Clinical Characteristics and Risk Factors of Mortality Among Severe COVID-19 Patients

Abstract Background:The novel corona virus is attacking several millions of people worldwide, resulting in death of almost a million and a half-humans. The rational of the current study was to detect clinical characteristics of severe COVID- 19 patients, and assessment of risk factors for death.Methodology:This retrospective cohort study included all laboratory confirmed COVID-19 patients with severe disease admitted to critical care unit in June and July 2020. All recorded data were collected,which included clinincal, radiological, and laboratory data, in addition to the outcome and duration of ICU stay.Statistical analysis was performed for obtaining descriptive information, comparison between living and dead patients,in addition to regression analysis to identify risk factors for mortality.Results:One hundred and three patients were included in the current study;cough and fever were the most common clinical presentations, and bilateral ground glass opacity was the most common radiological presentation. Patients had elevated values of neutrophils, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), serum ferritin, CRP, and D-dimer, also had longer ICU stay ,with reduced values of lymphocytes, and PaO2/FIO2 ratio. Most of these variables were more exaggerated in dead patients compared to living ones. Older age, lower values of PaO2/FIO2 ratio, and higher values of neutrophils, NLR, and D-dimer were predictors for death.Conclusion: Cough, fever and bilateral ground glass opacity were the most common clinical and radiological presentation of severe COVID 19. Older age, lower value of PaO2/FIO2 ratio, and higher values of D- dimer, neutrophil and NLR were risk factors associated with increased risk of mortality.

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Clinical characteristics and risk factors of Fulminant Mycoplasma pneumoniae pneumonia in children

10.21203/rs.2.22954/v1 ◽

2020 ◽

Author(s):

yaoyao ling ◽

Tongqiang Zhang ◽

Zhenli Zhu ◽

Jiao Tian ◽

yongsheng xu ◽

...

Keyword(s):

Risk Factors ◽

Pleural Effusion ◽

Mycoplasma Pneumoniae ◽

Clinical Characteristics ◽

Laboratory Data ◽

Clinical Manifestations ◽

Multivariate Logistic Regression Analysis ◽

Radiological Findings ◽

Mycoplasma Pneumoniae Pneumonia ◽

D Dimer

Abstract BACKGROUND: Analyze the clinical characteristics of Fulminant Mycoplasma pneumoniae pneumonia (FMPP), and explore the related factors predicting FMPP. METHODS: A retrospective case-control study was performed on 345 children with Mycoplasma pneumoniae pneumonia (MPP) hospitalized in our Hospital from January 2017 to June 2019. The clinical features, laboratory data and radiological findings were compared between the FMPP group, refractory Mycoplasma pneumoniae pneumonia (RMPP)group and general Mycoplasma pneumoniae pneumonia (GMPP) group. RESULTS: FMPP patients (n=69) had more severe presentations, higher incidence of extra-pulmonary complications and more serious radiological findings(P<0.05). And the days of fever and the days in hospital were longer, and FMPP patients also need more complicated treatments(P<0.05). Meanwhile, the levels of white blood cell count(WBC) ,C-reactive protein(CRP), lactic dehydrogenase (LDH), interleukin (IL)-6,ferritin, D-dimer, fibrinogen(FG),alanine aminotransferase(ALT) and the percentage of neutrophils in the FMPP group were significantly higher than those in the RMPP group and the GMPP group (both P<0.05). In ROC curve analysis, the percentage of neutrophils, WBC, CRP, LDH, IL-6, ferritin, D-dimer and ALT were contributed to identify FMPP patients. Multivariate logistic regression analysis showed that ferritin>174.15 ng/mL, IL-6>25.475pg/ml and pleural effusion had significant predictive effects on the early diagnosis of FMPP (P<0.01). Conclusion: FMPP patients presented more serious clinical manifestations. Ferritin>174.15 ng/mL, IL-6>25.475pg/ml and pleural effusion were high risk factors for FMPP.

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Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya

BMJ Global Health ◽

10.1136/bmjgh-2019-001715 ◽

2019 ◽

Vol 4 (5) ◽

pp. e001715 ◽

Cited By ~ 1

Author(s):

Liana Macpherson ◽

Morris Ogero ◽

Samuel Akech ◽

Jalemba Aluvaala ◽

David Gathara ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Clinical Characteristics ◽

Univariate Analysis ◽

Older Age ◽

Who Criteria ◽

Risk Of Death ◽

Increased Risk

IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population.

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Clinical and Laboratory Factors Associated with Severe Disease Course in Turkish Patients with SARS-COV-2 Infection

10.32592/ircmj.2021.23.2.283 ◽

2021 ◽

Keyword(s):

Risk Factors ◽

Severe Disease ◽

Laboratory Data ◽

Course Of Disease ◽

Neutrophil Lymphocyte Ratio ◽

Reactive Protein ◽

Pulmonary Infiltration ◽

Independent Risk Factors ◽

Turkish Patients ◽

D Dimer

Background: Coronavirus disease 2019 (COVID-19) can demonstrate different clinical spectra. Objectives: The current study aimed to analyze the clinical and laboratory risk factors of the severe course of disease in patients with COVID-19. Materials and Methods: Consecutive patients with a diagnosis of COVID-19 pneumonia were included in the present study. The demographic characteristics, comorbid diseases, symptoms, chest computed tomography (CT) findings, laboratory data, oxygen saturation (SpO2), and body temperature of the patients were recorded. The coexistence of pulmonary infiltration in CT and SpO2 of ≤ %93 on fingertip pulse oximeter was defined as the severe course of the disease. Results: A total of 475 patients were included in the current study. The mean age of the patients was 52.02±15.9 years, and 259 (54.5%) participants were male. The disease was mild and severe in 80% (n=380) and 20% (n=95) of the patients. The age of > 50 years, coexistence of hypertension (HT) and diabetes mellitus (DM), neutrophil/lymphocyte ratio (NLR) of > 4, high lactate dehydrogenase (LDH) of > 240 U/L, C-reactive protein (CRP) of > 8 mg/dL, and D-dimer of ≥ 1000 ng/mL were determined to be the risk factors for the severe course of the disease. Conclusion: Age, NLR, CRP, LDH, D-dimer, comorbidity, and coexistence of DM and HT were the independent risk factors for the severe course of the disease. The aforementioned factors should be taken into account during risk stratification and management of patients with COVID-19.

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Clinical characteristics of 134 convalescent patients with COVID-19 in Guizhou, China

10.21203/rs.3.rs-41986/v2 ◽

2020 ◽

Author(s):

Siqin Zhang ◽

Lin Liu ◽

Bin Yang ◽

Rou Li ◽

Jianhua Luo ◽

...

Keyword(s):

Clinical Characteristics ◽

Laboratory Data ◽

Ground Glass Opacity ◽

Ground Glass ◽

The Novel ◽

Positive Rate ◽

Discharged Patients ◽

Treatment Plans ◽

Normal Chest

Abstract Background: Previous studies have focused on the clinical characteristics of hospitalized patients with the novel 2019 coronavirus disease (COVID-19). Limited data are available for convalescent patients. This study aimed to evaluate the clinical characteristics of discharged COVID-19 patients.Methods: In this retrospective study, we extracted data for 134 convalescent patients with COVID-19 in Guizhou Provincial Staff Hospital from February 15 to March 31, 2020. Cases were analyzed on the basis of demographic, clinical, and laboratory data as well as radiological features. Results: Of 134 convalescent patients with COVID-19, 19 (14.2%) were severe cases, while 115 (85.8%) were non-severe cases. The median patient age was 33 years (IQR, 21.8 to 46.3), and the cohort included 69 men and 65 women. Compared with non-severe cases, severe patients were older and had more chronic comorbidities, especially hypertension, diabetes, and thyroid disease (P<0.05). Leukopenia was present in 32.1% of the convalescent patients and lymphocytopenia was present in 6.7%, both of which were more common in severe patients. 48 (35.8%) of discharged patients had elevated levels of alanine aminotransferase, which was more common in adults than in children (40.2% vs 13.6%, P=0.018). A normal chest CT was found in 61 (45.5%) patients during rehabilitation. Severe patients had more ground-glass opacity, bilateral patchy shadowing, and fibrosis. No significant differences were observed in the positive rate of IgG and/or IgM antibodies between severe and non-severe patients.Conclusion: Leukopenia, lymphopenia, ground-glass opacity, and fibrosis are common in discharged severe COVID-19 patients, and liver injury is common in discharged adult patients. We suggest physicians develop follow-up treatment plans based on the different clinical characteristics of convalescent patients.

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Neutrophil–Lymphocyte Ratio as a Predictive Factor of Growing Malignant Pulmonary Ground-glass Opacity

Cancer Management and Research ◽

10.2147/cmar.s319190 ◽

2021 ◽

Vol Volume 13 ◽

pp. 5651-5655

Author(s):

Wenfei Xue ◽

Xiaopeng Zhang ◽

Zhancong Niu ◽

Zhifei Xin ◽

Hua Zhang ◽

...

Keyword(s):

Predictive Factor ◽

Ground Glass Opacity ◽

Ground Glass ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio

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Characterization of Confirmed and Suspected COVID-19 Pneumonia Patients in a Retrospective Cohort Study in Wuhan

10.21203/rs.3.rs-92239/v1 ◽

2020 ◽

Author(s):

Maomao Xi ◽

Dan Cui ◽

Qiaomei Liu ◽

Lili Li ◽

Yilin Yin ◽

...

Keyword(s):

Risk Factors ◽

Lung Disease ◽

Mortality Risk ◽

Retrospective Cohort ◽

Clinical Characteristics ◽

Cox Regression ◽

Ground Glass Opacity ◽

Ground Glass ◽

Medical Attention ◽

Cox Regression Analysis

Abstract Background: A methodical comparison of confirmed and suspected COVID-19 patients has not been previously reported. Therefore, we thoroughly analyzed the demographic and clinical characteristics between these groups to identify mortality risk factors.Methods: A retrospective cohort of 1,276 hospitalized COVID-19 pneumonia patients at Tongren Hospital (Wuhan, China; January 27 to March 3, 2020) was studied. Cox regression analyses were performed to evaluate multiple mortality risk factors. Results: Both cohorts of confirmed (n=797) and suspected (n=479) patients exhibited typical demographic, clinical, and radiological characteristics. Treatment methods were consistent and both groups shared similarities in many demographic and clinical characteristics: age (≥65, 45.9% vs 41.8%, P=0.378) and lung disease (12.5% vs 14.6%, P=0.293). However, confirmed patients exhibited more severe disease manifestations than those in suspected patients: a higher incidence of fever (65.4% vs 58.0%, P<0.01), lower lymphocyte count (1.12×109/L vs 1.22×109/L, P=0.022), higher C-reactive protein (CRP) (11.60 mg/L vs 7.61mg/L, P=0.021), and more severe radiographic manifestations (lung infection incidence, 3.8% vs 3.0%, P=0.014; ground-glass opacity lesion incidence, 2.3% vs 2.0%, P=0.033). The dynamic profiles of lymphocytes, monocytes, D-dimer, and CRP, clearly delineated confirmed patients from suspected patients exhibiting critical illness. Cox regression analysis demonstrated that lung disease (adjusted hazard ratio 8.972, 95% CI: 3.782-21.283), cardiovascular disease (3.083, 1.347-7.059), neutrophil count (1.189, 1.081-1.307), age (1.068, 1.027-1.110), and ground-glass opacity lesions (1.039, 95% 1.013-1.065), were the main risk factors for mortality in confirmed patients; lung disease (14.725, 2.187-99.147), age (1.076, 1.004-1.153), and CRP level (1.012, 95% CI 1.004-1.020) were the primary factors in suspected patients.Conclusions: Suspected patients with serious illness should seek medical attention to reduce mortality. Multiple factors must be assessed to determine the mortality risk and the appropriate treatment.

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Clinical characteristics of 134 convalescent patients with COVID-19 in Guizhou, China

Respiratory Research ◽

10.1186/s12931-020-01580-0 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Siqin Zhang ◽

Lin Liu ◽

Bin Yang ◽

Rou Li ◽

Jianhua Luo ◽

...

Keyword(s):

Clinical Characteristics ◽

Laboratory Data ◽

Ground Glass Opacity ◽

Ground Glass ◽

The Novel ◽

Positive Rate ◽

Discharged Patients ◽

Treatment Plans ◽

Normal Chest

Abstract Background Previous studies have focused on the clinical characteristics of hospitalized patients with the novel 2019 coronavirus disease (COVID-19). Limited data are available for convalescent patients. This study aimed to evaluate the clinical characteristics of discharged COVID-19 patients. Methods In this retrospective study, we extracted data for 134 convalescent patients with COVID-19 in Guizhou Provincial Staff Hospital from February 15 to March 31, 2020. Cases were analyzed on the basis of demographic, clinical, and laboratory data as well as radiological features. Results Of 134 convalescent patients with COVID-19, 19 (14.2%) were severe cases, while 115 (85.8%) were non-severe cases. The median patient age was 33 years (IQR, 21.8 to 46.3), and the cohort included 69 men and 65 women. Compared with non-severe cases, severe patients were older and had more chronic comorbidities, especially hypertension, diabetes, and thyroid disease (P < 0.05). Leukopenia was present in 32.1% of the convalescent patients and lymphocytopenia was present in 6.7%, both of which were more common in severe patients. 48 (35.8%) of discharged patients had elevated levels of alanine aminotransferase, which was more common in adults than in children (40.2% vs 13.6%, P = 0.018). A normal chest CT was found in 61 (45.5%) patients during rehabilitation. Severe patients had more ground-glass opacity, bilateral patchy shadowing, and fibrosis. No significant differences were observed in the positive rate of IgG and/or IgM antibodies between severe and non-severe patients. Conclusion Leukopenia, lymphopenia, ground-glass opacity, and fibrosis are common in discharged severe COVID-19 patients, and liver injury is common in discharged adult patients. We suggest physicians develop follow-up treatment plans based on the different clinical characteristics of convalescent patients.

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Association between oxygen saturation, neutrophil-lymphocyte ratio and D-dimer with mortality based on clinical manifestation of COVID-19 patients

SCRIPTA MEDICA ◽

10.5937/scriptamed52-34641 ◽

2021 ◽

Vol 52 (4) ◽

pp. 284-288

Author(s):

Marwan Marwan ◽

Khalidi Rizqan ◽

Siti Khotimah ◽

Sri Wahyunie ◽

Kalalo Pertiwi ◽

...

Keyword(s):

Public Health ◽

Risk Factors ◽

Oxygen Saturation ◽

Global Public Health ◽

Peripheral Oxygen Saturation ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Chi Squared ◽

D Dimer

Background/Aim: Coronavirus 2019 (COVID-19) infection is caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). It has become an emergency condition for global public health. Oxygen saturation has important role for diagnosing the patient in the hospital. The neutrophil-lymphocyte ratio (NLR) is a marker for the viral inflammatory reaction to confirm the viral or bacterial infection. The D-dimer is also known as biomarker for severity and prognosis of COVID-19. The aim of the study was to investigate the risk factors of mortality in COVID-19 patients based on oxygen saturation, neutrophil-lymphocyte ratio and D-dimer. Methods: Data has been obtained from confirmed cases of COVID-19 in Abdul Wahab Sjahranie Hospital from October until November 2020. They were collected and analysed with Chi-squared test by SPSS 22.0 software. Results: There were 60 patients with SARS-CoV-2 infection in this study, 48 (80 %) patients survived and 12 (20 %) deceased. Peripheral oxygen saturation < 90 % had 13 (21.7 %) and ≥ 90 % had 47 (78.3 %) patients. There were 13 (21.7 %) patients with NLR value < 3.13 and ≥ 3.13 47 (78.3 %) patients. D-dimer value less than 0.5 had 9 (15 %) and ≥ 0.5 had 51 (85 %) patients. The results of statistical analysis have showed that there were relationship between oxygen saturation (p = 0.002) and survival rate of COVID patients. Conclusion: According to the research that has been conducted, there was correlation between oxygen saturation and mortality of COVID-19 patient. It could be used as biomarker to improve the management of COVID-19 patients.

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Clinical characteristics of 134 convalescent patients with COVID-19 in Guizhou, China

10.21203/rs.3.rs-41986/v1 ◽

2020 ◽

Author(s):

Siqin Zhang ◽

Lin Liu ◽

Bin Yang ◽

Rou Li ◽

Jianhua Luo ◽

...

Keyword(s):

Clinical Characteristics ◽

Laboratory Data ◽

Ground Glass Opacity ◽

Ground Glass ◽

The Novel ◽

Positive Rate ◽

Discharged Patients ◽

Treatment Plans ◽

Normal Chest

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OP0313 PRELIMINARY CRITERIA FOR MACROPHAGE ACTIVATION SYNDROME ASSOCIATED WITH CORONAVIRUS DISEASE-19

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3113 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 191.1-192

Author(s):

S. Amikishiyev ◽

M. G. Gunver ◽

M. Bektas ◽

S. Aghamuradov ◽

B. Ince ◽

...

Keyword(s):

Macrophage Activation Syndrome ◽

Macrophage Activation ◽

Laboratory Data ◽

Disease Onset ◽

Dynamic Changes ◽

Ferritin Concentration ◽

Neutrophil Lymphocyte Ratio ◽

Significant Difference ◽

D Dimer ◽

Activation Syndrome

Background:COVID-19 runs a severe disease associated with acute respiratory distress syndrome in a subset of patients, and a hyperinflammatory response developing in the second week contributes to the worse outcome. Inflammatory features are mostly compatible with macrophage activation syndrome (MAS) observed in other viral infections despite resulting in milder changes. Early detection and treatment of MAS may be associated with a better outcome. However, available criteria for MAS associated with other causes have not been helpful.Objectives:To identify distinct features of MAS associated with COVID-19 using a large database enabling to assess of dynamic changes.Methods:PCR-confirmed hospitalized COVID-19 patients followed between March and September 2020 constituted the discovery set. Patients considered to have findings of MAS by experienced physicians and given anakinra or tocilizumab were classified as the MAS group and the remaining patients as the non-MAS group. The MAS group was then re-grouped as the cases with exact-MAS and borderline-MAS cases by the study group. Clinical and laboratory data including the Ct values of the PCR test were obtained from the database, and dynamic changes were evaluated especially for the first 14 days of the hospitalization. The second set of 162 patients followed between September-December 2020 were used as the replication group to test the preliminary criteria. In the second set, hospitalization rules were changed, and all patients required oxygen support and received dexamethasone 6mg/day or equivalent glucocorticoids. Daily changes were calculated for the laboratory items in MAS, borderline, and non-MAS groups to see the days differentiating the groups, and ROC curves and lower and upper limits (10-90%) of the selected parameters were calculated to determine the cutoff values.Results:A total of 769 PCR-confirmed hospitalized patients were analysed, and 77 of them were classified as MAS and 83 as borderline MAS patients. There was no statistically significant difference in the baseline viral loads of MAS patients compared to the non-MAS group according to the Ct values. Daily dynamic changes in the MAS group differed from the non-MAS group especially around the 6th day of hospitalization, and more than a twofold increase in ferritin and a 1.5-fold increase in D-dimer levels compared to the baseline values help to define the MAS group. Twelve items selected for the criteria are given in Table 1 below. The total score of 45 provided 79.6% sensitivity for the MAS (including borderline cases) and 81.3% specificity around days 5 and 6 in the discovery set, and a score of 60 increased the specificity to 94.9% despite a decrease in sensitivity to 40.8%. The same set provided a similar sensitivity (80.3%) in the replication, but a lower specificity (47.4-66% on days 6 to 9) due to a group of control patients with findings of MAS possibly masked by glucocorticoids.Table 1.Preliminary Criteria for Macrophage Activation Syndrome Associated with Coronavirus Disease-191.Fever (>37.0 °C)2.Ferritin concentration > 550 ng/mL3.More than 2 times increase of ferritin concentration within 7 days of disease onset4.Neutrophil count > 6000 cell/mm35.Lymphopenia < 1000 cell/mm36.Neutrophil/lymphocyte ratio > 67.D-dimer concentration > 1000 ng/ml8.More than 50% increase of D-dimer concentration within 7 days of disease onset9.CRP concetration > 50 mg/L10.LDH concentration > 300 U/L11.ALT or AST concentration > 50 U/L12.Procalcitonin concentration < 1.21 point for each positive item assessed on Days 5-7Score calculation: Total points / 12 x 100Possible MAS ≥45 and Definite MAS ≥60Conclusion:This study defined a set of preliminary criteria using the most relevant items of MAS according to the dynamic changes in the parameters in a group of COVID-19 patients. A score of 45 would be helpful to define a possible MAS group with reasonable sensitivity and specificity to start necessary treatments as early as possible.Disclosure of Interests:None declared.

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