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The interval between onset and admission predicts disease progression in COVID-19 patients
Liang Peng1, Qing-Quan Lv2, Fan Yang3
1Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University; International Airway Research Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, China.
Insights
The time from symptom onset to hospital admission (O-A interval) predicts COVID-19 progression in mild cases. A shorter O-A interval indicates a higher risk of developing severe coronavirus disease 2019 (COVID-19).
Area of Science:
- Infectious Diseases
- Epidemiology
- Public Health
Background:
- The prognostic significance of the interval between disease onset and hospital admission (O-A interval) in coronavirus disease 2019 (COVID-19) patients was previously unclear.
- Understanding this interval could offer insights into disease progression and healthcare-seeking behaviors during the pandemic.
Purpose of the Study:
- To investigate the prognostic value of the O-A interval on disease progression and outcomes in COVID-19 patients.
- To evaluate whether the O-A interval can predict the likelihood of mild-to-moderate cases deteriorating into severe-to-critical stages.
Main Methods:
- A retrospective observational study included 205 laboratory-confirmed COVID-19 inpatients admitted to Hankou Hospital, Wuhan.
- Data on demographics, medical history, and laboratory results were collected.
- Logistic regression models assessed the prognostic effect of O-A interval (≤7 vs. >7 days) on disease progression in mild-to-moderate patients; log-rank and Mann-Whitney U tests compared outcomes in severe-to-critical patients.
Main Results:
- Mild-to-moderate COVID-19 patients with a shorter O-A interval (≤7 days) were significantly more likely to progress to severe-to-critical stages compared to those with a longer interval (>7 days).
- The unadjusted odds ratio was 2.93 (95% CI, 1.32-6.55), and the adjusted odds ratio was 3.44 (95% CI, 1.20-9.83).
- No significant association was found between the O-A interval and in-hospital mortality or length of hospital stay in severe-to-critical patients.
Conclusions:
- The O-A interval demonstrates predictive value for disease progression in mild-to-moderate COVID-19 patients.
- In Wuhan's specific healthcare context, the O-A interval may reflect the natural course of COVID-19, influenced by patient self-assessment.
- Further validation in diverse cohorts and healthcare systems is recommended to confirm these findings.
Background:
The prognostic role of the interval between disease onset and hospital admission (O-A interval) was undetermined in patients with the coronavirus disease 2019 (COVID-19).
Methods:
A total of 205 laboratory-confirmed inpatients admitted to Hankou hospital of Wuhan from January 11 to March 8, 2020 were consecutively included in this retrospective observational study. Demographic data, medical history, laboratory testing results were collected from medical records. Univariate and multivariate logistic regression models were used to evaluate the prognostic effect of the O-A interval (≤7 versus >7 days) on disease progression in mild-to-moderate patients. For severe-to-critical patients, the in-hospital mortality and the length of hospital stay were compared between the O-A interval subgroups using log-rank test and Mann-Whitney U test, respectively.
Results:
Mild-to-moderate patients with a short O-A interval (≤7 days) are more likely to deteriorate to severe-to-critical stage compared to those with a long O-A interval (>7 days) [unadjusted odds ratio =2.93, 95% confidence interval (CI), 1.32-6.55; adjusted odds ratio =3.44, 95% CI, 1.20-9.83]. No association was identified between the O-A interval and the mortality or the length of hospital stay of severe-to-critical patients.
Conclusions:
The O-A interval has predictive values for the disease progression in mild-to-moderate COVID-19 patients. Under circumstances of the specific health system in Wuhan, China, the spontaneous healthcare-seeking behavior is usually determined by patients' own heath conditions. Hence, the O-A interval can be reflective of the natural course of COVID-19 to some extent. However, our findings should be validated further in other cohorts and in other health systems.
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