Assessment of COVID-19 progression on day 5 from symptoms onset

Elisa Gentilotti; Alessia Savoldi; Monica Compri; Anna Górska; Pasquale De Nardo; Alessandro Visentin; Giorgia Be; Elisa Razzaboni; Nicola Soriolo; Dario Meneghin; Domenico Girelli; Claudio Micheletto; Sara Mehrabi; Elda Righi; Evelina Tacconelli

doi:10.1186/s12879-021-06596-5

Assessment of COVID-19 progression on day 5 from symptoms onset

BMC Infect Dis. 2021 Aug 28;21(1):883. doi: 10.1186/s12879-021-06596-5.

Authors

Affiliations

¹ Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy.
² Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy. pasquale.denardo@univr.it.
³ Department of Medicine, Section of Internal Medicine, University of Verona, EuroBloodNet Referral Center for Iron Metabolism Disorders, Azienda Ospedaliera Universitaria Integrata Verona, 37138, Verona, Italy.
⁴ Cardio-Thoracic Department, Respiratory Unit, Azienda Ospedaliera Universitaria Integrata Verona, 37124, Verona, Italy.
⁵ Department of Radiology, University of Verona, Piazzale L.A. Scuro, 10, 37100, Verona, Italy.

Abstract

Background: A major limitation of current predictive prognostic models in patients with COVID-19 is the heterogeneity of population in terms of disease stage and duration. This study aims at identifying a panel of clinical and laboratory parameters that at day-5 of symptoms onset could predict disease progression in hospitalized patients with COVID-19.

Methods: Prospective cohort study on hospitalized adult patients with COVID-19. Patient-level epidemiological, clinical, and laboratory data were collected at fixed time-points: day 5, 10, and 15 from symptoms onset. COVID-19 progression was defined as in-hospital death and/or transfer to ICU and/or respiratory failure (PaO₂/FiO₂ ratio < 200) within day-11 of symptoms onset. Multivariate regression was performed to identify predictors of COVID-19 progression. A model assessed at day-5 of symptoms onset including male sex, age > 65 years, dyspnoea, cardiovascular disease, and at least three abnormal laboratory parameters among CRP (> 80 U/L), ALT (> 40 U/L), NLR (> 4.5), LDH (> 250 U/L), and CK (> 80 U/L) was proposed. Discrimination power was assessed by computing area under the receiver operating characteristic (AUC) values.

Results: A total of 235 patients with COVID-19 were prospectively included in a 3-month period. The majority of patients were male (148, 63%) and the mean age was 71 (SD 15.9). One hundred and ninety patients (81%) suffered from at least one underlying illness, most frequently cardiovascular disease (47%), neurological/psychiatric disorders (35%), and diabetes (21%). Among them 88 (37%) experienced COVID-19 progression. The proposed model showed an AUC of 0.73 (95% CI 0.66-0.81) for predicting disease progression by day-11.

Conclusion: An easy-to-use panel of laboratory/clinical parameters computed at day-5 of symptoms onset predicts, with fair discrimination ability, COVID-19 progression. Assessment of these features at day-5 of symptoms onset could facilitate clinicians' decision making. The model can also play a role as a tool to increase homogeneity of population in clinical trials on COVID-19 treatment in hospitalized patients.

Keywords: COVID-19; Disease progression; Outcome; Public health.

MeSH terms

Aged
COVID-19 Drug Treatment*
Female
Hospital Mortality
Humans
Male
Prospective Studies
Retrospective Studies
SARS-CoV-2
Treatment Outcome