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Published on: November 10, 2023
The natural course of COVID-19 patients without clinical intervention
Daxian Wu1, Qunfang Rao1, Wenfeng Zhang1
1Department of Infectious Diseases, The First Affiliated Hospital, Nanchang University, Nanchang, China.
Insights
The total computed tomography (CT) score is a reliable indicator for identifying severe coronavirus disease 2019 (COVID-19). Patients without intervention worsen initially, then improve after 10-14 days.
Area of Science:
- Medical Imaging
- Infectious Diseases
- Pulmonology
Background:
- The natural progression of coronavirus disease 2019 (COVID-19) in patients not receiving clinical intervention remains underdocumented.
- Understanding disease trajectory and identifying indicators of severity are crucial for managing COVID-19.
Purpose of the Study:
- To identify indicators of severe COVID-19.
- To observe the natural course of COVID-19 in patients without clinical intervention.
Main Methods:
- One hundred and fifty-eight patients from two hospitals were enrolled.
- Computed tomography (CT) scans were used to assess lesion severity with a total CT score.
- Multivariate logistic regression was employed to identify independent factors for severe COVID-19.
Main Results:
- The total CT score demonstrated superior performance in assessing lesion severity compared to other CT-based assessments.
- Independent predictors for severe COVID-19 included total CT score, chest tightness, lymphocyte count, and lactate dehydrogenase (LDH) levels.
- Delayed hospitalization (within 2 weeks of onset) correlated with increased severity, more frequent symptoms, elevated inflammatory markers, and decreased lymphocyte counts.
- Alterations in clinical and laboratory parameters were most pronounced 10-14 days after symptom onset.
- Patients without intervention showed gradual deterioration in the first 10-14 days, followed by improvement.
Conclusions:
- The total CT score is a simple and effective tool for identifying severe COVID-19.
- Delayed hospitalization is associated with increased disease severity and progression.
- COVID-19 patients exhibit a characteristic natural course of initial deterioration followed by gradual recovery.
Abstract:
The natural course of coronavirus disease 2019 (COVID-19) patients without clinical intervention has not yet been documented. One hundred and fifty-eight patients from two hospitals were enrolled to identify the indicators of severe COVID-19 and observe the natural course of COVID-19 patients without clinical intervention. The total computed tomography (CT) score, a quantitative score based on assessment of the number, quadrant, and area of the lesions in CT, tended to perform better than assessment based only on the number or area of the lesions (p = 0.0004 and p = 0.0887, respectively). Multivariate logistic regression showed that the total CT score, chest tightness, lymphocyte, and lactate dehydrogenase (LDH) were independent factors for severe COVID-19. For patients admitted in 2 weeks from onset to hospitalization, the frequency of severe COVID-19 was gradually increased with the delayed hospitalization. The symptoms of fatigue, dry cough, sputum production, chest tightness, and polypnea were gradually more frequent. The levels of C-reactive protein, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, γ-glutamyl transpeptidase, LDH, and d-dimer were also gradually increased, as well as the scores based on CT. Conversely, the lymphocyte count and the albumin level were gradually decreased with the delayed hospitalization. Detail turning points of the above alterations were observed after 10-14 days from onset to hospitalization. Total CT score was a simple and feasible score for identifying severe COVID-19. COVID-19 patients without clinical intervention deteriorated gradually during the initial 10-14 days but gradually improved thereafter.
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