Clinical Features and Predictors for Patients with Severe SARS-CoV-2 Pneumonia: A Retrospective Multicenter Cohort Study
20 Pages Posted: 31 Mar 2020More...
Background: Starting from early December 2019, cases of human infection with a novel coronavirus were identified in Wuhan, Hubei Province, China. It spreads rapidly to other cities and numerous countries. This study was performed to investigate clinical features of patients with severe SARS-CoV-2 pneumonia and identify risk factors for converting to severe cases in those who had mild to moderate diseases.
Methods: In this retrospective, multicenter cohort study, patients with mild to moderate SARS-CoV-2 pneumonia were included from Ningbo First Hospital and Jingzhou Central Hospital. Demographic data, symptoms, laboratory values, comorbidities, and clinical outcomes were collected. Data were compared between non-severe and severe patients. Logistic regression analysis was performed to assess risk factors in predicting the patients with SARS-CoV-2 pneumonia who would convert to severe cases.
Findings: 120 patients (36 from Ningbo First Hospital and 84 from Jingzhou Central Hospital) were included in this study, among which 62 were excluded and 58 were included in the final analysis. Compared with non-severe cases, severe patients with SARS-CoV-2 pneumonia had a longer: time to clinical recovery (12·9±4·4 vs 8·3±4·7; p=0·0011), duration of viral shedding (15·7±6·7 vs 11·8±5·0; p=0·0183), and hospital stay (20·7±1·2 vs 14·4±4·3; p=0·0211). Multivariate logistic regression indicated that lymphocyte count was significantly associated with the rate of converting to severe cases (odds ratio 1·28, 95%CI 1·06–1·54, per 0·1×109/L reduced; p=0·007), while using of low-to-moderate doses of systematic corticosteroids was associated with reduced likelihood of converting to a severe case (odds ratio 0·14, 95%CI 0·02–0·80; p=0·0275).
Interpretation: The low peripheral blood lymphocyte count was an independent risk factor for SARS-CoV-2 pneumonia patients converting to severe cases. This finding may help clinicians more accurately predict prognosis, and triage priorities to improve clinical outcomes.
Funding Statement: None.
Declaration of Interests: All authors declare no competing interests.
Ethics Approval Statement: Ethical approvals for this study were obtained from the Ethics Commission of Ningbo First Hospital (2020-R017) and the Ethics Commission of Jingzhou Central Hospital (2020-2-19). Written informed consent was waived due to the rapid emergence of this disease.
Keywords: SARS-CoV-2; pneumonia; lymphocyte counts; corticosteroids
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