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Patterns of Deterioration in Moderate Patients With COVID-19 From Jan 2020 to Mar 2020: A Multi-Center, Retrospective
Sheng-Long Chen1, Hui-Ying Feng2, Hui Xu1,3
1Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
Moderate COVID-19 patients often worsen around day 11 after symptom onset. Respiratory dysfunction and acute respiratory distress syndrome (ARDS) followed by acute kidney injury (AKI) are key signs of deterioration.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Moderate coronavirus disease 2019 (COVID-19) cases represent the majority of infections globally.
- Deterioration of moderate COVID-19 cases is a significant contributor to mortality.
- Limited data exist on the specific timing and mechanisms of deterioration in moderate COVID-19 patients.
Purpose of the Study:
- To investigate the clinical characteristics and deterioration patterns of moderate COVID-19 patients.
- To identify key indicators and time points associated with disease progression in moderate COVID-19.
- To analyze the sequence of organ dysfunction in patients with moderate COVID-19 who deteriorated.
Main Methods:
- A multicenter retrospective cohort study was conducted.
- Moderate COVID-19 patients hospitalized in Guangdong Province between January 14 and March 16, 2020, were analyzed.
- Patients were categorized into deteriorated and non-deteriorated groups based on clinical status, with data on demographics, symptoms, treatments, and lab results collected.
Main Results:
- Out of 1,168 moderate COVID-19 patients, 148 (13%) deteriorated to severe or critical conditions.
- Deterioration typically occurred around the 11th day post-onset (IQR 9-14 days), with a subset progressing to critical status within 3 days (IQR 2-6.5 days) of becoming severe.
- Key deterioration signs included respiratory dysfunction (respiratory rate >30 breaths/min) and hypoxia (SaO2 <93%), with common organ dysfunctions being acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI).
Conclusions:
- The 11th day post-onset is a critical time point for moderate COVID-19 deterioration.
- Progression to critical illness can occur rapidly (within 3 days) after developing severe symptoms.
- The typical sequence of organ damage involves ARDS followed by AKI in deteriorating moderate COVID-19 patients.
Abstract:
Background: Around the globe, moderate cases account for the largest proportion of all coronavirus disease 2019 (COVID-19) patients, and deteriorated moderate patients contribute the most in mortality. However, published articles failed to address the deterioration details of moderate cases, especially on when and how they deteriorated. Methods: All moderate COVID-19 patients hospitalized in Guangdong Province from January 14 to March 16, 2020, were included in this multicenter retrospective cohort study and were divided into deteriorated and non-deteriorated groups according to clinical status. Symptoms and demographic, therapeutic, and laboratory test result characteristics were collected to explore the features of disease deterioration. Results: Of 1,168 moderate patients included, 148 (13%) deteriorated to severe (130 cases) or critical (18 cases) status. Over 20% of the older subgroup (>50 years old) showed deterioration. The median time for deterioration was 11 days after onset [interquartile range (IQR) 9-14 days]. In addition, 12.2% severe cases could further develop to critical status after 3 days (IQR 2-6.5 days) of having a severe condition. Respiratory dysfunction and hypoxia were the major manifestations as disease deterioration, while 76 cases (52.1%) showed respiratory rate >30 breaths/min, 119 cases (80.4%) showed SaO2 <93%, 100 cases (67.5%) had 201 < PaO2/FiO2 < 300, and 27 cases (18.9%) had blood lactic acid >2.0 mmol/L. In view of multiple organ dysfunction, 87.8% of acute respiratory distress syndrome (ARDS), 20.2% of acute kidney injury (AKI), 6.8% of coagulopathy, 4% of acute heart failure (AHF), 3.4% of acute hepatic injury (AHI), and 5.4% of shock occurred in deteriorated patients, while organ injury occurred in the following sequence: ARDS, AKI, AHF, coagulopathy, AHI, and shock. Conclusions: The deteriorated pattern of moderate COVID-19 patients is characterized as the 11th day from onset (IQR 9-14 days) being an important time point of disease deterioration with further exacerbation to critical condition in 3 days (IQR 2-6.5 days), A RDS followed by AKI being the typical modes of sequential organ damage.
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