Clinical analysis of risk factors for severe patients with novel coronavirus pneumonia

Yun Ling; Yixiao Lin; Zhiping Qian; Dan Huang; Dandan Zhang; Tao LI; Min Liu; Shuli Song; Jun Wang; Yuyi Zhang; Shuibao XU; Jun Chen; Jianliang Zhang; Tongyu Zhu; Bijie HU; Sheng Wang; Enqiang Mao; Lei Zhu; Hongzhou LU

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Clinical analysis of risk factors for severe patients with novel coronavirus pneumonia

VernacularTitle: 新型冠状病毒肺炎患者重症化危险因素的临床分析
Author: Yun LING ¹ ; Yixiao LIN ² ; Zhiping QIAN ³ ; Dan HUANG ⁴ ; Dandan ZHANG ⁵ ; Tao LI ⁶ ; Min LIU ⁷ ; Shuli SONG ⁸ ; Jun WANG ⁹ ; Yuyi ZHANG ³ ; Shuibao XU ² ; Jun CHEN ² ; Jianliang ZHANG ⁷ ; Tongyu ZHU ¹⁰ ; Bijie HU ¹¹ ; Sheng WANG ¹² ; Enqiang MAO ¹³ ; Lei ZHU ¹⁴ ; Hongzhou LU ²
Author Information

1. Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai 201508, China
2. Department of Infectious Disease and Immunology, Shanghai Public Health Clinical Center, Shanghai 201508, China
3. Department of Severe Hepatitis, Shanghai Public Health Clinical Center, Shanghai 201508, China
4. Department of Hepatobiliary Disease, Shanghai Public Health Clinical Center, Shanghai 201508, China
5. Department of Hepatology, Shanghai Public Health Clinical Center, Shanghai 201508, China
6. Department of Tuberculosis, Shanghai Public Health Clinical Center, Shanghai 201508, China
7. Department of Gastroenterology, Shanghai Public Health Clinical Center, Shanghai 201508, China
8. Department of Nephrology, Shanghai Public Health Clinical Center, Shanghai 201508, China
9. Department of Thoracic Surgery, Shanghai Public Health Clinical Center, Shanghai 201508, China
10. Department of Urology, Shanghai Public Health Clinical Center, Shanghai 201508, China
11. Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
12. Department of Critical Care Medicine, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China
13. Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
14. Department of Pulmonology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Publication Type:Journal Article
Keywords: Coronavirus infection; Pneumonia; 2019 novel coronavirus; Severe case; Risk factor
From: Chinese Journal of Infectious Diseases 2020;38(0):E023-E023
CountryChina
Language:Chinese
Abstract: Objective To analyze the clinical features of patients with coronavirus disease 2019 (COVID-19) in Shanghai and to investigate the risk factors for disease progression to severe cases. Methods The clinical data of 292 adult patients with COVID-19 hospitalized in Shanghai Public Health Clinical Center from January 20, 2020 to February 10, 2020 were retrospectively analyzed, including 21 severe patients and 271 mild patients. The demographic characteristics, epidemiological history, history of underlying diseases and laboratory examinations were compared between the two groups. Measurement data were compared using t test or Mann-Whitney U test. The count data were compared using hi-square test. The binary logistic regression equation was used to analyze the risk factors for the progression of patients to severe cases. Results Among the 292 patients, 21 were severe cases with the rate of 7.2% (21/292). One patient died, and the mortality rate was 4.8% in severe patients. The severe patients aged (65.0±15.7) years old, 19 (90.5%) were male, 11 (52.4%) had underlying diseases, 7 (33.3%) had close relatives diagnosed with COVID-19. The mild patients aged (48.7±15.7) years old, 135 (49.8%) were male, 74 (27.3%) had underlying diseases, 36 (13.3%) had close relatives diagnosed with COVID-19. The differences between two groups were all significant statistically ( t =-4.730, χ 2 =12.930, 5.938 and 4.744, respectively, all P <0.05). Compared with the mild patients, the levels of absolute numbers of neutrophils, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatinine, serum cystatin C, C reactive protein (CRP), procalcitonin , D -dimer, pro-B-type natriuretic peptide (proBNP), serum myoglobin, creatine kinase (CK), creatine kinase isoenzyme (CK-MB), serum troponin I (cTnI) in severe patients were all significantly higher ( U =2 091.5, 1 928.0, 1 215.5, 729.0, 1 580.5, 1 375.5, 917.5, 789.5, 1 209.0, 1 434.0, 638.0, 964.5, 1 258.0 and 1 747.5, respectively, all P <0.05), while the levels of lymphocyte count, albumin, transferrin, CD3 + T lymphocyte count, CD8 + T lymphocyte count and CD4 + T lymphocyte count in severe patients were all significantly lower ( U =1 263.5, t =4.716, U =1 214.0, 962.0, 1 167.5 and 988.0, respectively, all P <0.05). Further logistic regression analysis showed that the albumin (odds ratio ( OR )=0.806, 95% CI 0.675-0.961), CRP ( OR =1.016, 95% CI 1.000-1.032), serum myoglobin ( OR =1.010, 95% CI 1.004-1.016), CD3 + T lymphocyte count ( OR =0.996, 95% CI 0.991-1.000) and CD8 + T lymphocyte count ( OR =1.006, 95% CI 1.001-1.010) at admission were independent risk factors for the progression of COVID-19 patients to severe illness (all P <0.05). Conclusions Severe cases of patients with COVID-19 in Shanghai are predominantly elderly men with underlying diseases. Albumin, CRP, serum myoglobin, CD3 + T lymphocyte count and CD8 + T lymphocyte count could be used as early warning indicators for severe cases, which deserve more clinical attention.