tetano
Editor, Senior Moderator
Curr Med Res Opin
. 2021 Jan 16;1.
doi: 10.1080/03007995.2021.1876005. Online ahead of print.
Predictors of clinical deterioration in non-severe patients with COVID-19: a retrospective cohort study
Yitao Zhang[SUP] 1 [/SUP], Mu Chen[SUP] 2 [/SUP], Ling Zhou[SUP] 3 4 [/SUP], Shiyao Cheng[SUP] 1 [/SUP], Jiaojie Xue[SUP] 1 [/SUP], Zhichong Chen[SUP] 1 [/SUP], Huajing Peng[SUP] 1 [/SUP], Maode Ou[SUP] 1 [/SUP], Kanglin Cheng[SUP] 1 [/SUP], Mao Ou Yang[SUP] 1 [/SUP], Xiaoneng Mo[SUP] 2 [/SUP], Weijie Zeng[SUP] 1 [/SUP]
Affiliations
Abstract
Objective: Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains pandemic with considerable morbidity and mortality around the world. The aim of this study was to identify the predictors for the clinical deterioration in patients with COVID-19 who did not show clinical deterioration upon hospital admission.
Methods: Two-hundred fifty-seven patients with confirmed COVID-19 pneumonia admitted to Guangzhou Eighth People's Hospital between January 23 and March 21, 2020, were retrospectively enrolled. Demographic data, symptoms, laboratory values, comorbidities, and treatments were all collected. The study endpoint was clinical deterioration within 20 days from hospital admission. Univariate and multivariable logistic regression methods were used to explore the risk factors associated with clinical deterioration.
Results: A total of 49 (19%) patients showed clinical deterioration after admission. Compared with patients that did not experience clinical deterioration, clinically deteriorated patients had more dyspnea, cough and myalgia (65.3% versus 29.3%) symptoms and more had comorbidities (89.8% versus 36.1%). Clinical and laboratory characteristics at admission that were associated with clinical deterioration included senior age, diabetes, hypertension, myalgia, higher temperature, systolic blood pressure, CRP, procalcitonin, activated partial thromboplastin time, aspertate aminotransferase, alanine transaminase, direct bilirubin, plasma creatinine, lymphocytopenia, thrombocytopenia, decreased albumin and bicarbonate concentration. Medical history of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers, calcium channel blockers and metformin were also risk factors.
Conclusion: The four best predictors for clinical deterioration were CRP, procalcitonin, age, and albumin. A "best" multivariable prediction model, resulting from using a variable selection procedure, included senior age, presentation with myalgia, and higher level of CRP and serum creatinine (bias-corrected c-statistic =0.909). Sensitivity and specificity corresponding to a cut point of CRP ≥18.45 mg/L for predicting clinical deterioration were 85% and 74%, respectively.
Keywords: COVID-19; clinical deterioration; myalgia; predictor.
. 2021 Jan 16;1.
doi: 10.1080/03007995.2021.1876005. Online ahead of print.
Predictors of clinical deterioration in non-severe patients with COVID-19: a retrospective cohort study
Yitao Zhang[SUP] 1 [/SUP], Mu Chen[SUP] 2 [/SUP], Ling Zhou[SUP] 3 4 [/SUP], Shiyao Cheng[SUP] 1 [/SUP], Jiaojie Xue[SUP] 1 [/SUP], Zhichong Chen[SUP] 1 [/SUP], Huajing Peng[SUP] 1 [/SUP], Maode Ou[SUP] 1 [/SUP], Kanglin Cheng[SUP] 1 [/SUP], Mao Ou Yang[SUP] 1 [/SUP], Xiaoneng Mo[SUP] 2 [/SUP], Weijie Zeng[SUP] 1 [/SUP]
Affiliations
- PMID: 33459077
- DOI: 10.1080/03007995.2021.1876005
Abstract
Objective: Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains pandemic with considerable morbidity and mortality around the world. The aim of this study was to identify the predictors for the clinical deterioration in patients with COVID-19 who did not show clinical deterioration upon hospital admission.
Methods: Two-hundred fifty-seven patients with confirmed COVID-19 pneumonia admitted to Guangzhou Eighth People's Hospital between January 23 and March 21, 2020, were retrospectively enrolled. Demographic data, symptoms, laboratory values, comorbidities, and treatments were all collected. The study endpoint was clinical deterioration within 20 days from hospital admission. Univariate and multivariable logistic regression methods were used to explore the risk factors associated with clinical deterioration.
Results: A total of 49 (19%) patients showed clinical deterioration after admission. Compared with patients that did not experience clinical deterioration, clinically deteriorated patients had more dyspnea, cough and myalgia (65.3% versus 29.3%) symptoms and more had comorbidities (89.8% versus 36.1%). Clinical and laboratory characteristics at admission that were associated with clinical deterioration included senior age, diabetes, hypertension, myalgia, higher temperature, systolic blood pressure, CRP, procalcitonin, activated partial thromboplastin time, aspertate aminotransferase, alanine transaminase, direct bilirubin, plasma creatinine, lymphocytopenia, thrombocytopenia, decreased albumin and bicarbonate concentration. Medical history of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers, calcium channel blockers and metformin were also risk factors.
Conclusion: The four best predictors for clinical deterioration were CRP, procalcitonin, age, and albumin. A "best" multivariable prediction model, resulting from using a variable selection procedure, included senior age, presentation with myalgia, and higher level of CRP and serum creatinine (bias-corrected c-statistic =0.909). Sensitivity and specificity corresponding to a cut point of CRP ≥18.45 mg/L for predicting clinical deterioration were 85% and 74%, respectively.
Keywords: COVID-19; clinical deterioration; myalgia; predictor.