tetano
Editor, Senior Moderator
Front Med (Lausanne)
. 2020 Dec 3;7:567296.
doi: 10.3389/fmed.2020.567296. eCollection 2020.
Patterns of Deterioration in Moderate Patients With COVID-19 From Jan 2020 to Mar 2020: A Multi-Center, Retrospective Cohort Study in China
Sheng-Long Chen[SUP] 1 [/SUP], Hui-Ying Feng[SUP] 2 [/SUP], Hui Xu[SUP] 1 3 [/SUP], Shan-Shan Huang[SUP] 2 [/SUP], Jiu-Feng Sun[SUP] 4 [/SUP], Lin Zhou[SUP] 2 [/SUP], Jun-Lei He[SUP] 2 [/SUP], Wen-Liang Song[SUP] 1 5 [/SUP], Rui-Jie Wang[SUP] 1 6 [/SUP], Xin Li[SUP] 1 [/SUP], Ming Fang[SUP] 1 5 7 [/SUP]
Affiliations
Abstract
Background: Around the globe, moderate cases account for the largest proportion of all coronavirus disease 2019 (COVID-19) patients, and deteriorated moderate patients contribute the most in mortality. However, published articles failed to address the deterioration details of moderate cases, especially on when and how they deteriorated. Methods: All moderate COVID-19 patients hospitalized in Guangdong Province from January 14 to March 16, 2020, were included in this multicenter retrospective cohort study and were divided into deteriorated and non-deteriorated groups according to clinical status. Symptoms and demographic, therapeutic, and laboratory test result characteristics were collected to explore the features of disease deterioration. Results: Of 1,168 moderate patients included, 148 (13%) deteriorated to severe (130 cases) or critical (18 cases) status. Over 20% of the older subgroup (>50 years old) showed deterioration. The median time for deterioration was 11 days after onset [interquartile range (IQR) 9-14 days]. In addition, 12.2% severe cases could further develop to critical status after 3 days (IQR 2-6.5 days) of having a severe condition. Respiratory dysfunction and hypoxia were the major manifestations as disease deterioration, while 76 cases (52.1%) showed respiratory rate >30 breaths/min, 119 cases (80.4%) showed SaO[SUB]2[/SUB] <93%, 100 cases (67.5%) had 201 < PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] < 300, and 27 cases (18.9%) had blood lactic acid >2.0 mmol/L. In view of multiple organ dysfunction, 87.8% of acute respiratory distress syndrome (ARDS), 20.2% of acute kidney injury (AKI), 6.8% of coagulopathy, 4% of acute heart failure (AHF), 3.4% of acute hepatic injury (AHI), and 5.4% of shock occurred in deteriorated patients, while organ injury occurred in the following sequence: ARDS, AKI, AHF, coagulopathy, AHI, and shock. Conclusions: The deteriorated pattern of moderate COVID-19 patients is characterized as the 11th day from onset (IQR 9-14 days) being an important time point of disease deterioration with further exacerbation to critical condition in 3 days (IQR 2-6.5 days), A RDS followed by AKI being the typical modes of sequential organ damage.
Keywords: COVID-19; deterioration; moderate; pattern; time point.
. 2020 Dec 3;7:567296.
doi: 10.3389/fmed.2020.567296. eCollection 2020.
Patterns of Deterioration in Moderate Patients With COVID-19 From Jan 2020 to Mar 2020: A Multi-Center, Retrospective Cohort Study in China
Sheng-Long Chen[SUP] 1 [/SUP], Hui-Ying Feng[SUP] 2 [/SUP], Hui Xu[SUP] 1 3 [/SUP], Shan-Shan Huang[SUP] 2 [/SUP], Jiu-Feng Sun[SUP] 4 [/SUP], Lin Zhou[SUP] 2 [/SUP], Jun-Lei He[SUP] 2 [/SUP], Wen-Liang Song[SUP] 1 5 [/SUP], Rui-Jie Wang[SUP] 1 6 [/SUP], Xin Li[SUP] 1 [/SUP], Ming Fang[SUP] 1 5 7 [/SUP]
Affiliations
- PMID: 33344469
- PMCID: PMC7744800
- DOI: 10.3389/fmed.2020.567296
Abstract
Background: Around the globe, moderate cases account for the largest proportion of all coronavirus disease 2019 (COVID-19) patients, and deteriorated moderate patients contribute the most in mortality. However, published articles failed to address the deterioration details of moderate cases, especially on when and how they deteriorated. Methods: All moderate COVID-19 patients hospitalized in Guangdong Province from January 14 to March 16, 2020, were included in this multicenter retrospective cohort study and were divided into deteriorated and non-deteriorated groups according to clinical status. Symptoms and demographic, therapeutic, and laboratory test result characteristics were collected to explore the features of disease deterioration. Results: Of 1,168 moderate patients included, 148 (13%) deteriorated to severe (130 cases) or critical (18 cases) status. Over 20% of the older subgroup (>50 years old) showed deterioration. The median time for deterioration was 11 days after onset [interquartile range (IQR) 9-14 days]. In addition, 12.2% severe cases could further develop to critical status after 3 days (IQR 2-6.5 days) of having a severe condition. Respiratory dysfunction and hypoxia were the major manifestations as disease deterioration, while 76 cases (52.1%) showed respiratory rate >30 breaths/min, 119 cases (80.4%) showed SaO[SUB]2[/SUB] <93%, 100 cases (67.5%) had 201 < PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] < 300, and 27 cases (18.9%) had blood lactic acid >2.0 mmol/L. In view of multiple organ dysfunction, 87.8% of acute respiratory distress syndrome (ARDS), 20.2% of acute kidney injury (AKI), 6.8% of coagulopathy, 4% of acute heart failure (AHF), 3.4% of acute hepatic injury (AHI), and 5.4% of shock occurred in deteriorated patients, while organ injury occurred in the following sequence: ARDS, AKI, AHF, coagulopathy, AHI, and shock. Conclusions: The deteriorated pattern of moderate COVID-19 patients is characterized as the 11th day from onset (IQR 9-14 days) being an important time point of disease deterioration with further exacerbation to critical condition in 3 days (IQR 2-6.5 days), A RDS followed by AKI being the typical modes of sequential organ damage.
Keywords: COVID-19; deterioration; moderate; pattern; time point.