Epidemiology and Mortality Predictors for Severe Childhood Pneumonia in ICUs: A Real-World Study in China

Abstract Background To identify the epidemiology and mortality predictors for severe childhood pneumonia and evaluate the influence of medications on clinical outcome in the real world.Methods We performed a retrospective observation study among children with severe pneumonia aged ≤ 5 years of age, separately comparing the detailed information between the in-hospital death cases and the survival cases in two different age groups. Multivariate regression model was used to figure out mortality predictors.Results 945 children were recruited, including 604 infants and 341 young children. Overall 88 deaths occurred (9.3%). There was low adherence to guidelines in antimicrobials and carbapenems were widely served as initial empiric regimens, but the efficacy was not superior to the guidelines recommended. In multivariate analyses, very severe pneumonia (OR: 3.55; 95% CI: 1.39–9.09), lower birth weight (OR: 3.92; 95% CI: 1.50-10.23), severe underweight (OR: 4.72; 95% CI: 1.92–11.62), mechanical ventilation (OR: 5.06; 95% CI: 1.97–12.95;OR: 14.43; 95% CI 3.31–62.96),comorbidity including anemia (OR: 5.61; 95% CI: 2.36–13.35), neonatal asphyxia (OR: 6.03; 95% CI: 1.57–23.12), gastrointestinal hemorrhage (OR: 3.73; 95% CI: 1.21–11.48) and sedative-hypnotics ( OR: 4.32; 95% CI: 1.76–10.61; OR: 4.13; 95% CI༚1.50-11.38) were independent risk factors for death, whereas a lower mortality was present in infants with probiotics (OR: 0.24; 95% CI: 0.10–0.54).Conclusions Severe pneumonia remains a primary cause of death in children under 5 years of age. Clinical characteristics, comorbidity and medications are evidently associated with death. Importantly, we should pay particular attention to the identification of the mortality predictors and establish prophylactic measures to reduce the mortality.

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Epidemiology and Mortality Predictors for Severe Childhood Community-acquired Pneumonia in ICUs: A Case-control Study

10.21203/rs.3.rs-228019/v1 ◽

2021 ◽

Author(s):

lu cao ◽

zhuo li ◽

zhaohua ji ◽

yan zuo ◽

jingwen wang

Keyword(s):

Case Control Study ◽

Age Groups ◽

Severe Pneumonia ◽

Case Control ◽

Community Acquired Pneumonia ◽

Hospital Death ◽

Retrospective Case ◽

Prophylactic Measures ◽

Mortality Predictors ◽

Control Study

Abstract Background: To identify the epidemiology and mortality predictors for severe childhood community-acquired pneumonia (CAP) and evaluate the influence of medications on clinical outcome in the real world.Methods: We performed a retrospective case-control study among children with severe CAP aged ≤5 years of age, separately comparing the detailed information between the in-hospital death cases and the survival cases in two different age groups. Multivariate regression model was used to figure out mortality predictors.Results: 945 children were recruited, including 604 infants and 341 young children. Overall 88 deaths occurred (9.3%). There was low adherence to guidelines in antimicrobials and carbapenems were widely served as initial empiric regimens, but the efficacy was not superior to the guidelines recommended. In multivariate analyses, very severe pneumonia (OR: 3.55; 95% CI: 1.39-9.09), lower birth weight (OR: 3.92; 95% CI: 1.50-10.23), severe underweight (OR: 4.72; 95% CI: 1.92-11.62), mechanical ventilation (OR: 5.06; 95% CI: 1.97-12.95；OR：14.43; 95% CI 3.31-62.96)，comorbidity including anemia (OR: 5.61; 95% CI: 2.36-13.35), neonatal asphyxia (OR: 6.03; 95% CI: 1.57-23.12), gastrointestinal hemorrhage (OR: 3.73; 95% CI: 1.21-11.48) and sedative-hypnotics ( OR: 4.32; 95% CI: 1.76-10.61; OR: 4.13; 95% CI：1.50-11.38) were independent risk factors for death, whereas a lower mortality was present in infants with probiotics (OR: 0.24; 95% CI: 0.10-0.54).Conclusions: Severe pneumonia remains a primary cause of death in children under 5 years of age. Clinical characteristics, comorbidity and medications are evidently associated with death. Importantly, we should pay particular attention to the identification of the mortality predictors and establish prophylactic measures to reduce the mortality.

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Risk Factors of Very Severe Pneumonia Incidence in Children

Jurnal Respirologi Indonesia ◽

10.36497/jri.v40i4.147 ◽

2020 ◽

Vol 40 (4) ◽

pp. 243-250

Author(s):

Retno Asih Setyoningrum ◽

Hedi Mustiko

Keyword(s):

Risk Factors ◽

Severe Pneumonia ◽

Chi Square ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Childhood Pneumonia ◽

Risk Of Mortality ◽

Chi Square Test ◽

Independent Risk Factors ◽

In Infants And Children

Background: Childhood pneumonia is a significant cause of mortality and morbidity in developing countries. About 7-13% of childhood pneumonia present with very severe pneumonia with a high risk of mortality. Identification of risk factors is necessary for early intervention and better management. Methods: Analytic observational study with a cross-sectional approach was conducted with subjects of pneumonia patients aged 2-59 months admitted in Respirology Ward and PICU Department of Pediatrics Dr. Soetomo Surabaya from January 2017 to December 2018. Results: A total of 253 were roled in this study. Group with very severe pneumonia are 140 patients and 113 patients with severe pneumonia. Independent risk factors were analysed by chi-square test and Continuity Correction. Independent risk factors that intluence the incidence of very severe pneumonia in infants and children are patient's age (PR=1.365;P=0.009;95% confidence interval (CI)=1.089-1.712), low birth weight (PR=1.380;P=0.010;95% CI=1.115-1,708), prematurity (PR=1,412;P=0.007;95% CI=1,141-1,747), exclusive breastfeeding (PR=1,434;P=0.007;95% CI=1,093-1,880), nutritional status (PR=2,412;P

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Early prognostication of COVID-19 to guide hospitalisation versus outpatient monitoring using a point-of-test risk prediction score

Thorax ◽

10.1136/thoraxjnl-2020-216425 ◽

2021 ◽

pp. thoraxjnl-2020-216425

Author(s):

Felix Chua ◽

Rama Vancheeswaran ◽

Adrian Draper ◽

Tejal Vaghela ◽

Matthew Knight ◽

...

Keyword(s):

Operating Characteristic ◽

Predictive Accuracy ◽

Fatal Outcome ◽

Individual Characteristics ◽

Adverse Outcomes ◽

Hospital Death ◽

Outpatient Monitoring ◽

Characteristic Values ◽

Large Random Sample ◽

Mortality Predictors

IntroductionRisk factors of adverse outcomes in COVID-19 are defined but stratification of mortality using non-laboratory measured scores, particularly at the time of prehospital SARS-CoV-2 testing, is lacking.MethodsMultivariate regression with bootstrapping was used to identify independent mortality predictors in patients admitted to an acute hospital with a confirmed diagnosis of COVID-19. Predictions were externally validated in a large random sample of the ISARIC cohort (N=14 231) and a smaller cohort from Aintree (N=290).Results983 patients (median age 70, IQR 53–83; in-hospital mortality 29.9%) were recruited over an 11-week study period. Through sequential modelling, a five-predictor score termed SOARS (SpO2, Obesity, Age, Respiratory rate, Stroke history) was developed to correlate COVID-19 severity across low, moderate and high strata of mortality risk. The score discriminated well for in-hospital death, with area under the receiver operating characteristic values of 0.82, 0.80 and 0.74 in the derivation, Aintree and ISARIC validation cohorts, respectively. Its predictive accuracy (calibration) in both external cohorts was consistently higher in patients with milder disease (SOARS 0–1), the same individuals who could be identified for safe outpatient monitoring. Prediction of a non-fatal outcome in this group was accompanied by high score sensitivity (99.2%) and negative predictive value (95.9%).ConclusionThe SOARS score uses constitutive and readily assessed individual characteristics to predict the risk of COVID-19 death. Deployment of the score could potentially inform clinical triage in preadmission settings where expedient and reliable decision-making is key. The resurgence of SARS-CoV-2 transmission provides an opportunity to further validate and update its performance.

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Performance in complex life situations: effects of age, cognition, and walking speed in virtual versus real life environments

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00830-6 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Michal Kafri ◽

Patrice L. Weiss ◽

Gabriel Zeilig ◽

Moshe Bondi ◽

Ilanit Baum-Cohen ◽

...

Keyword(s):

Older Adults ◽

Heart Rate ◽

Virtual Environment ◽

Real World ◽

Age Groups ◽

Age Effects ◽

Shopping Mall ◽

Complex Task ◽

The Real ◽

Gait Parameters

Abstract Background Virtual reality (VR) enables objective and accurate measurement of behavior in ecologically valid and safe environments, while controlling the delivery of stimuli and maintaining standardized measurement protocols. Despite this potential, studies that compare virtual and real-world performance of complex daily activities are scarce. This study aimed to compare cognitive strategies and gait characteristics of young and older healthy adults as they engaged in a complex task while navigating in a real shopping mall and a high-fidelity virtual replica of the mall. Methods Seventeen older adults (mean (SD) age = 71.2 (5.6) years, 64% males) and 17 young adults (26.7 (3.7) years, 35% males) participated. In two separate sessions they performed the Multiple Errands Test (MET) in a real-world mall or the Virtual MET (VMET) in the virtual environment. The real-world environment was a small shopping area and the virtual environment was created within the CAREN™ (Computer Assisted Rehabilitation Environment) Integrated Reality System. The performance of the task was assessed using motor and physiological measures (gait parameters and heart rate), MET or VMET time and score, and navigation efficiency (cognitive performance and strategy). Between (age groups) and within (environment) differences were analyzed with ANOVA repeated measures. Results There were no significant age effects for any of the gait parameters but there were significant environment effects such that both age groups walked faster (F(1,32) = 154.96, p < 0.0001) with higher step lengths (F(1,32) = 86.36, p < 0.0001), had lower spatial and temporal gait variability (F(1,32) = 95.71–36.06, p < 0.0001) and lower heart rate (F(1,32) = 13.40, p < 0.01) in the real-world. There were significant age effects for MET/VMET scores (F(1,32) = 19.77, p < 0.0001) and total time (F(1,32) = 11.74, p < 0.05) indicating better performance of the younger group, and a significant environment effect for navigation efficiency (F(1,32) = 7.6, p < 0.01) that was more efficient in the virtual environment. Conclusions This comprehensive, ecological approach in the measurement of performance during tasks reminiscent of complex life situations showed the strengths of using virtual environments in assessing cognitive aspects and limitations of assessing motor aspects of performance. Difficulties by older adults were apparent mainly in the cognitive aspects indicating a need to evaluate them during complex task performance.

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Real world heart failure epidemiology and outcome: a population-based analysis of 1,990,162 heart failure patients

European Heart Journal ◽

10.1093/ehjci/ehaa946.0968 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Leszek ◽

M Zaleska-Kociecka ◽

D Was ◽

K Witczak ◽

K Bartolik ◽

...

Keyword(s):

Heart Failure ◽

Real World ◽

Age Groups ◽

Developed Countries ◽

Funding Source ◽

Newly Diagnosed ◽

The European Union ◽

Ministry Of Health ◽

The Real ◽

Incidence Prevalence

Abstract Background Heart failure (HF) is the leading cause of death and hospitalization in developed countries. Most of the information about HF is based on selected cohorts, the real epidemiology of HF is scarce. Purpose To assess trends in the real world incidence, prevalence and mortality of all in-and outpatients with HF who presented in public health system in 2009–2018 in Poland. Methods It is a retrospective analysis of 1,990,162 patients who presented with HF in Poland in years 2009–2018. It is a part of nationwide Polish Ministry of Health registry that collects detailed information for the entire Polish population (38,495,659 in 2013) since 2009. Detailed data within the registry were collected since 2013. HF was recorded if HF diagnosis was coded (ICD-10). Results The incidence of HF in Poland fell down from 2013 to reach 127,036 newly diagnosed cases (330 per 100,000 population) in 2018 that equals to 43.6% drop. This decrease was mainly driven by marked reduction in females (p<0.001; Fig. 1A) and HF of ischaemic etiology (HF-IE vs HF-nonIE, Fig. 1B. p<0.001). The HF incidence per 100,000 population decreased across all age groups with the greatest drop in the youngest (Table 1). The prevalence rose by 11.6% to reach 1,242,129 (3233 per 100,000 population) in 2018 with significantly greater increase in females and HF-IE (both p<0.0001, Fig. 1C and D, respectively). The HF prevalence per 100,000 population increased across all age groups except for the 70–79 years old. (Table 1). Mortality increased by 28.5% to reach 142,379 cases (370 per 100,000 population) in 2018. The rise was more pronounced among females (p=0.015, Fig. 1E) and in HF-IE (p<0.001, Fig. 1F). The HF mortality per 100 000 population increased across all age groups, except for the 50–59 subgroup (Table 1). Conclusions Heart failure incidence plummeted in years 2013–2018 in Poland due to drop in newly diagnosed HF-IE. Despite that fact, the prevalence and mortality increased with rising trends in HF-IE. Figure 1. Incidence, prevalence, mortality trends Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): The project is co-financed by the European Union from the European Social Fund under the Operational Programme Knowledge Education Development and it is being carried out by the Analyses and Strategies Department of the Polish Ministry of Health

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Efficacy and Safety of Teriflunomide in Multiple Sclerosis across Age Groups: Analysis from Pooled Pivotal and Real-world Studies

Journal of Central Nervous System Disease ◽

10.1177/11795735211028781 ◽

2021 ◽

Vol 13 ◽

pp. 117957352110287

Author(s):

Jiwon Oh ◽

Sandra Vukusic ◽

Klaus Tiel-Wilck ◽

Jihad Said Inshasi ◽

David Rog ◽

...

Keyword(s):

Multiple Sclerosis ◽

Real World ◽

Age Groups ◽

Phase Iii ◽

Efficacy And Safety ◽

Additional Group ◽

Disability Status ◽

Scale Scores ◽

Post Hoc ◽

Phase Ii And Iii

Background: Evidence suggests that efficacy and safety of disease-modifying treatments for multiple sclerosis may differ with age. We evaluate efficacy and safety of teriflunomide across age subgroups of patients from pooled clinical trials and real-world studies. Methods: Post hoc analyses of patients who received teriflunomide 14 mg in the pooled phase II and III TEMSO, TOWER, TENERE, and TOPIC core and extension studies (n = 1978), and the real-world Teri-PRO (n = 928) and TAURUS-MS I (n = 1126) studies were conducted. Data were stratified by age at study entry: ⩽25, >25 to ⩽35, >35 to ⩽45, and >45 years. In Teri-PRO and TAURUS-MS I, an additional group, >55 years, was assessed. Results: In the pooled core studies, teriflunomide reduced annualized relapse rate (ARR) versus placebo across all ages. Unadjusted ARRs remained low across age groups in pooled extensions (0.18-0.30), Teri-PRO (0.10-0.35), and TAURUS-MS I (0.14-0.35). Baseline Expanded Disability Status Scale scores were higher with age, but stable through core and extension studies (mean increases over 7 years: ⩽25 years, +0.59; >25 to ⩽35 years, +0.46; >35 to ⩽45 years, +0.35; >45 years, +0.81). Across age groups, adverse event (AE) incidences were 78.4% to 90.7% in pooled core and extension studies and Teri-PRO, and 29.2% to 37.7% in TAURUS-MS I; serious AE incidences were ⩽21.3% in all studies. In pooled phase III and Teri-PRO studies, lymphocyte count decreases over 1 year after initiating teriflunomide, and proportions of patients developing lymphopenia, were small across age groups. Conclusions: Teriflunomide efficacy was demonstrated regardless of age. Safety was generally consistent across age groups.

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Effectiveness of protected aminopenicillins in treatment of non-social pneumonia in children

Лечащий врач ◽

10.51793/os.2021.24.10.003 ◽

2021 ◽

Author(s):

Е.Е. Краснова ◽

В.В. Чемоданов ◽

Е.Г. Кузнецова

Keyword(s):

Viral Infections ◽

Respiratory Infections ◽

Acquired Resistance ◽

Age Groups ◽

Clinical Manifestations ◽

Severe Pneumonia ◽

Physical Symptoms ◽

Community Acquired Pneumonia ◽

Natural Activity ◽

Respiratory Viral Infections

Пневмония – острое инфекционно-воспалительное заболевание легких преимущественно бактериальной этиологии, характеризующееся выраженной в разной степени дыхательной недостаточностью, токсическими и респираторными нарушениями, локальными физикальными симптомами, а также инфильтративными изменениями на рентгенограмме. Заболеваемость внебольничными пневмониями повышается в октябре-декабре, достигая максимума в январе-апреле, коррелируя с сезонным повышением уровня острых респираторных вирусных инфекций. Схожесть симптомов дебюта пневмонии с проявлениями острых респираторных вирусных инфекций может привести к несвоевременной ее диагностике и, как следствие, к отсроченному началу лечения. Поэтому в период сезонной заболеваемости респираторными инфекциями должна повышаться настороженность врачей-педиатров в отношении внебольничной пневмонии. Антибактериальная терапия оказывает решающее влияние на прогноз пневмонии, поэтому при достоверном диагнозе или у больного в тяжелом состоянии с вероятным диагнозом ее следует начать незамедлительно. Выбор антибиотика в каждом случае внебольничной пневмонии проводят индивидуально с учетом природной активности препаратов в отношении предполагаемого возбудителя и их возможной приобретенной резистентности, тяжести и течения заболевания, наличия у пациента противопоказаний к использованию тех или иных антибиотиков. В статье приводятся сведения о диагностических критериях внебольничных пневмоний. Рассмотрены вопросы антибактериального лечения типичной нетяжелой пневмонии у детей разных возрастных групп амоксициллином с клавулановой кислотой и показана его эффективность. Результаты проведенного исследования позволяют заключить, что пероральное использование одного курса защищенного аминопенициллина эффективно при лечении типичной внебольничной нетяжелой пневмонии у детей разного возраста, о чем свидетельствует ликвидация основных клинических проявлений болезни в короткие сроки. Pneumonia is an acute infectious and inflammatory lung disease of predominantly bacterial etiology, characterized by respiratory failure, toxic and respiratory disorders, local physical symptoms, and infiltrative changes on the roentgenogram. The incidence of community-acquired pneumonia increases in October-December, reaching a maximum in January-April, correlating with the seasonal increase in the level of acute respiratory viral infections. The similarity of the symptoms of the onset of pneumonia with the manifestations of acute respiratory viral infections can lead to its untimely diagnosis and, as a consequence, to a delayed start of treatment. Therefore, during the period of seasonal morbidity with respiratory infections, the alertness of pediatricians in relation to community-acquired pneumonia should increase. Antibiotic therapy has a decisive influence on the prognosis of pneumonia, therefore, with a reliable diagnosis or in a patient in serious condition with a probable diagnosis, it should be started immediately. The choice of antibiotic in each case of community-acquired pneumonia is carried out individually, taking into account the natural activity of the drugs in relation to the alleged pathogen and their possible acquired resistance, the severity and course of the disease, the patient's contraindications to the use of certain antibiotics. The article provides information on the diagnostic criteria for community-acquired pneumonia. The issues of antibacterial treatment of typical non-severe pneumonia in children of different age groups with amoxicillin with clavulanic acid are considered and its effectiveness is shown. The results of the study allow us to conclude that the oral use of one course of protected aminopenicillin is effective in the treatment of typical community-acquired non-severe pneumonia in children of different ages, as evidenced by the elimination of the main clinical manifestations of the disease in a short time.

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Barriers to seeking timely treatment for severe childhood pneumonia in rural Bangladesh

Archives of Disease in Childhood ◽

10.1136/archdischild-2021-321993 ◽

2021 ◽

pp. archdischild-2021-321993

Author(s):

Kamal Ibne Amin Chowdhury ◽

Ishrat Jabeen ◽

Mahfuzur Rahman ◽

Abu Syed Golam Faruque ◽

Nur H Alam ◽

...

Keyword(s):

Severe Pneumonia ◽

Medical Attention ◽

Long Distance ◽

Childhood Pneumonia ◽

Delayed Treatment ◽

Rural Bangladesh ◽

Tertiary Hospitals ◽

Household Heads ◽

Facility Level ◽

Rural Mothers

ObjectiveDelays in seeking medical attention for childhood pneumonia may lead to increased morbidity and mortality. This study aimed at identifying the drivers of delayed seeking of treatment for severe childhood pneumonia in rural Bangladesh.MethodsWe conducted a formative study from June to September 2015 in one northern district of Bangladesh. In-depth interviews were conducted with 20 rural mothers of children under 5 years with moderate or severe pneumonia. We analysed the data thematically.ResultsWe found that mothers often failed to assess severity of pneumonia accurately due to lack of knowledge or misperception about symptoms of pneumonia. Several factors delayed timely steps that could lead to initiation of appropriate treatment. They included time lost in consultation with non-formal practitioners, social norms that required mothers to seek permission from male household heads (eg, husbands) before they could seek healthcare for their children, avoiding community-based public health centres due to their irregular schedules, lack of medical supplies, shortage of hospital beds and long distance of secondary or tertiary hospitals from households. Financial hardships and inability to identify a substitute caregiver for other children at home while the mother accompanied the sick child in hospital were other factors.ConclusionsThis study identified key social, economic and infrastructural factors that lead to delayed treatment for childhood pneumonia in the study district in rural Bangladesh. Interventions that inform mothers and empower women in the decision to seek healthcare, as well as improvement of infrastructure at the facility level could lead to improved behaviour in seeking and getting treatment of childhood pneumonia in rural Bangladesh.

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Early prediction of extubation failure in patients with severe pneumonia: a retrospective cohort study

Bioscience Reports ◽

10.1042/bsr20192435 ◽

2020 ◽

Vol 40 (2) ◽

Author(s):

He Yu ◽

Jian Luo ◽

Yuenan Ni ◽

Yuehong Hu ◽

Dan Liu ◽

...

Keyword(s):

Blood Glucose ◽

Medical Records ◽

Severe Pneumonia ◽

Extubation Failure ◽

Apache Ii ◽

Apache Ii Score ◽

Common Causes ◽

Independent Risk Factors ◽

Logistic Regressions ◽

Rbc Transfusion

Abstract Backgroud: Severe pneumonia is one of the most common causes for mechanical ventilation. We aimed to early identify severe pneumonia patients with high risk of extubation failure in order to improve prognosis. Methods: From April 2014 to December 2015, medical records of intubated patients with severe pneumonia in intensive care unit were retrieved from database. Patients were divided into extubation success and failure groups, and multivariate logistic regressions were performed to identify independent predictors for extubation failure. Results: A total of 125 eligible patients were included, of which 82 and 43 patients had extubation success and failure, respectively. APACHE II score (odds ratio (OR) 1.141, 95% confident interval (CI) 1.022–1.273, P = 0.019, cutoff at 17.5), blood glucose (OR 1.122, 95%CI 1.008–1.249, P = 0.035, cutoff at 9.87 mmol/l), dose of fentanyl (OR 3.010, 95%CI 1.100–8.237, P = 0.032, cutoff at 1.135 mg/d), and the need for red blood cell (RBC) transfusion (OR 2.774, 95%CI 1.062–7.252, P = 0.037) were independent risk factors for extubation failure. Conclusion: In patients with severe pneumonia, APACHE II score > 17.5, blood glucose > 9.87 mmol/l, fentanyl usage > 1.135 mg/d, and the need for RBC transfusion might be associated with higher risk of extubation failure.

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Rhabdomyolysis is Associated with Hospital Mortality in Patients with COVID-19

10.21203/rs.3.rs-90892/v1 ◽

2020 ◽

Author(s):

Yan Geng ◽

Yong-sheng Du ◽

Na Peng ◽

Ting Yang ◽

Shi-yu Zhang ◽

...

Keyword(s):

Kidney Injury ◽

Adverse Outcomes ◽

Hospital Death ◽

Proportional Hazard ◽

Coagulation Activation ◽

Virus Clearance ◽

Cox Proportional Hazard ◽

Independent Risk Factors ◽

Cox Proportional Hazard Regression ◽

Serum Myoglobin

Abstract Purpose: To evaluate the clinical features and outcomes of rhabdomyolysis (RM) in patients with COVID-19. Method: A single center retrospective cohort study of 1,014 consecutive hospitalized patients with confirmed COVID-19 at the Huoshenshan hospital in Wuhan, China, between February 17 and April 12, 2020. Results: The overall incidence of RM was 2.2%. Comparing with patients without RM, patients with RM tended to have a higher risk of deterioration, representing by higher ratio to be admitted to the intensive care unit (ICU) (90.9 % vs 5.3%, P<0.001), and to undergo mechanical ventilation (86.4 % vs 2.7% P<0.001). Compared with patients without RM, patients with RM had laboratory test abnormalities, including indicators of inflammation, coagulation activation and kidney injury. Patients with RM had a higher risk of hospital death (P < 0.001). Cox proportional hazard regression model confirmed that RM indicators, including peak creatine kinase (CK) >1000 IU/L (HR=6.46, 95% CI: 3.02-13.86), peak serum myoglobin (MYO) >1000 ng/mL (HR=9.85, 95% CI: 5.04-19.28) were independent risk factors for in-hospital death. Additionally, patients with COVID-19 that developed RM tended to have a delayed virus clearance.Conclusion: RM might be an important factor contributing to adverse outcomes of patients with COVID-19. Early detection and effective intervention of RM may help reduce deaths of patients with COVID-19.

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