Clinical features and risk factors of severely and critically ill patients with COVID-19

Xin Chu; Gui-Fang Zhang; Yong-Ke Zheng; Yi-Gang Zhong; Li Wen; Ping Zeng; Chun-Yi Fu; Xun-Liang Tong; Yun-Fei Long; Jing Li; Ya-Lin Liu; Zhi-Gang Chang; Huan Xi

doi:10.12998/wjcc.v10.i3.840

Clinical features and risk factors of severely and critically ill patients with COVID-19

World J Clin Cases. 2022 Jan 21;10(3):840-855. doi: 10.12998/wjcc.v10.i3.840.

Authors

Xin Chu¹, Gui-Fang Zhang², Yong-Ke Zheng³, Yi-Gang Zhong⁴, Li Wen⁵, Ping Zeng², Chun-Yi Fu⁵, Xun-Liang Tong⁶, Yun-Fei Long⁷, Jing Li⁸, Ya-Lin Liu¹, Zhi-Gang Chang¹, Huan Xi⁹

Affiliations

¹ Department of Surgical Intensive Care Medicine, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.
² The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital /National Center of Gerontology of National Health Commission, Beijing 100730, China.
³ Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China.
⁴ Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China.
⁵ Department of Emergency, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.
⁶ Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.
⁷ Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.
⁸ Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.
⁹ Department of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China. xih@bjhmoh.cn.

Abstract

Background: As of June 1, 2020, over 370000 coronavirus disease 2019 (COVID-19) deaths have been reported to the World Health Organization. However, the risk factors for patients with moderate-to-severe or severe-to-critical COVID-19 remain unclear.

Aim: To explore the characteristics and predictive markers of severely and critically ill patients with COVID-19.

Methods: A retrospective study was conducted at the B11 Zhongfaxincheng campus and E1-3 Guanggu campus of Tongji Hospital affiliated with Huazhong University of Science and Technology in Wuhan. Patients with COVID-19 admitted from 1^st February 2020 to 8^th March 2020 were enrolled and categorized into 3 groups: The moderate group, severe group and critically ill group. Epidemiological data, demographic data, clinical symptoms and outcomes, complications, laboratory tests and radiographic examinations were collected retrospectively from the hospital information system and then compared between groups.

Results: A total of 126 patients were enrolled. There were 59 in the moderate group, 49 in the severe group, and 18 in the critically ill group. Multivariate logistic regression analysis showed that age [odd ratio (OR) = 1.055, 95% (confidence interval) CI: 1.099-1.104], elevated neutrophil-to-lymphocyte ratios (OR = 4.019, 95%CI: 1.045-15.467) and elevated high-sensitivity cardiac troponin I (OR = 10.126, 95%CI: 1.088 -94.247) were high-risk factors.

Conclusion: The following indicators can help clinicians identify patients with severe COVID-19 at an early stage: age, an elevated neutrophil-to-lymphocyte ratio and high sensitivity cardiac troponin I.

Keywords: Amino-terminal pro-brain natriuretic peptide; Aspartate transaminase; COVID-19; Calcium; Creatinine; Critically ill; Risk factors; SARS-CoV-2.