CLINICAL CHARACTERISTICS OF SEVERE AND CRITICAL CORONAVIRUS DISEASE AND ASSESSMENT OF RISK FACTORS FOR PROGRESSION: A RETROSPECTIVE COHORT STUDY

Chuming Zhang^{1, #}, Wei Lu^{1, #}, Wenmin Wang^{2, #}, Jun Yi³, Guomin Wu⁴, Xijiang Zhang^{1, *}, Wenhui Tu^{5, *}, Cheng Zheng^{1, *}

¹Critical Care Medicine Department, Taizhou Municipal Hospital, Taizhou 318000, Zhejiang, China - ²Neurology Department, Taizhou Municipal Hospital, Taizhou 318000, Zhejiang, China - ³Cardiothoracic Surgery Department, Jingmen No. 1 People’s Hospital, Jingmen 448000, Hubei, China - ⁴Infectious Disease Department, Jingmen No. 1 People’s Hospital, Jingmen 448000, Hubei, China - ⁵Infectious Disease Department, Taizhou Municipal Hospital, Taizhou 318000, Zhejiang, China

Purpose: To examine the clinical characteristics of patients with severe and critical coronavirus disease and analyze the risk factors for progression to critical disease and adverse outcomes.

Methods: Seventy-four clinical markers were analyzed. Patients were followed up until the clinical endpoint (survival or death). Subgroup analyses of severe/critical patients and survivors/deaths examined the risk factors for disease progression and patient outcomes.

Results: Median patient age was 65.5 (54.0-73.0) years; 64.5% were male. Thirty-two (51.6%) patients had comorbid hypertension; 60 (96.8%), fever; and 5 (8.1%), diarrhea. Median lymphocyte count was significantly lower than the reference range (P<0.05); inflammatory marker levels exceeded normal ranges. The probability of comorbid diabetes was higher in the critical group than in the severe group (35.5% vs. 9.7%; P=0.031). There were 50 survivors and 12 deaths. The critical group’s mortality rate was 38.7%. Intra-subgroup comparisons of severe/critical and survivor/death groups indicated patients with multiple comorbidities and elevated total white blood cell count had higher risks of progressing to critical disease (odds ratio [OR] [95% confidence interval (CI)], 2.3 [1.2-4.7], P=0.016; 1.2 [1.0-1.4], P=0.017). A high SOFA score, lactic acid elevation, and a D-dimer level >2 ug/mL were risk factors for poor prognosis (OR [95% CI], 2.2 [1.0-4.8], P=0.047; 3.9 [1.4-11.0], P=0.008; 10.0 [1.2-84.2], P=0.033).

Conclusion: Patients with multiple comorbidities and elevated total white blood cell count should be monitored closely. A high SOFA score, elevated lactate levels, and a D-dimer level of >2 ug/mL should also be considered as risk factors.