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Clinical Characteristics Predicting Progression of COVID-19

18 Pages Posted: 20 Feb 2020

See all articles by Dong Ji

Dong Ji

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

Dawei Zhang

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

Zhu Chen

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

Zhe Xu

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

Peng Zhao

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

Mingjie Zhang

University of Macau - Faculty of Health Sciences

Lunqing Zhang

University of Macau - Faculty of Health Sciences

Gregory Cheng

Humanity & Health Medical Group - Humanity and Health Research Center

Yudong Wang

Humanity and Health Medical Group

Guang Yang

Government of the People's Republic of China - Department of Clinical Laboratory

Hongxia Liu

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

Boyu Li

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

Junsheng Ji

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

George Lau

Humanity & Health Medical Group - Humanity and Health Research Center; Government of the People's Republic of China - Fifth Medical Center

Enqiang Qin

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

More...

Abstract

Background: With the outbreak of COVID-19 from Wuhan, Hubei Province, China since January 2020, there is a tremendous pressure on medical resources. We studied predictive factors of progression to severe disease to facilitate proper allocation of patients to different level of medical facilities.

Methods: All COVID-19 patients admitted to our hospital from 20 Jan 2020 were enrolled and follow-up until16 Feb 2020.The patients were divided into two groups: stable non-severe and progressive to severe diseases. Clinical data was prospectively collected and compared between the two groups.

Findings: Forty-nine COVID-19 patients, mean age: 43·6±17·1 years, 63·3% male, were enrolled. Sixteen (32·7%) had at least one comorbidity (hypertension, diabetes mellitus, cardiovascular disease and lung disease). Thirty-four 34 (69·4%) had stable non-severe disease and 15 (30·6%) progressed to severe disease. Univariate analysis showed that comorbidity, age >50, lymphocyte counts <1500 /μL and serum ferritin >400 ng/mL at presentation were predictive of progression to severe diseases. Seventy-three percent of patients (11/15) with three or all four risk factors progressed to severe disease, requiring intubation or intensive unit care as compared with 11·8% (4/34) of subjects with 0-2 risk factors (odds ratio 6·2,95 % CI: 1·7 to 22·8, p =0·006). None of the subjects with absence of all 4 risk factors progressed to more severe diseases.

Interpretation: Around one-fifth of patients with COVID-19 will progress to severe diseases.Four simple clinical parameters at presentation, namely comorbidity, age, lymphocyte counts and serum ferritin were able to identify a group of patients with low risk of progression. This will greatly facilitate optimal utilization of the very tight medical resources in places with huge patient loads.

Funding Statement: This work was funded by the Special Emergency Research Project for Novel Coronavirus Pneumonia of Chinese PLA General Hospital (20EP013), Medical big data and artificial intelligence development fund of Chinese PLA General Hospital (2019MBD-024), and the Capital Characteristic Clinic Project of Beijing Municipal Science and Technology Commission (Z181100001718034).

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: The study was approved by the Ethics Committees of the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China (2020005D). Written informed consent was waived in view of the new emerging infectious diseases in a designated hospital.

Keywords: COVID-19, prediction, risk factors, severity of disease

Suggested Citation

Ji, Dong and Zhang, Dawei and Chen, Zhu and Xu, Zhe and Zhao, Peng and Zhang, Mingjie and Zhang, Lunqing and Cheng, Gregory and Wang, Yudong and Yang, Guang and Liu, Hongxia and Li, Boyu and Ji, Junsheng and Lau, George and Qin, Enqiang, Clinical Characteristics Predicting Progression of COVID-19 (2/17/2020). Available at SSRN: https://ssrn.com/abstract=3539674 or http://dx.doi.org/10.2139/ssrn.3539674

Dong Ji

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

Beijing, 100039
China

Dawei Zhang

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

Beijing, 100039
China

Zhu Chen

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

Beijing, 100039
China

Zhe Xu

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

Beijing, 100039
China

Peng Zhao

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

Beijing, 100039
China

Mingjie Zhang

University of Macau - Faculty of Health Sciences

Macao
China

Lunqing Zhang

University of Macau - Faculty of Health Sciences

Macao
China

Gregory Cheng

Humanity & Health Medical Group - Humanity and Health Research Center

Hong Kong

Yudong Wang

Humanity and Health Medical Group

Hong Kong
China

Guang Yang

Government of the People's Republic of China - Department of Clinical Laboratory

China

Hongxia Liu

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

Beijing, 100039
China

Boyu Li

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital

Beijing, 100039
China

Junsheng Ji

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital ( email )

Beijing, 100039
China

George Lau (Contact Author)

Humanity & Health Medical Group - Humanity and Health Research Center ( email )

Hong Kong

Government of the People's Republic of China - Fifth Medical Center ( email )

China

Enqiang Qin

Government of the People's Republic of China - Fifth Medical Center of Chinese PLA General Hospital ( email )

Beijing, 100039
China

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