scholarly journals The timeline and risk factors of clinical progression of COVID-19 in Shenzhen, China

2020 ◽  
Author(s):  
Fang Wang ◽  
Mengyuan Qu ◽  
Xuan Zhou ◽  
kai zhao ◽  
Changxiang Lai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Early Stage ◽  
Clinical Progression ◽  
Stable Group ◽  
Progressive Group ◽  
Potential Risk Factors ◽  
Novel Coronavirus ◽  
High Level ◽  
Clinical Records

Abstract Background The novel coronavirus disease 2019(COVID-19) broke out globally. Early prediction of the clinical progression was essential but still unclear. We aimed to evaluate the timeline of COVID-19 development and analyze risk factors of disease progression.Methods In this retrospective study, we included 333 patients with laboratory-confirmed COVID-19 infection hospitalized in the Third People's Hospital of Shenzhen from 10 January to 10 February 2020. Epidemiological feature, clinical records, laboratory and radiology manifestations were collected and analyzed. 323 patients with mild-moderate symptoms on admission were observed to determine whether they exacerbated to severe-critically ill conditions (progressive group) or not (stable group). We used logistic regression to identify the risk factors associated with clinical progression.Results Of all the 333 patients, 70(21.0%) patients progressed into severe-critically ill conditions during hospitalization and assigned to the progressive group, 253(76.0%) patients belonged to the stable group, another 10 patients were severe before admission. we found that the clinical features of aged over 40 (3.80[1.72, 8.52]), males (2.21[1.20, 4.07]), with comorbidities (1.78[1.13, 2.81]) certain exposure history (0.38[0.20, 0.71]), abnormal radiology manifestations (3.56[1.13, 11.40]), low level of T lymphocytes (0.99[0.997, 0.999]), high level of NLR (0.99[0.97, 1.01]), IL-6 (1.05[1.03, 1.07]) and CRP (1.67[1.12, 2.47]) were the risk factors of disease progression by logistic regression.Conclusions the potential risk factors of males, older age, with comorbidities, low T lymphocyte level and high level of NLR, CRP, IL-6 can help to predict clinical progression of COVID-19 at an early stage.

scholarly journals Epidemiological,clinical and radiological findings in medical staff with COVID-19 in Wuhan, China: a single-centered, retrospective cohort study

2020 ◽  
Author(s):  
Jie Liu ◽  
Liu Ouyang ◽  
Pi Guo ◽  
Haisheng Wu ◽  
Peng Fu ◽  
...  
Keyword(s):  
Small Proportion ◽  
Medical Staff ◽  
Cox Regression ◽  
Early Stage ◽  
Wholesale Market ◽  
Regression Methods ◽  
Kaplan Meier ◽  
Union Hospital ◽  
Potential Risk Factors ◽  
Novel Coronavirus

Abstract Backgrounds In December 2019, a pneumonia associated with the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) emerged in Wuhan city, China. As of 20 Feb 2020, a total of 2,055 medical staff infected with SARS-Cov-2 in China had been reported. The predominant cause of the infection and the failure of protection among medical staff remains unclear. We sought to explore the epidemiological, clinical characteristics and prognosis of novel coronavirus-infected medical staff.Methods Medical staff who infected with SARS-Cov-2 and admitted to Union Hospital, Wuhan between 16 Jan, 2020 to 25 Feb, 2020 were included retrospectively. Epidemiological, clinical and radiological data were compared by occupation and analyzed with the Kaplan-Meier and Cox regression methods.Results A total of 101 medical staff (32 males and 69 females; median age: 33 years old) were included in this study and 74% were nurses. None had an exposure to Huanan seafood wholesale market or wildlife. A small proportion of the cohort had contact with specimens (3%) as well as patients infected with SARS-Cov-2 in fever clinics (15%) and isolation wards (3%). 80% of medical staff showed abnormal IL-6 levels and 33% had lymphocytopenia. Chest CT mainly manifested as bilateral (62%), septal/subpleural (77%) and ground­glass opacities (48%). The major differences between doctors and nurses manifested in laboratory indicators. As of the last observed date, no patient was transferred to intensive care unit or died, and 98 (97%) had been discharged. Fever (HR=0.57; 95% CI 0.36-0.90) and IL-6 levels greater than >2.9 pg/ml (HR=0.50; 95% CI 0.30-0.86) on admission were unfavorable factors for discharge.Conclusions Our findings suggested that the infection of medical staff mainly occurred at the early stages of SARS-CoV-2 epidemic in Wuhan, and only a small proportion of infection had an exact mode. Meanwhile, medical staff infected with COVID-19 have relatively milder symptoms and favorable clinical course than other ordinary patients, which may be partly due to their medical expertise, younger age and less underlying diseases. The potential risk factors of presence of fever and IL-6 levels greater than >2.9 pg/ml could help to identify medical staff with poor prognosis at an early stage.

scholarly journals Incidence of Delirium in Critically Ill Cancer Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Luis A. Sánchez-Hurtado ◽  
Nancy Hernández-Sánchez ◽  
Mario Del Moral-Armengol ◽  
Humberto Guevara-García ◽  
Francisco J. García-Guillén ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Cancer Patients ◽  
Critically Ill ◽  
Potential Risk ◽  
Assessment Method ◽  
Icu Stay ◽  
Potential Risk Factors

Objective. The aim of this study was to estimate the incidence of delirium and its risk factors among critically ill cancer patients in an intensive care unit (ICU). Materials and Methods. This is a prospective cohort study. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was measured daily at morning to diagnose delirium by a physician. Delirium was diagnosed when the daily was positive during a patient’s ICU stay. All patients were followed until they were discharged from the ICU. Using logistic regression, we estimated potential risk factors for developing delirium. The primary outcome was the development of ICU delirium. Results. There were 109 patients included in the study. Patients had a mean age of 48.6 ± 18.07 years, and the main reason for admission to the ICU was septic shock (40.4%). The incidence of delirium was 22.9%. The mortality among all subjects was 15.6%; the mortality rate in patients who developed delirium was 12%. The only variable that had an association with the development of delirium in the ICU was the days of use of mechanical ventilation (OR: 1.06; CI 95%: 0.99–1.13;p=0.07). Conclusion. Delirium is a frequent condition in critically ill cancer patients admitted to the ICU. The duration in days of mechanical ventilation is potential risk factors for developing delirium during an ICU stay. Delirium was not associated with a higher rate of mortality in this group of patients.

Skin Integrity in Critically Ill and Injured Children

2007 ◽  
Vol 16 (6) ◽  
pp. 568-574 ◽  
Author(s):  
Christine A. Schindler ◽  
Theresa A. Mikhailov ◽  
Kay Fischer ◽  
Gloria Lukasiewicz ◽  
Evelyn M. Kuhn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Ventilatory Support ◽  
Pediatric Intensive Care ◽  
Cost Of Care ◽  
Respiratory Illnesses ◽  
Skin Breakdown ◽  
Potential Risk Factors

Background Skin breakdown increases the cost of care, may lead to increased morbidity, and has negative psychosocial implications because of secondary scarring or alopecia. The scope of this problem has not been widely studied in critically ill and injured children. Objectives To determine the incidence of skin breakdown in critically ill and injured children and to compare the characteristics of patients who experience skin breakdown with those of patients who do not. Methods Admission and follow-up data for a 15-week period were collected retrospectively on children admitted to a large pediatric intensive care unit. The incidence of skin breakdown was calculated. The risk for skin breakdown associated with potential risk factors (relative risk) and 95% confidence intervals were determined. Results The sample consisted of 401 distinct stays in the intensive care unit for 373 patients. During the 401 stays, skin breakdown occurred in 34 (8.5%), redness in 25 (6.2%), and breakdown and redness in 13 (3.2%); the overall incidence was 18%. Patients who had skin breakdown or redness were younger, had longer stays, and were more likely to have respiratory illnesses and require mechanical ventilatory support than those who did not. Patients who had skin breakdown or redness had a higher risk of mortality than those who did not. Conclusions Risk factors for skin breakdown were similar to those previously reported. Compared with children of other ages, children 2 years or younger are at higher risk for skin breakdown.

scholarly journals The independent risk factors of early diarrhoea in enteral nutrition for ICU patients

2019 ◽  
Vol 47 (10) ◽  
pp. 4929-4939 ◽  
Author(s):  
Weiting Chen ◽  
Hehao Wang ◽  
Yingzi Chen ◽  
Danqin Yuan ◽  
Renhui Chen
Keyword(s):  
Risk Factors ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Early Stage ◽  
Multivariate Logistic Regression Analysis ◽  
Severity Of Illness ◽  
Icu Patients ◽  
Feeding Method ◽  
Prokinetic Agents ◽  
Independent Risk Factors

Objective To investigate the prevalence of and factors associated with diarrhoea in the early stage of enteral nutrition in critically ill patients in intensive care units (ICUs). Methods This prospective, multicentre, observational study enrolled consecutive patients who were newly admitted to ICUs and received enteral nutrition treatment. Events were observed continuously for 7 days or until patients were transferred out of the ICU after enteral nutrition. Demographic and clinical data, enteral nutrition data, diarrhoea-related data and outcomes were recorded. A multivariate logistic regression analysis was used to analyse the risk factors for diarrhoea. Results The study included 533 patients, of whom 164 (30.8%) developed diarrhoea. Diarrhoea was most commonly observed on the first to third days after starting enteral nutrition treatment. The median (interquartile range) duration of diarrhoea was 2 (1–3) days. The administration of gastrointestinal prokinetic agents, the increase in acute physiological and chronic health scores and the pyloric posterior feeding method were independent risk factors for diarrhoea. Conclusion The increased severity of illness, the administration of gastrointestinal prokinetic agents and the pyloric posterior feeding method were independent risk factors for diarrhoea in critically ill ICU patients undergoing enteral nutrition treatment.

scholarly journals The decrease of CD4 T cell is associated with mortality in critical inpatients with COVID-19

2020 ◽  
Author(s):  
Jun Xiong ◽  
Mei Yang ◽  
Weize Yang ◽  
Xiaomin Luo ◽  
Ke Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
T Cell ◽  
Cell Count ◽  
Intravenous Immunoglobulin ◽  
Critically Ill ◽  
Cardiac Troponin ◽  
Cd4 T Cell ◽  
Critical Patients ◽  
Clinical Records ◽  
D Dimer

Abstract Background The 2019 novel coronavirus (SARS-CoV-2) has caused an outbreak in the world. The critically ill patients had a high mortality. However, the possible risk factors of critical patients with coronavirus disease 2019 (COVID-19) are not fully known. We aim to investigate the risk factors in critical patients with COVID-19 and to address their role in predicting disease progression.Methods In this single-centered, retrospective, observational study, we enrolled 91 critically ill adult patients with COVID-19 in Renmin Hospital of Wuhan University between Jan 20, 2020 and Feb 28, 2020. Data were collected using a standard method including clinical records and laboratory findings.Results 39 patients (42.9%) were dead and 52 patients (57.1%) were cured and discharged before Mar 22, 2020. CD4 T cell count, CD8 T cell count and glomerular filtration rate were significantly lower in non-survivors than in survivors. However, the non-survivors presented a higher proportion of D-dimer, Cardiac troponin and immunoglobulin G than in survivors. Intravenous immunoglobulin was more common in survivors than in non-survivors. On multivariate analysis, D-dimer (༞1 µg/mL, OR = 9.53, 95% CI, 2.53–35.88), CD4 + T count (༜200/µl, OR = 9.68, 95%CI, 2.76-40.00 ) and cardiac troponin (༞0.04 ng/mL, OR = 5.73, 95% CI, 1.86–17.66) were independent risk factors for mortality.Conclusion The decrease of CD4 T cell is associated with higher risk mortality in critical inpatients with COVID-19. Intravenous immunoglobulin was more common in survivors than in non-survivors.

scholarly journals Early Prediction of Disease Progression in 2019 Novel Coronavirus Pneumonia Patients Outside Wuhan with CT and Clinical Characteristics

2020 ◽  
Author(s):  
Zhichao Feng ◽  
Qizhi Yu ◽  
Shanhu Yao ◽  
Lei Luo ◽  
Junhong Duan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Disease Progression ◽  
Severity Score ◽  
Clinical Characteristics ◽  
Lung Involvement ◽  
Multivariate Logistic Regression ◽  
Short Term ◽  
Progressive Group ◽  
Novel Coronavirus

AbstractObjectiveTo determine the predictive value of CT and clinical characteristics for short-term disease progression in patients with 2019 novel coronavirus pneumonia (NCP).Materials and Methods224 patients with confirmed 2019 novel coronavirus (COVID-19) infection outside Wuhan who had chest CT examinations were retrospectively screened. Clinical data were obtained from electronic medical records. CT images were reviewed and scored for lesion distribution, lobe and segment involvement, ground-glass opacities, consolidation, and interstitial thickening. All included patients with moderate NCP were observed for at least 14 days from admission to determine whether they exacerbated to severe NCP (progressive group) or not (stable group). CT and clinical characteristics between the two groups were compared, and multivariate logistic regression and sensitivity analyses were performed to identify the risk factors for developing severe NCP.ResultsA total of 141 patients with moderate NCP were included, of which 15 (10.6%) patients developed severe NCP during hospitalization and assigned to the progressive group. Multivariate logistic regression analysis showed that higher neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] and 95% confidence interval [CI], 1.26 [1.04-1.53]; P = 0.018) and CT severity score (OR and 95% CI, 1.25 [1.08-1.46]; P = 0.004) on admission were independent predictors for progression to severe NCP, and sensitivity analysis confirmed the consistent results in nonimported patients but not in imported patients. However, no significant difference in lung involvement was found on CT between imported and nonimported patients (all P > 0.05). Patients who were admitted more than 4 days from symptom onset tended to have more severe lung involvement. Spearman correlation analysis showed the close association between CT severity score and inflammatory indexes (r = 0.17∼0.47, all P < 0.05).ConclusionCT severity score was associated with inflammatory levels and higher NLR and CT severity score on admission were independent risk factors for short-term progression in patients with NCP outside Wuhan. Furthermore, early admission and surveillance by CT should be recommended to improve clinical outcomes.

scholarly journals Temporal Dynamics in Clinical and Laboratory Manifestations During COVID-19 Progression

2020 ◽  
Author(s):  
Lin-Lin Ye ◽  
Wen-Bei Peng ◽  
Xiao-Shan Wei ◽  
Xu Wang ◽  
Zi-Hao Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Temporal Dynamics ◽  
Early Stage ◽  
White Blood Cells ◽  
Smoking History ◽  
Stable Group ◽  
Laboratory Findings ◽  
Associated Risk Factors ◽  
D Dimer ◽  
Time Point

Abstract BAckground Severe COVID-19 patients account for most of the mortality of this disease. Early detection of severe cases of the disease remains a major challenge. Here, we performed clinical and laboratory profiling of COVID-19 to explore the early warning indicators of severe cases. Methods An analysis of the evolution during the hospitalization of clinical and laboratory findings from 78 confirmed COVID-19 patients and the associated risk factors. Results Of the 78 patients who were classified as un-severe at admission, 60 patients(stable group) were stable as mild cases until discharge, and the remaining 18 patients progressed to severe cases(exacerbated group) during hospitalization. Compared with stable patients, exacerbated patients exhibited older, higher BMI values and higher proportion of smokers. In the exacerbated patients, the median time from onset to deterioration was 7.5 days. Before the time point(days 0–7 from onset), we observed higher-levels of White blood cells(WBC), neutrophil, Neutrophi-Lymphocyte-Ratio(NLR), Lactose-dehydrogenase(LDH), D-dimer, and lower-levels of albumin in the exacerbated group, compared with the stable group. In the second week after the time point, the exacerbated patients displayed lower numbers of lymphocytes, CD3+, and CD8+T-cells, and higher-levels of C-reactive protein(CRP), erythrocyte-sedimentation-rate(ESR), Alanine-aminotransferase(ALT),Aspartate-aminotransferase(AST), and Interleukin-6. In the third week, the highest temperature and the proportion of febrile patients declined. All of the laboratory indicators gradually improved. Conclusions Advanced age and smoking history could be risk factors for COVID-19 progression. In the early stage, high-levels of WBC and neutrophils, with noticeably increased LDH and D-dimer, could be early indicators of the disease’s conversion from mild to severe, followed by elevated inflammatory markers, liver enzymes, and decreased T-lymphocytes in the next week.

scholarly journals Identifying and quantifying robust risk factors for mortality in critically ill patients with COVID-19 using quantile regression

2020 ◽  
Author(s):  
Zeqiang Linli ◽  
Yinyin Chen ◽  
Shuixia Guo
Keyword(s):  
Risk Factors ◽  
Quantile Regression ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Early Stage ◽  
Skewed Distribution ◽  
Risk Indicator ◽  
Fatality Risk ◽  
Cell Counts

Abstract Objective: Many laboratory indicators form a skewed distribution with outliers, for which robust methods are needed to precisely determine and quantify fatality risk factors.Method: A total of 192 critically ill patients (142 were discharged and 50 died in the hospital) with COVID-19 were included in the sample. Quantile regression was used to determine discrepant laboratory indexes between survivors and non-survivors and quantile shift (QS) was used to quantify the difference. Logistic regression was then used to calculate the odds ratio (OR) and the predictive power of death for each risk indicator. Results: After adjusting for multiple comparisons and controlling numerous confounders, quantile regression revealed that the laboratory indexes of non-survivors were significantly higher in C-reactive protein (CRP; QS = 0.835, p <0.001), white blood cell counts (WBC; QS = 0.743, p <0.001), glutamic oxaloacetic transaminase (AST; QS = 0.735, p <0.001), blood glucose (BG; QS = 0.608, p = 0.059), fibrin degradation product (FDP; QS = 0.730, p = 0.080), and partial pressure of carbon dioxide (PCO2), and lower in oxygen saturation (SO2; QS = 0.312, p <0.001), calcium (Ca2+; QS = 0.306, p = 0.073), and PH. Most of these abnormalities were associated with increased fatality risk and can predict the probability of death, especially, CRP which is the most prominent index with an odds ratio of 205.97 and predictive accuracy of 93.2%.Conclusion: Laboratory indexes provided reliable information on mortality in critically ill patients, which might help improve clinical prediction and treatment at an early stage.

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