Identification of risk factors for in-hospital death of COVID - 19 pneumonia -- lessions from the early outbreak

Novel Coronavirus ◽

Abstract Objective: To examine the clinical characteristics and identify independent risk factors for in-hospital mortality of 2019 novel coronavirus (COVID-19) pneumonia.Methods: A total of 156 patients diagnosed with COVID-19 pneumonia at the central Hospital of Wuhan from January 29, 2020, to March 20, 2020 and 20 healthy individuals were enrolled in this single-centered retrospective study. The epidemiological parameters, clinical presentations, underlying diseases, laboratory test results and disease outcomes were collected and analyzed. Results: The median age of all enrolled patients was 66 years. At least one underlying disease was identified in 101 COVID-19 patients, with hypertension being the most common one, followed by cardiovascular disease and diabetes. The most common symptoms identified upon admission were fever, cough, dyspnea and fatigue. Compared to survival cases, patients who dead during hospitalization had higher plasma levels of D-dimer, creatinine, creatine kinase, lactate dehydrogenase, lactate and lower percentage of lymphocytes (LYM [%]), platelet count and albumin levels. Most enrolled patients received anti-biotics and anti-viral treatment. In addition, 60 patients received corticosteroid and 51 received intravenous immunoglobulin infusion. 44 patients received noninvasive ventilation and 19 received invasive ventilation. Respiratory failure was the most frequently observed complication (106 [67.9%]), followed by sepsis (103 [66.0%]), acute respiratory distress syndrome (ARDS) (67 [42.9%]) and septic shock (50 [32.1%]). Multivariable regression suggested that advanced age (OR [odds ratio]=1.098, 95% CI [confidence interval]: 1.006-1.199, P=0.037), shorter duration from onset to admission (OR= 0.853, 95% CI: 0.750-0.969, P=0.015) and elevated lactate level upon admission (OR= 2.689, 95% CI: 1.044-6.926, P=0.040) were independent risk factors for in-hospital mortality for COVID-19 infection. Meanwhile, increased LYM (%) at admission (OR= 0.787, 95% CI: 0.686-0.903, P=0.001) indicated a better prognosis. Conclusions: In this study, we discovered that age, duration from onset to admission, LYM (%) and lactate level upon admission were independent factors that affecting in-hospital mortality rate.

Identification of risk factors for in-hospital death of COVID - 19 pneumonia -- lessions from the early outbreak

BMC Infectious Diseases ◽

10.1186/s12879-021-05814-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhigang Wang ◽

Zhiqiang Wang

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Lactate Level ◽

Underlying Disease ◽

Lower Percentage ◽

Hospital Death ◽

Laboratory Test Results ◽

Novel Coronavirus ◽

Abstract Background To examine the clinical characteristics and identify independent risk factors for in-hospital mortality of 2019 novel coronavirus (COVID-19) pneumonia. Methods A total of 156 patients diagnosed with COVID-19 pneumonia at the Central Hospital of Wuhan from January 29, 2020, to March 20, 2020, and 20 healthy individuals were enrolled in this single-centered retrospective study. The epidemiological parameters, clinical presentations, underlying diseases, laboratory test results, and disease outcomes were collected and analyzed. Results The median age of all enrolled patients was 66 years. At least one underlying disease was identified in 101 COVID-19 patients, with hypertension being the most common one, followed by cardiovascular disease and diabetes. The most common symptoms identified upon admission were fever, cough, dyspnea, and fatigue. Compared to survival cases, patients who died during hospitalization had higher plasma levels of D-dimer, creatinine, creatine kinase, lactate dehydrogenase, lactate, and lower percentage of lymphocytes (LYM [%]), platelet count and albumin levels. Most enrolled patients received antibiotics and anti-viral treatment. In addition, 60 patients received corticosteroids, and 51 received intravenous immunoglobulin infusion. Forty-four patients received noninvasive ventilation and 19 received invasive ventilation. Respiratory failure was the most frequently observed complication (106 [67.9%]), followed by sepsis (103 [66.0%]), acute respiratory distress syndrome (ARDS) (67 [42.9%]), and septic shock (50 [32.1%]). Multivariable regression suggested that advanced age (OR [odds ratio] = 1.098, 95% CI [confidence interval]: 1.006–1.199, P = 0.037), shorter duration from onset to admission (OR = 0.853, 95% CI: 0.750–0.969, P = 0.015) and elevated lactate level upon admission (OR = 2.689, 95% CI: 1.044–6.926, P = 0.040) were independent risk factors for in-hospital mortality for COVID-19 infection. Meanwhile, increased LYM (%) at admission (OR = 0.787, 95% CI: 0.686–0.903, P = 0.001) indicated a better prognosis. Conclusions In this study, we discovered that age, duration from onset to admission, LYM (%), and lactate level upon admission were independent factors that affecting the in-hospital mortality rate.

Identification of risk factors for in-hospital death of COVID - 19 pneumonia -- lessions from the early outbreak

10.21203/rs.3.rs-42478/v3 ◽

2020 ◽

Author(s):

Zhigang Wang ◽

Zhiqiang Wang

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Lactate Level ◽

Underlying Disease ◽

Lower Percentage ◽

Hospital Death ◽

Laboratory Test Results ◽

Novel Coronavirus ◽

Abstract Objective: To examine the clinical characteristics and identify independent risk factors for in-hospital mortality of 2019 novel coronavirus (COVID-19) pneumonia.Methods: A total of 156 patients diagnosed with COVID-19 pneumonia at the Central Hospital of Wuhan from January 29, 2020, to March 20, 2020, and 20 healthy individuals were enrolled in this single-centered retrospective study. The epidemiological parameters, clinical presentations, underlying diseases, laboratory test results, and disease outcomes were collected and analyzed.Results: The median age of all enrolled patients was 66 years. At least one underlying disease was identified in 101 COVID-19 patients, with hypertension being the most common one, followed by cardiovascular disease and diabetes. The most common symptoms identified upon admission were fever, cough, dyspnea, and fatigue. Compared to survival cases, patients who died during hospitalization had higher plasma levels of D-dimer, creatinine, creatine kinase, lactate dehydrogenase, lactate, and lower percentage of lymphocytes (LYM [%]), platelet count and albumin levels. Most enrolled patients received antibiotics and anti-viral treatment. In addition, 60 patients received corticosteroids, and 51 received intravenous immunoglobulin infusion. 44 patients received noninvasive ventilation and 19 received invasive ventilation. Respiratory failure was the most frequently observed complication (106 [67.9%]), followed by sepsis (103 [66.0%]), acute respiratory distress syndrome (ARDS) (67 [42.9%]), and septic shock (50 [32.1%]).Multivariable regression suggested that advanced age (OR [odds ratio]=1.098, 95% CI [confidence interval]: 1.006-1.199, P=0.037), shorter duration from onset to admission (OR= 0.853, 95% CI: 0.750-0.969, P=0.015) and elevated lactate level upon admission (OR= 2.689, 95% CI: 1.044-6.926, P=0.040) were independent risk factors for in-hospital mortality for COVID-19 infection. Meanwhile, increased LYM (%) at admission (OR= 0.787, 95% CI: 0.686-0.903, P=0.001) indicated a better prognosis.Conclusions: In this study, we discovered that age, duration from onset to admission, LYM (%), and lactate level upon admission were independent factors that affecting the in-hospital mortality rate.

Identification of risk factors for in-hospital death of COVID - 19 pneumonia -- lessions from the early outbreak

10.21203/rs.3.rs-42478/v4 ◽

2021 ◽

Author(s):

Zhigang Wang ◽

Zhiqiang Wang

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Lactate Level ◽

Underlying Disease ◽

Lower Percentage ◽

Hospital Death ◽

Laboratory Test Results ◽

Novel Coronavirus ◽

Abstract Background: To examine the clinical characteristics and identify independent risk factors for in-hospital mortality of 2019 novel coronavirus (COVID-19) pneumonia.Methods: A total of 156 patients diagnosed with COVID-19 pneumonia at the Central Hospital of Wuhan from January 29, 2020, to March 20, 2020, and 20 healthy individuals were enrolled in this single-centered retrospective study. The epidemiological parameters, clinical presentations, underlying diseases, laboratory test results, and disease outcomes were collected and analyzed. Results: The median age of all enrolled patients was 66 years. At least one underlying disease was identified in 101 COVID-19 patients, with hypertension being the most common one, followed by cardiovascular disease and diabetes. The most common symptoms identified upon admission were fever, cough, dyspnea, and fatigue. Compared to survival cases, patients who died during hospitalization had higher plasma levels of D-dimer, creatinine, creatine kinase, lactate dehydrogenase, lactate, and lower percentage of lymphocytes (LYM [%]), platelet count and albumin levels. Most enrolled patients received antibiotics and anti-viral treatment. In addition, 60 patients received corticosteroids, and 51 received intravenous immunoglobulin infusion. 44 patients received noninvasive ventilation and 19 received invasive ventilation. Respiratory failure was the most frequently observed complication (106 [67.9%]), followed by sepsis (103 [66.0%]), acute respiratory distress syndrome (ARDS) (67 [42.9%]), and septic shock (50 [32.1%]). Multivariable regression suggested that advanced age (OR [odds ratio]=1.098, 95% CI [confidence interval]: 1.006-1.199, P=0.037), shorter duration from onset to admission (OR= 0.853, 95% CI: 0.750-0.969, P=0.015) and elevated lactate level upon admission (OR= 2.689, 95% CI: 1.044-6.926, P=0.040) were independent risk factors for in-hospital mortality for COVID-19 infection. Meanwhile, increased LYM (%) at admission (OR= 0.787, 95% CI: 0.686-0.903, P=0.001) indicated a better prognosis. Conclusions: In this study, we discovered that age, duration from onset to admission, LYM (%), and lactate level upon admission were independent factors that affecting the in-hospital mortality rate.

Identification of Risk Factors for in-Hospital Death of COVID - 19 Pneumonia

10.21203/rs.3.rs-30755/v1 ◽

2020 ◽

Author(s):

Zhigang Wang ◽

Zhiqiang Wang

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Lactate Level ◽

Lower Percentage ◽

Hospital Death ◽

Laboratory Test Results ◽

Multivariable Regression ◽

Novel Coronavirus ◽

Abstract Objective: To examine the clinical characteristics and identify independent risk factors for in-hospital mortality of 2019 novel coronavirus (COVID-19) pneumonia.Methods: A total of 156 patients diagnosed with COVID-19 pneumonia at the central Hospital of Wuhan from January 29, 2020, to March 20, 2020 were enrolled in this single-centered retrospective study. Their epidemiological parameters, clinical presentations, underlying diseases, laboratory test results and disease outcomes were collected and analyzed.Results: The median age of enrolled patients was 66. Underlying diseases were identified in 101 patients, with hypertension being the most common one, followed by cardiovascular disease and diabetes. The most common symptoms identified upon admission were fever, cough, dyspnea and fatigue. Compared to survival cases, patients who dead during hospitalization had higher plasma levels of D-dimer, creatinine, creatine kinase, lactate dehydrogenase, lactate and lower percentage of lymphocytes (LYM [%]), platelet count and albumin levels. Most enrolled patients received anti-biotics and anti-viral treatment. In addition, 60 patients received corticosteroid and 51 received intravenous immunoglobulin infusion. 44 patients received noninvasive ventilation, 19 received invasive ventilation. Respiratory failure was the most frequently observed complication (106 [67.9%]), followed by sepsis (103 [66.0%]), acute respiratory distress syndrome (ARDS) (67 [42.9%]) and septic shock (50 [32.1%]). Multivariable regression suggested that advanced age (OR [odds ratio]= 1.059, 95% CI [confidence interval]: 1.011-1.110, P= 0.016) and elevated lactate level upon admission (OR= 2.411, 95% CI: 1.177-4.941, P= 0.016) were independent risk factors for in-hospital mortality for COVID-19 infection. Meanwhile, increased LYM (%) at admission (OR= 0.798, 95% CI: 0.728-0.876, P< 0.001) indicated a better prognosis. Conclusions: In this study, we discovered that age, LYM (%) and lactate level upon admission were independent factors that could influence in-hospital mortality rate.

Identification of Risk Factors for in-hospital Death of COVID - 19 Pneumonia

10.21203/rs.3.rs-42478/v1 ◽

2020 ◽

Author(s):

Zhigang Wang ◽

Zhiqiang Wang

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Lactate Level ◽

Lower Percentage ◽

Hospital Death ◽

Laboratory Test Results ◽

Multivariable Regression ◽

Novel Coronavirus ◽

Abstract Objective: To examine the clinical characteristics and identify independent risk factors for in-hospital mortality of 2019 novel coronavirus (COVID-19) pneumonia.Methods: A total of 156 patients diagnosed with COVID-19 pneumonia at the central Hospital of Wuhan from January 29, 2020, to March 20, 2020 were enrolled in this single-centered retrospective study. Their epidemiological parameters, clinical presentations, underlying diseases, laboratory test results and disease outcomes were collected and analyzed. Results: The median age of enrolled patients was 66. Underlying diseases were identified in 101 patients, with hypertension being the most common one, followed by cardiovascular disease and diabetes. The most common symptoms identified upon admission were fever, cough, dyspnea and fatigue. Compared to survival cases, patients who dead during hospitalization had higher plasma levels of D-dimer, creatinine, creatine kinase, lactate dehydrogenase, lactate and lower percentage of lymphocytes (LYM [%]), platelet count and albumin levels. Most enrolled patients received anti-biotics and anti-viral treatment. In addition, 60 patients received corticosteroid and 51 received intravenous immunoglobulin infusion. 44 patients received noninvasive ventilation, 19 received invasive ventilation. Respiratory failure was the most frequently observed complication (106 [67.9%]), followed by sepsis (103 [66.0%]), acute respiratory distress syndrome (ARDS) (67 [42.9%]) and septic shock (50 [32.1%]). Multivariable regression suggested that advanced age (OR [odds ratio]= 1.059, 95% CI [confidence interval]: 1.011-1.110, P= 0.016) and elevated lactate level upon admission (OR= 2.411, 95% CI: 1.177-4.941, P= 0.016) were independent risk factors for in-hospital mortality for COVID-19 infection. Meanwhile, increased LYM (%) at admission (OR= 0.798, 95% CI: 0.728-0.876, P< 0.001) indicated a better prognosis. Conclusions: In this study, we discovered that age, LYM (%) and lactate level upon admission were independent factors that could influence in-hospital mortality rate.

A New Rapid Approach for Predicting Death in Coronavirus Patients: The Development and Validation of the COVID-19 Risk-Score in Fars Province (CRSF)

Iranian Journal of Public Health ◽

10.18502/ijph.v51i1.8310 ◽

2022 ◽

Author(s):

Mehrdad Sharifi ◽

Mohammad Hossein Khademian ◽

Razieh Sadat Mousavi-Roknabadi ◽

Vahid Ebrahimi ◽

Robab Sadegh

Keyword(s):

Risk Factors ◽

Risk Score ◽

Predictive Value ◽

Assessment Tool ◽

Fars Province ◽

Risk Of Mortality ◽

Risk Patients ◽

Development And Validation ◽

Background:Patients who are identified to be at a higher risk of mortality from COVID-19 should receive better treatment and monitoring. This study aimed to propose a simple yet accurate risk assessment tool to help decision-making in the management of the COVID-19 pandemic. Methods: From Jul to Nov 2020, 5454 patients from Fars Province, Iran, diagnosed with COVID-19 were enrolled. A multiple logistic regression model was trained on one dataset (training set: n=4183) and its prediction performance was assessed on another dataset (testing set: n=1271). This model was utilized to develop the COVID-19 risk-score in Fars (CRSF). Results: Five final independent risk factors including gender (male: OR=1.37), age (60-80: OR=2.67 and >80: OR=3.91), SpO2 (≤85%: OR=7.02), underlying diseases (yes: OR=1.25), and pulse rate (<60: OR=2.01 and >120: OR=1.60) were significantly associated with in-hospital mortality. The CRSF formula was obtained using the estimated regression coefficient values of the aforementioned factors. The point values for the risk factors varied from 2 to 19 and the total CRSF varied from 0 to 45. The ROC analysis showed that the CRSF values of ≥15 (high-risk patients) had a specificity of 73.5%, sensitivity of 76.5%, positive predictive value of 23.2%, and negative predictive value (NPV) of 96.8% for the prediction of death (AUC=0.824, P<0.0001). Conclusion:This simple CRSF system, which has a high NPV,can be useful for predicting the risk of mortality in COVID-19 patients. It can also be used as a disease severity indicator to determine triage level for hospitalization.

Comparison of Survivors and Nonsurvivors of Diffuse Alveolar Hemorrhage: Risk Factors for In-hospital Death

10.21203/rs.3.rs-353894/v1 ◽

2021 ◽

Author(s):

Swathi Sangli ◽

Misbah Baqir ◽

Jay Ryu

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Distress Syndrome ◽

Signs And Symptoms ◽

Diffuse Alveolar Hemorrhage ◽

Alveolar Hemorrhage ◽

Hospital Death ◽

P Value ◽

Steroid Use ◽

Hemorrhage Risk

Abstract ObjectiveThe objective of this study was to identify the predictors of in-hospital mortality among patients with diffuse alveolar hemorrhage (DAH).Patients and MethodsWe conducted a retrospective review of 89 patients hospitalized for DAH at our institution between 2001 and 2017: 49 patients who died during hospitalization and 40 patients who survived were compared. We reviewed their presenting signs and symptoms, clinical course, radiologic and pathologic findings, along with medical management. We then performed univariate and multivariate analyses to identify the risk factors associated with in-hospital mortality.ResultsWe identified 12 factors to be associated with mortality when comparing survivor vs non-survivor cohorts: smoking (27 [67%] vs 21 [42%], p = 0.02), malignancy (7 [17%] vs 24 [49%], p = 0.002), interstitial lung disease (0 vs 7 [14%], p = 0.01), liver failure (1 [2%] vs 14 [28%], p = 0.001), autoimmune diseases (16 [40%] vs 4 [8%], p =0.0006), thrombocytopenia (3 [7%] vs 35 [71%], p <0.0001), ICU admission (23 [57%] vs 40 [85%], p=0.004), mean duration of ICU stay (3.5 days [± 6.7] vs 5.5 days [± 5.5], p = 0.4), steroid use (36 [90%] vs 31 [63%], p = 0.003), use of plasma exchange (6 [15%] vs 0, p = 0.005), use of mechanical ventilation (15 [37%] vs 36 [75%], p value = 0.0007) and development of acute respiratory distress syndrome (ARDS) (9 [22%] vs 37 [77%], p <0.0001), respectively. On multivariate analysis, thrombocytopenia (OR 52.08: 95% CI, 8.59-315.71; p <0.0001) and ARDS (OR 11.71: 95% CI, 2.60-52.67; p = 0.0013) were associated with higher odds of mortality in DAH while steroid use (OR 0.05: 95% CI, 0.007-0.39; p = 0.0004) was associated with a lower risk of in-hospital mortality in patients with DAH.ConclusionIn DAH, thrombocytopenia and ARDS were predictors of in-hospital mortality whereas the use of steroid was associated with a more favorable prognosis.

Hospital mortality in hematogenous vertebral osteomyelitis

Hirurgiâ pozvonočnika ◽

10.14531/ss2021.3.86-93 ◽

2021 ◽

Vol 18 (3) ◽

pp. 86-93

Author(s):

A. Yu. Bazarov ◽

K. S. Sergeyev ◽

A. O. Faryon ◽

R. V. Paskov ◽

I. A. Lebedev

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Hospital Mortality ◽

Medical Records ◽

Vertebral Osteomyelitis ◽

Hospital Death ◽

Factors Affecting ◽

Comorbidity Index ◽

Probability Of Death ◽

Type C

Objective. To analyze lethal outcomes in patients with hematogenous vertebral osteomyelitis.Material and Methods. Study design: retrospective analysis of medical records. A total of 209 medical records of inpatients who underwent treatment for hematogenous vertebral osteomyelitis in 2006–2017 were analyzed. Out of them 68 patients (32.5 %) were treated conservatively, and 141 (67.5 %) – surgically. The risk factors for lethal outcomes were studied for various methods of treatment, and a statistical analysis was performed.Results. Hospital mortality (n = 9) was 4.3 %. In patients who died in hospital, average time for diagnosis making was 4 times less (p = 0.092). The main factors affecting mortality were diabetes mellitus (p = 0.033), type C lesion according to the Pola classification (p = 0.014) and age over 70 years (p = 0.006). To assess the relationship between hospital mortality and the revealed differences between the groups, a regression analysis was performed, which showed that factors associated with mortality were Pola type C.4 lesions (OR 9.73; 95 % CI 1.75–54.20), diabetes mellitus (OR 5.86; 95 % CI 1.14–30.15) and age over 70 years (OR 12.58; 95 % CI 2.50–63.34). The combination of these factors increased the likelihood of hospital mortality (p = 0.001). Sensitivity (77.8 %) and specificity (84.2 %) were calculated using the ROC curve. In the group with mortality, the comorbidity index (CCI) was significantly higher (≥4) than in the group without mortality (p = 0.002). With a CCI of 4 or more, the probability of hospital death increases significantly (OR 10.23; 95 % CI 2.06–50.82), p = 0.005. Long-term mortality was 4.3 % (n = 9), in 77.8 % of cases the cause was acute cardiovascular pathology, and no recurrence of vertebral osteomyelitis was detected.Conclusion. Hospital mortality was 4.3 %, and there was no mortality among patients treated conservatively. The main risk factors were diabetes mellitus, type C lesion according to Pola and age over 70 years. There was a significant mutual burdening of these factors (p = 0.001). With CCI ≥4, the probability of death is higher (p = 0.005).

Risk Factors for Postoperative Urinary Tract Infection and Urinary Retention in Patients Undergoing Surgery for Colorectal Cancer

The American Surgeon ◽

10.1177/000313481207801020 ◽

2012 ◽

Vol 78 (10) ◽

pp. 1100-1104 ◽

Cited By ~ 23

Author(s):

Celeste Y. Kang ◽

Obaid O. Chaudhry ◽

Wissam J. Halabi ◽

Vinh Nguyen ◽

Joseph C. Carmichael ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Urinary Tract Infection ◽

Logistic Regression ◽

Urinary Tract ◽

Tract Infection ◽

Hospital Mortality ◽

Urinary Retention ◽

Surgical Patients ◽

Independent Risk Factors

The aim of this study was to analyze risk factors for postoperative urinary tract infection (UTI) and urinary retention (UR) in patients with colorectal cancer. Using Nationwide Inpatient Sample 2006–2009, a retrospective analysis of surgical patients with colorectal cancer was conducted. Patients were stratified into groups, with or without UTI/UR. The LASSO algorithm for logistic regression identified independent risk factors. A total of 93,931 surgical patients with colorectal cancer were identified. The incidences of UTI and UR were 5.91 and 2.52 per cent, respectively. Overall in-hospital mortality was 2.68 per cent. The UTI group demonstrated significantly higher in-hospital mortality rates compared with those without. Both UTI and UR groups were associated with prolonged hospital stay and increased hospital charge. Multivariate logistic regression analysis revealed age older than 60 years, females, anemia, congestive heart failure, coagulopathy, diabetes with chronic complications, fluid and electrolyte, paralysis, pulmonary circulation disorders, renal failure, and weight loss were independent risk factors of UTI. Age older than 60 years, male gender, rectal and rectosigmoid cancers, and postoperative anastomotic leakage and ileus were independent risk factors for UR. Postoperative UTI increases in-house mortality. Postoperative UTI/UR in patients with colorectal cancer increases length of stay and hospital charges. Knowledge of these specific risk factors for UTI and UR is needed to counsel patients and prevent these complications in this high-risk population.

Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China.

10.21203/rs.3.rs-16485/v2 ◽

2020 ◽

Author(s):

Dawei Wang ◽

Yimei Yin ◽

Chang Hu ◽

Xing Liu ◽

Xingguo Zhang ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Clinical Course ◽

Case Series ◽

Kidney Injury ◽

Retrospective Case ◽

Illness Onset ◽

Systemic Symptoms ◽

Novel Coronavirus

Abstract Background In December 2019, Coronavirus Disease 2019 (COVID-19) outbreak was reported from Wuhan, China. Information on the clinical course and prognosis of COVID-19 was not thoroughly described. We described the clinical courses and prognosis in COVID-19 patients. Methods Retrospective case series of COVID-19 patients from Zhongnan Hospital of Wuhan University in Wuhan, and Xi-shui Hospital, Hubei Province, China, up to February 10, 2020. Epidemiological, demographic and clinical data were collected. Clinical course of survivors and non-survivors were compared. Risk factors for death were analyzed. Results A total of 107 discharged patients with COVID-19 were enrolled. The clinical course of COVID-19 presented as a tri-phasic pattern. Week 1 after illness onset was characterized by fever, cough, dyspnea, lymphopenia and radiological multilobar pulmonary infiltrates. In severe cases, thrombocytopenia, acute kidney injury, acute myocardial injury or adult respiratory distress syndrome were observed. During week 2, in mild cases, fever, cough and systemic symptoms began to resolve and platelet count rose to normal range, but lymphopenia persisted. In severe cases, leukocytosis, neutrophilia and deteriorating multi-organ dysfunction were dominant. By week 3, mild cases had clinically resolved except for lymphopenia. However, severe cases showed persistent lymphopenia, severe acute respiratory dyspnea syndrome , refractory shock, anuric acute kidney injury, coagulopathy, thrombocytopenia and death. Older age and male sex were independent risk factors for poor outcome of the illness. Conclusions A period of 7–13 days after illness onset is the critical stage in COVID-19 course. Age and male gender were independent risk factors for death of COVID-19.