International Journal of General Medicine (Aug 2021)

Independent Risk Factors for the Dynamic Development of COVID-19: A Retrospective Study

  • Liu M,
  • Jiang H,
  • Li Y,
  • Li C,
  • Tan Z,
  • Jin F,
  • Zhang T,
  • Nan Y

Journal volume & issue
Vol. Volume 14
pp. 4349 – 4367


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Miaomiao Liu,1,&ast; Hua Jiang,1,&ast; Yujuan Li,1 Chunmei Li,1 Zhijun Tan,2 Faguang Jin,1 Tao Zhang,1 Yandong Nan1 1Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Military Medical University, Xi’an, 710038, People’s Republic of China; 2Department of Health Statistics, Air Force Military Medical University, Xi’an, 710032, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yandong Nan; Tao Zhang Email [email protected]; [email protected]: To identify the risk factors for predicting the dynamic progression of COVID-19.Methods: A total of 2321 eligible patients were included in this study from February 4 to April 15, 2020. Two illness conditions, including mild/moderate (M/M) subtype to severe/critical (S/C) and S/C to fatality, were classified. Clinical message was collected and compared, respectively. Kaplan–Meier method, Cox regression model and risk score system were used to predict disease progression in S/C COVID-19.Results: A total of 112 of 1761 patients with M/M subtype were progressors (P) and 1649 non-progressors (NP). Increasing disease progression associated with higher levels of neutrophils count (HR=1.958, 95% CI=1.253– 3.059, P=0.003), CK (HR=2.203, 95% CI=1.048– 4.632, P=0.037), LDH (HR=3.309, 95% CI=2.083– 5.256, P< 0.001) and CRP (HR=2.575, 95% CI=1.638– 4.049, P< 0.001), and lower level of lymphocytes count (HR=1.549, 95% CI=1.018– 2.355, P=0.041), as well as total lesion volume ratio greater than ≥ 10% (HR=2.286, 95% CI=1.451– 3.601, P< 0.001) on admission. In progression to fatality, 56 of the 672 S/C cases died and 616 survived. Increasing fatality associated with lower level of lymphocytes count (HR:2.060, 95% CI:1.000– 4.242, P=0.050), higher levels of BUN (HR:2.715, 95% CI:1.539– 4.790, P< 0.001), CK-MB (HR:3.412, 95% CI:1.760– 6.616, P< 0.001), LDH (HR:5.578, 95% CI:2.317– 13.427, P< 0.001), and PT (HR:3.619, 95% CI:2.102– 6.231, P< 0.001). Furthermore, high risk of neutrophils count, lymphocytes count, CK, LDH, CRP, and total lesion volume ratio was powerfully correlated with the incidence of progression to S/C in patients with NS COVID-19 and high odds of lymphocytes count, BUN, CK-MB, LDH, and PT were significantly associated with death in patients with S/C COVID-19. In addition, the progression and mortality rates increased with increasing risk scores.Conclusion: Elevated LDH level and lymphopenia were independent predictors for COVID-19 sustainable management in classifying non-severe patients who progressed to severe condition and identifying S/C patients who deteriorated to fatal outcomes as well. Total lesion volume ratio ≥ 10% may provide early predictive evidence with COVID-19 patients at high risk of developing into S/C to improve prognosis.Keywords: COVID-19, mild/moderate, severe/critical, progression, fatality, risk factors