

Keyword(s):

Risk Factors ◽

Clinical Characteristics ◽

Acanthosis Nigricans ◽

Obese Patients ◽

Independent Risk Factors

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Clinical Presentation and Bacterial Etiology of Adult Community Acquired Pneumonia

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v34i3.32343 ◽

2017 ◽

Vol 34 (3) ◽

pp. 128-134

Author(s):

Md Abdus Salam ◽

Md Robed Amin ◽

Quazi Tarikul Islam

Keyword(s):

Streptococcus Pneumoniae ◽

Blood Culture ◽

Mycoplasma Pneumoniae ◽

Chlamydia Pneumoniae ◽

Community Acquired Pneumonia ◽

Sputum Culture ◽

Gram Positive ◽

Gram Negative ◽

The Mean ◽

Gram Positive Cocci

Introduction: Pneumonia is a worldwide, serious threat to health and an enormous socio-economic burden for health care system. According to recent WHO data, each year 3-4 million patients die from pneumonia. The clinical presentations and bacterial agents responsible for community acquired pneumonia (CAP) varies according to geography and culture.Methods: A cross sectional observational study conducted among the 53 consecutive patients with a clinical diagnosis of CAP in admitted patient in the department of Medicine, DMCH, during January 2010 to December 2010. Hematological measurements (TC of WBC, Hb%, ESR, platelet count), blood culture, chest X-ray P/A view, sputum for Gram staining and culture sensitivity, sputum for AFB, blood urea and random blood sugar were done in all cases. ELISA for IgM antibody of Mycoplasma pneumoniae and Chlamydia pneumoniae were done in sputum culture negative cases.Results: The mean (±SD) age was 38.9±17.3 years and Male female ratio was 3:1. Fever, chest pain and productive cough were the most common clinical features. The mean (±SD) respiratory rate was 23.0±2.8 /minute . COPD and DM were found in 17.0% and 5.7% of patients respectively . Blood culture was found positive in only 1.9% of the study patients. Gram positive Cocci 62.26%, Gram negative Bacilli 9.43%, mixed Gram positive cocci and Gram negative bacilli 11.32% and Gram negative Cocco Bacilli 1.9% were observed and in 15.03 % cases, no bacteria could be seen. Sputum culture revealed 53.8% streptococcus pneumoniae, 26.9% Klebsiella pneumonia as predominant organism. Mycoplasma pneumoniae and Chlamydia pneumoniae were found in 7.4% and 3.7% respectively by serological test. For Streptococcus pneumoniae, sensitive antibiotics were Amoxyclav and Levofloxacin. For Gram negative bacilli and coccobacilli, more sensitive antibiotics were Meropenem, Ceftriaxone, and Clarithromycin. The best sensitive drug were found meropenem. The mean (±SD) duration of hospital stay was 5.0±1.7 days with ranging from 3 to 10 days.Conclusion: Region based bacteroiological diagnosis of Cap is important for selecting the best and sensitive drugs for complete cure.J Bangladesh Coll Phys Surg 2016; 34(3): 128-134

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NEW INSIGHT ON EPIDEMIOLOGY AND MANAGEMENT OF BACTERIAL BLOODSTREAM INFECTION IN PATIENTS WITH HEMATOLOGICAL MALIGNACIES

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2015.044 ◽

2015 ◽

Vol 7 ◽

pp. e2015044 ◽

Cited By ~ 5

Author(s):

Sara Lo Menzo ◽

Giulia La Martire ◽

Giancarlo Ceccarelli ◽

Mario Venditti

Keyword(s):

Febrile Neutropenia ◽

Bloodstream Infections ◽

Multidrug Resistant ◽

Empirical Treatment ◽

Rational Approach ◽

Attributable Mortality ◽

Low Grade ◽

Gram Positive ◽

Adequate Treatment ◽

Gram Negative

Bloodstream infections (BSI) are an important cause of morbidity and mortality in onco-hematologic patients. The Gram-negative etiology was the main responsible of the febrile neutropenia in the sixties and its impact declined due to the use of fluoroquinolone prophylaxis; this situation was followed by the gradual emergence of Gram-positive bacteria also following of the increased use of intravascular devices and the introduction of new chemotherapeutic strategies. In the last decade the Gram-negative etiology is raising again because of the emergence of resistant strains that make questionable the usefulness of currentstrategies for prophylaxis and empirical treatment. Gram-negative BSI attributable mortality is relevant and the appropriate empirical treatment significantly improves the prognosis; on the other hand the delayed adequate treatment of Gram-positive BSI does not seem to have an high impact on survival. The clinician has to be aware of the epidemiology of his institution and of colonizations of his patients in order to choose the most appropriate empiric therapy. Ina setting of high endemicity of multidrug-resistant infections, even the choice of a targeted therapy can be a challenge, often requiring strategies based on off-label prescriptions and low grade evidences.In this review we summarize the current evidences for the best targeted therapies for difficult to treat bacteria BSIs and future perspectives in this topic. We also provide a flow chart for a rational approach to the empirical treatment of febrile neutropenia in a multidrug resistant high prevalence setting.

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Comparing the Performance of the New Fully Automated Urine Particle Analyzer UF-5000 with UF-1000i and Gram Stain in Predicting Bacteria Growth Patterns in Women with Uncomplicated Urinary Tract Infections

10.21203/rs.3.rs-120218/v1 ◽

2020 ◽

Author(s):

Stephen Shei-Dei Yang ◽

Chun-Chun yang ◽

Yi-Shen Chen ◽

Shangjen chang

Keyword(s):

Urinary Tract ◽

Urine Analysis ◽

Growth Patterns ◽

Gram Stain ◽

Gram Positive ◽

Gram Negative ◽

Bacterial Patterns ◽

Tract Infections ◽

Sensitivity Specificity ◽

Gram Positive Cocci

Abstract BackgroudTo compare the performance of the new flow cytometer UF-5000 with UF-1000i (Sysmex, Kobe, Japan) and Gram stain in predicting the bacterial patterns in urine samples MethodsWomen with symptoms suggestive of urinary tract infection were enrolled. Mid-stream urine sample was collected for gram staining, urine analysis and urine culture. Bacterial patterns were classified though UF1000i (none, cocci bacteria or rods/mixed growth), UF-5000 (none, cocci, rods or mixed growth) and Gram stain. Results Among the 102 samples, there were 10 gram-positive cocci, 2 gram-positive bacilli, 66 gram-negative rods, and 24 mixed growth. The sensitivity/specificity of the UF-1000i was 81.8/91.1% for gram-negative rods and 23.5/96.9% for cocci/mixed. The sensitivity/specificity of the UF-5000 was 80.0/88.2% for gram negative rods and 70.0/86.5% for gram-positive cocci.ConclusionsThe UF-5000 demonstrated the good sensitivity and specificity for Gram-negative bacilli bacteria and demonstrated an improved sensitivity for detecting Gram-positive cocci.

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Nomogram for Predicting COVID-19 Disease Progression Based on Single-Center Data: Observational Study and Model Development (Preprint)

10.2196/preprints.19588 ◽

2020 ◽

Author(s):

Tao Fan ◽

Bo Hao ◽

Shuo Yang ◽

Bo Shen ◽

Zhixin Huang ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Clinical Characteristics ◽

Cox Regression ◽

Disease Onset ◽

Lasso Regression ◽

Prediction Ability ◽

Calibration Curves ◽

Independent Risk Factors ◽

Critical Patients

BACKGROUND In late December 2019, a pneumonia caused by SARS-CoV-2 was first reported in Wuhan and spread worldwide rapidly. Currently, no specific medicine is available to treat infection with COVID-19. OBJECTIVE The aims of this study were to summarize the epidemiological and clinical characteristics of 175 patients with SARS-CoV-2 infection who were hospitalized in Renmin Hospital of Wuhan University from January 1 to January 31, 2020, and to establish a tool to identify potential critical patients with COVID-19 and help clinical physicians prevent progression of this disease. METHODS In this retrospective study, clinical characteristics of 175 confirmed COVID-19 cases were collected and analyzed. Univariate analysis and least absolute shrinkage and selection operator (LASSO) regression were used to select variables. Multivariate analysis was applied to identify independent risk factors in COVID-19 progression. We established a nomogram to evaluate the probability of progression of the condition of a patient with COVID-19 to severe within three weeks of disease onset. The nomogram was verified using calibration curves and receiver operating characteristic curves. RESULTS A total of 18 variables were considered to be risk factors after the univariate regression analysis of the laboratory parameters (P<.05), and LASSO regression analysis screened out 10 risk factors for further study. The six independent risk factors revealed by multivariate Cox regression were age (OR 1.035, 95% CI 1.017-1.054; P<.001), CK level (OR 1.002, 95% CI 1.0003-1.0039; P=.02), CD4 count (OR 0.995, 95% CI 0.992-0.998; P=.002), CD8 % (OR 1.007, 95% CI 1.004-1.012, P<.001), CD8 count (OR 0.881, 95% CI 0.835-0.931; P<.001), and C3 count (OR 6.93, 95% CI 1.945-24.691; P=.003). The areas under the curve of the prediction model for 0.5-week, 1-week, 2-week and 3-week nonsevere probability were 0.721, 0.742, 0.87, and 0.832, respectively. The calibration curves showed that the model had good prediction ability within three weeks of disease onset. CONCLUSIONS This study presents a predictive nomogram of critical patients with COVID-19 based on LASSO and Cox regression analysis. Clinical use of the nomogram may enable timely detection of potential critical patients with COVID-19 and instruct clinicians to administer early intervention to these patients to prevent the disease from worsening.

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Risk factors and clinical features of deterioration in COVID-19 patients in Zhejiang, China: a single- centre, retrospective study

10.21203/rs.3.rs-22481/v4 ◽

2020 ◽

Author(s):

Ping Yi ◽

Xiang Yang ◽

Cheng Ding ◽

Yanfei Chen ◽

Kaijin Xu ◽

...

Keyword(s):

Risk Factors ◽

T Lymphocyte ◽

Lymphocyte Count ◽

Clinical Characteristics ◽

B Lymphocyte ◽

Blood Cell Count ◽

Single Centre ◽

Multiple Factors ◽

Independent Risk Factors ◽

Severity Of The Disease

Abstract BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection swept through Wuhan and spread across China and overseas beginning in December 2019. To identify predictors associated with disease progression, we evaluated clinical risk factors for exacerbation of SARS-CoV-2 infection.MethodsA retrospective analysis was used for PCR-confirmed COVID-19 (coronavirus disease 2019)-diagnosed hospitalized cases between January 19, 2020, and February 19, 2020, in Zhejiang, China. We systematically analysed the clinical characteristics of the patients and predictors of clinical deterioration.ResultsOne hundred patients with COVID-19, with a median age of 54 years, were included. Among them, 49 patients (49%) had severe and critical disease. Age ([36-58] vs [51-70], P=0.0001); sex (49% vs 77.6%, P=0.0031); Body Mass Index (BMI ) ([21.53-25.51] vs [23.28-27.01], P=0.0339); hypertension (17.6% vs 57.1%, P<0.0001); IL-6 ([6.42-30.46] vs [16.2-81.71], P=0.0001); IL-10 ([2.16-5.82] vs [4.35-9.63], P<0.0001); T lymphocyte count ([305- 1178] vs [167.5-440], P=0.0001); B lymphocyte count ([91-213] vs [54.5-163.5], P=0.0001); white blood cell count ([3.9-7.6] vs [5.5-13.6], P=0.0002); D2 dimer ([172-836] vs [408-953], P=0.005), PCT ([0.03-0.07] vs [0.04-0.15], P=0.0039); CRP ([3.8-27.9] vs [17.3-58.9], P<0.0001); AST ([16, 29] vs [18, 42], P=0.0484); artificial liver therapy (2% vs 16.3%, P=0.0148); and glucocorticoid therapy (64.7% vs 98%, P<0.0001) were associated with the severity of the disease. Age and weight were independent risk factors for disease severity.ConclusionDeterioration among COVID-19-infected patients occurred rapidly after hospital admission. In our cohort, we found that multiple factors were associated with the severity of COVID19. Early detection and monitoring of these indicators may reduce the progression of the disease. Removing these factors may halt the progression of the disease. In addition, Oxygen support, early treatment with low doses of glucocorticoids and liver therapy, when necessary, may help reduce mortality in critically ill patients.

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