Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease.
TL;DR: Investigation of the factors affecting the progression of pneumonia in COVID-19 patients in Wuhan aimed to investigate the risk factors for disease progression and find the optimal treatment regimens for CO VID-19 pneumonia.
Abstract: BACKGROUND: Since early December 2019, the 2019 novel coronavirus disease (COVID-19) has caused pneumonia epidemic in Wuhan, Hubei province of China. This study aimed to investigate the factors affecting the progression of pneumonia in COVID-19 patients. Associated results will be used to evaluate the prognosis and to find the optimal treatment regimens for COVID-19 pneumonia. METHODS: Patients tested positive for the COVID-19 based on nucleic acid detection were included in this study. Patients were admitted to 3 tertiary hospitals in Wuhan between December 30, 2019, and January 15, 2020. Individual data, laboratory indices, imaging characteristics, and clinical data were collected, and statistical analysis was performed. Based on clinical typing results, the patients were divided into a progression group or an improvement/stabilization group. Continuous variables were analyzed using independent samples t-test or Mann-Whitney U test. Categorical variables were analyzed using Chi-squared test or Fisher's exact test. Logistic regression analysis was performed to explore the risk factors for disease progression. RESULTS: Seventy-eight patients with COVID-19-induced pneumonia met the inclusion criteria and were included in this study. Efficacy evaluation at 2 weeks after hospitalization indicated that 11 patients (14.1%) had deteriorated, and 67 patients (85.9%) had improved/stabilized. The patients in the progression group were significantly older than those in the disease improvement/stabilization group (66 [51, 70] vs. 37 [32, 41] years, Uâ=â4.932, Pâ=â0.001). The progression group had a significantly higher proportion of patients with a history of smoking than the improvement/stabilization group (27.3% vs. 3.0%, χâ=â9.291, Pâ=â0.018). For all the 78 patients, fever was the most common initial symptom, and the maximum body temperature at admission was significantly higher in the progression group than in the improvement/stabilization group (38.2 [37.8, 38.6] vs. 37.5 [37.0, 38.4]°C, Uâ=â2.057, Pâ=â0.027). Moreover, the proportion of patients with respiratory failure (54.5% vs. 20.9%, χâ=â5.611, Pâ=â0.028) and respiratory rate (34 [18, 48] vs. 24 [16, 60] breaths/min, Uâ=â4.030, Pâ=â0.004) were significantly higher in the progression group than in the improvement/stabilization group. C-reactive protein was significantly elevated in the progression group compared to the improvement/stabilization group (38.9 [14.3, 64.8] vs. 10.6 [1.9, 33.1] mg/L, Uâ=â1.315, Pâ=â0.024). Albumin was significantly lower in the progression group than in the improvement/stabilization group (36.62â±â6.60 vs. 41.27â±â4.55âg/L, Uâ=â2.843, Pâ=â0.006). Patients in the progression group were more likely to receive high-level respiratory support than in the improvement/stabilization group (χâ=â16.01, Pâ=â0.001). Multivariate logistic analysis indicated that age (odds ratio [OR], 8.546; 95% confidence interval [CI]: 1.628-44.864; Pâ=â0.011), history of smoking (OR, 14.285; 95% CI: 1.577-25.000; Pâ=â0.018), maximum body temperature at admission (OR, 8.999; 95% CI: 1.036-78.147, Pâ=â0.046), respiratory failure (OR, 8.772, 95% CI: 1.942-40.000; Pâ=â0.016), albumin (OR, 7.353, 95% CI: 1.098-50.000; Pâ=â0.003), and C-reactive protein (OR, 10.530; 95% CI: 1.224-34.701, Pâ=â0.028) were risk factors for disease progression. CONCLUSIONS: Several factors that led to the progression of COVID-19 pneumonia were identified, including age, history of smoking, maximum body temperature at admission, respiratory failure, albumin, and C-reactive protein. These results can be used to further enhance the ability of management of COVID-19 pneumonia.
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TL;DR: Several biomarkers which may potentially aid in risk stratification models for predicting severe and fatal COVID-19 were identified and clinicians are advised to closely monitor WBC count, lymphocyte count, platelet count, IL-6 and serum ferritin as markers for potential progression to critical illness.
Abstract: Background As coronavirus disease 2019 (COVID-19) pandemic rages on, there is urgent need for identification of clinical and laboratory predictors for progression towards severe and fatal forms of this illness. In this study we aimed to evaluate the discriminative ability of hematologic, biochemical and immunologic biomarkers in patients with and without the severe or fatal forms of COVID-19. Methods An electronic search in Medline (PubMed interface), Scopus, Web of Science and China National Knowledge Infrastructure (CNKI) was performed, to identify studies reporting on laboratory abnormalities in patients with COVID-19. Studies were divided into two separate cohorts for analysis: severity (severe vs. non-severe and mortality, i.e. non-survivors vs. survivors). Data was pooled into a meta-analysis to estimate weighted mean difference (WMD) with 95% confidence interval (95% CI) for each laboratory parameter. Results A total number of 21 studies was included, totaling 3377 patients and 33 laboratory parameters. While 18 studies (n = 2984) compared laboratory findings between patients with severe and non-severe COVID-19, the other three (n = 393) compared survivors and non-survivors of the disease and were thus analyzed separately. Patients with severe and fatal disease had significantly increased white blood cell (WBC) count, and decreased lymphocyte and platelet counts compared to non-severe disease and survivors. Biomarkers of inflammation, cardiac and muscle injury, liver and kidney function and coagulation measures were also significantly elevated in patients with both severe and fatal COVID-19. Interleukins 6 (IL-6) and 10 (IL-10) and serum ferritin were strong discriminators for severe disease. Conclusions Several biomarkers which may potentially aid in risk stratification models for predicting severe and fatal COVID-19 were identified. In hospitalized patients with respiratory distress, we recommend clinicians closely monitor WBC count, lymphocyte count, platelet count, IL-6 and serum ferritin as markers for potential progression to critical illness.
1,368 citations
TL;DR: Low platelet count is associated with increased risk of severe disease and mortality in patients with COVID-19, and thus should serve as clinical indicator of worsening illness during hospitalization.
1,256 citations
TL;DR: A retrospective study of patients with new coronavirus pneumonia who were hospitalized in Hainan Provincial People's Hospital from January 15, 2020 to February 18, 2020, finds that elderly patients with COVID-19 are more likely to progress to severe disease.
1,219 citations
TL;DR: To determine the prevalence of bacterial co-infection and secondary infection in patients with confirmed COVID-19, a systematic search of MEDLINE, OVID Epub and EMBASE databases for English language literature from 2019 to April 16, 2020 was performed.
974 citations
08 Apr 2020
TL;DR: The meta-analysis revealed no correlation between increased risk of COVID-19 and liver disease, malignancy, or renal disease and Hypertension, diabetes, COPD, cardiovascular disease, and cerebrovascular disease are major risk factors for patients with CO VID-19.
Abstract: Currently, the number of patients with coronavirus disease 2019 (COVID-19) has increased rapidly, but relationship between comorbidity and patients with COVID-19 still not clear. The aim was to explore whether the presence of common comorbidities increases COVID-19 patients' risk. A literature search was performed using the electronic platforms (PubMed, Cochrane Library, Embase, and other databases) to obtain relevant research studies published up to March 1, 2020. Relevant data of research endpoints in each study were extracted and merged. All data analysis was performed using Stata12.0 software. A total of 1558 patients with COVID-19 in 6 studies were enrolled in our meta-analysis eventually. Hypertension (OR: 2.29, P<0.001), diabetes (OR: 2.47, P<0.001), chronic obstructive pulmonary disease (COPD) (OR: 5.97, P<0.001), cardiovascular disease (OR: 2.93, P<0.001), and cerebrovascular disease (OR:3.89, P=0.002)were independent risk factors associated with COVID-19 patients. The meta-analysis revealed no correlation between increased risk of COVID-19 and liver disease, malignancy, or renal disease. Hypertension, diabetes, COPD, cardiovascular disease, and cerebrovascular disease are major risk factors for patients with COVID-19. Knowledge of these risk factors can be a resource for clinicians in the early appropriate medical management of patients with COVID-19.
936 citations
Cites background from "Analysis of factors associated with..."
...Six studies [1, 4–8] reported that hypertension, diabetes, and COPD, five covered liver disease [1, 4–7], four investigated malignancy [1, 4, 5, 8], renal disease [4–7], and cardiovascular disease [4–7], and three [4, 5, 7] researched cerebrovascular disease....
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...Until now, the source and pathogenesis of the COVID-19 remain unclear, and no specific treatment has been recommended for coronavirus infection except for meticulous supportive care [8, 11]....
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References
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TL;DR: The epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of patients with laboratory-confirmed 2019-nCoV infection in Wuhan, China, were reported.
36,578 citations
"Analysis of factors associated with..." refers background in this paper
...Thus, certain researchers have proposed that the anti-HIV drug, lopinavir, may play a role in inhibiting COVID-19....
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...[3] A previous study found that the highest temperature, dyspnea, respiratory rate (RR), white blood cell count, neutrophil count, lymphocyte count, D-dimer, albumin, procalcitonin were risk factors for intensive care unit (ICU) care in patients with COVID-19....
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...Respiratory system indices, such as RR and whether respiratory failure occurred, are particularly crucial for assessing the condition severity in patients with COVID-19....
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...A previous study found that the highest temperature, dyspnea, respiratory rate (RR), white blood cell count, neutrophil count, lymphocyte count, D-dimer, albumin, procalcitonin were risk factors for intensive care unit (ICU) care in patients with COVID-19.([4]) Therefore, it is absolutely necessary to evaluate the possible factors affecting the progression of disease in COVID-19 patients....
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...Therefore, further studies should include more drugs for the treatment of COVID-19....
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TL;DR: Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily, which is the seventh member of the family of coronaviruses that infect humans.
Abstract: In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.).
21,455 citations
TL;DR: The recent outbreak of clusters of viral pneumonia due to a 2019-nCoV in the Wuhan market poses significant threats to international health and may be related to sale of bush meat derived from wild or captive sources at the seafood market.
2,839 citations
"Analysis of factors associated with..." refers background in this paper
..., pneumonia) caused by a novel coronavirus.([1,2]) Clinical investigation of confirmed cases and cases under observation has shown that the number of patients with no history of exposure to theHuanan Seafood Market has been rapidly increasing....
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TL;DR: This review will help understand the biology and potential risk of CoVs that exist in richness in wildlife such as bats and describe diseases caused by different CoVs in humans and animals.
Abstract: The recent emergence of a novel coronavirus (2019-nCoV), which is causing an outbreak of unusual viral pneumonia in patients in Wuhan, a central city in China, is another warning of the risk of CoVs posed to public health. In this minireview, we provide a brief introduction of the general features of CoVs and describe diseases caused by different CoVs in humans and animals. This review will help understand the biology and potential risk of CoVs that exist in richness in wildlife such as bats.
2,480 citations
TL;DR: A novel bat-borne CoV was identified that is associated with severe and fatal respiratory disease in humans and the amino acid sequence of the tentative receptor-binding domain resembles that of SARS-CoV, indicating that these viruses might use the same receptor.
Abstract: Background:
Human infections with zoonotic coronaviruses (CoVs), including severe acute respiratory syndrome (SARS)-CoV and Middle East respiratory syndrome (MERS)-CoV, have raised great public health concern globally. Here, we report a novel bat-origin CoV causing severe and fatal pneumonia in humans.
Methods:
We collected clinical data and bronchoalveolar lavage (BAL) specimens from five patients with severe pneumonia from Jin Yin-tan Hospital, Wuhan, Hubei province, China. Nucleic acids of the BAL were extracted and subjected to next-generation sequencing. Virus isolation was carried out, and maximum-likelihood phylogenetic trees were constructed.
Results:
Five patients hospitalized from December 18 to December 29, 2019 presented with fever, cough, and dyspnea accompanied by complications of acute respiratory distress syndrome. Chest radiography revealed diffuse opacities and consolidation. One of these patients died. Sequence results revealed the presence of a previously unknown β-CoV strain in all five patients, with 99.8–99.9% nucleotide identities among the isolates. These isolates showed 79.0% nucleotide identity with the sequence of SARS-CoV (GenBank NC_004718) and 51.8% identity with the sequence of MERS-CoV (GenBank NC_019843). The virus is phylogenetically closest to a bat SARS-like CoV (SL-ZC45, GenBank MG772933) with 87.6–87.7% nucleotide identity, but is in a separate clade. Moreover, these viruses have a single intact open reading frame gene 8, as a further indicator of bat-origin CoVs. However, the amino acid sequence of the tentative receptor-binding domain resembles that of SARS-CoV, indicating that these viruses might use the same receptor.
Conclusion:
A novel bat-borne CoV was identified that is associated with severe and fatal respiratory disease in humans.
Key words:
Bat-origin; Coronavirus; Zoonotic transmission; Pneumonia; Etiology; Next-generation sequencing
999 citations
"Analysis of factors associated with..." refers background in this paper
...The RR and proportion of patients 037 isolated from the lower respiratory tract in patients with unexplained pneumonia, in Wuhan, China....
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...037 isolated from the lower respiratory tract in patients with unexplained pneumonia, in Wuhan, China.([10,11]) Currently, the source and pathogenesis of the COVID-19 remain unclear, and there are no uniform diagnostic and treatment standards....
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