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Risk factors for disease progression in patients with mild to moderate coronavirus disease 2019-a multi-centre
1Department of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China; Department of Infectious Disease, Huoshenshan Hospital, Wuhan, China.
Insights
Older age, male sex, and certain medical conditions like hypertension and diabetes increase the risk of COVID-19 progression. Smoking history, however, appears protective against severe outcomes in mild to moderate cases.
Area of Science:
- Infectious Diseases
- Epidemiology
- Public Health
Background:
- The novel coronavirus disease 2019 (COVID-19) has caused a global pandemic since December 2019.
- Progression to severe or critical stages significantly increases the risk of poor outcomes in COVID-19 patients.
Purpose of the Study:
- To investigate risk factors associated with disease progression in individuals experiencing mild to moderate COVID-19.
- Identify predictors for advancement to severe or critical illness stages.
Main Methods:
- A cohort study involving 1007 patients with mild to moderate COVID-19 was conducted in Wuhan.
- Clinical characteristics and baseline laboratory findings were collected.
- Patients were monitored for 28 days to observe disease progression, with the primary endpoint being advancement to a more severe disease stage.
Main Results:
- Among 1007 patients, 22.05% progressed to severe disease, 2.18% to critical illness, and 4.27% died within 28 days.
- Multivariate analysis revealed that increased age, male sex, hypertension, diabetes, COPD, and coronary artery disease were significant risk factors for progression.
- Elevated procalcitonin, urea nitrogen, α-hydroxybutyrate dehydrogenase, and D-dimer levels were also associated with increased risk, while a history of smoking showed a protective effect.
Conclusions:
- This study successfully identified a range of risk factors contributing to COVID-19 disease progression in patients with initially mild to moderate symptoms.
- The findings highlight the importance of considering demographic, comorbidity, and baseline laboratory markers for predicting severe outcomes.
Objectives:
Since December 2019, the novel coronavirus disease 2019 (COVID-19) that emerged in Wuhan city has spread rapidly around the world. The risk for poor outcome dramatically increases once a patient progresses to the severe or critical stage. The present study aims to investigate the risk factors for disease progression in individuals with mild to moderate COVID-19.
Methods:
We conducted a cohort study that included 1007 individuals with mild to moderate COVID-19 from three hospitals in Wuhan. Clinical characteristics and baseline laboratory findings were collected. Patients were followed up for 28 days for observation of disease progression. The end point was the progression to a more severe disease stage.
Results:
During a follow up of 28 days, 720 patients (71.50%) had recovered or were symptomatically stable, 222 patients (22.05%) had progressed to severe disease, 22 patients (2.18%) had progressed to the critically ill stage and 43 patients (4.27%) had died. Multivariate Cox proportional hazards models identified that increased age (hazard ratio (HR) 2.56, 95% CI 1.97-3.33), male sex (HR 1.79, 95% CI 1.41-2.28), presence of hypertension (HR 1.44, 95% CI 1.11-1.88), diabetes (HR 1.82, 95% CI 1.35-2.44), chronic obstructive pulmonary disease (HR 2.01, 95% CI 1.38-2.93) and coronary artery disease (HR 1.83, 95% CI 1.26-2.66) were risk factors for disease progression. History of smoking was protective against disease progression (HR 0.56, 95% CI 0.34-0.91). Elevated procalcitonin (HR 1.72, 95% CI 1.02-2.90), urea nitrogen (HR 1.72, 95% CI 1.21-2.43), α-hydroxybutyrate dehydrogenase (HR 3.02, 95% CI 1.26-7.21) and D-dimer (HR 2.01, 95% CI 1.12-3.58) at baseline were also associated with risk for disease progression.
Conclusions:
This study identified a panel of risk factors for disease progression in individuals with mild to moderate COVID-19.
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