ABSTRACT
Background: Novel coronavirus disease 2019(COVID-19)has a large population base of infection, and only worsening cases required hospitalization. A hospitalization risk score of COVID-19(HRS-COVID-19) to identify and treat worsening patients early thus seems crucial.Method: We conducted a multicenter nested case-control study with 200 cases enrolling confirmed symptomatic COVID-19 patients from four designated hospitals before worsened. Least Absolute Shrinkage and Selection Operator(LASSO), Directed Acyclic Graph(DAG)and Change-in-Estimate(CIE) screened out independent risk factors for HRS-COVID-19 from demographic, clinical and imaging data of the cases. The HRS-COVID-19 was evaluated by the area under curve(AUC), calibration curve, decision curve and clinical impact curve; internal validation by the bootstrap-resampling(boot=1000); and through a nomogram and a network calculator to show.Results: In the nested case cohort, 50 patients reached the compound endpoint(requiring hospitalization) and 150 patients were able to avoid hospitalization. Dyspnea, incubation period, age, lymphocyte count, C-reactive protein and semi-quantitative CT scores were included in HRS-COVID-19. The HRS-COVID-19 has good fitting(Hosmer-Lemeshow goodness,P=0.45); high discrimination(AUC 0.980,95%CI, 0.965-0.996); with excellent calibration and clinical benefits. We make a free online risk calculator (https://hospitalization-risk-score-of-covid-19.shinyapps.io/DynNomapp/).Conclusion: In the study, the HRS-COVID-19 based on the clinical characteristics at admission is helpful for early identification and active treatment of aggravated high-risk COVID-19 patients.
Subject(s)
Dyspnea , COVID-19 , Myoclonic Epilepsies, ProgressiveABSTRACT
Abstract Background: The clinical outcomes of COVID-19 patients in Hubei and other areas are different. We aim to investigate the epidemiological and clinical characteristics of patient with COVID-19 in Hunan which is adjacent to Hubei. Methods: In this double-center, observational study, we recruited all consecutive patients with laboratory confirmed COVID-19 from January 23 to February 14, 2020 in two designated hospitals in Hunan province, China. Epidemiological and clinical data from patients' electronic medical records were collected and compared between mild, moderate and severe/critical group in detail. Clinical outcomes were followed up to February 20, 2020. Findings: 291 patients with COVID-19 were categorized into mild group (10.0%), moderate group (72.8%) and severe/critical group (17.2%). The median age of all patients was 46 years (49.8% were male). 86.6% patients had an indirect exposure history. The proportion of patients that had been to Wuhan in severe/critical group (48.0% vs 17.2%, p=0.006) and moderate group (43.4% vs 17.2%, p=0.007) were higher than mild group. Fever (68.7%), cough (60.5%), and fatigue (31.6%) were common symptoms especially for severe and critical patients. Typical lung imaging finding were bilateral and unilateral ground glass opacity or consolidation. Leukopenia, lymphopenia and eosinopenia occurred in 36.1%, 22.7% and 50.2% patients respectively. Increased fibrinogen was detected in 45 of 58 (77.6%) patients with available results. 29 of 44 (65.9%) or 22 of 40 (55.0%) patients were positive in Mycoplasma pneumonia or Chlamydia pneumonia antibody test respectively. Compared with mild or moderate group, severe/critical group had a relative higher level of neutrophil, Neutrophil-to-Lymphocyte Ratio, h-CRP, ESR, CK, CK-MB, LDH, D-dimer, and a lower level of lymphocyte, eosinophils, platelet, HDL and sodium (all p<0.01). Most patients received antiviral therapy and Chinese Medicine therapy. As of February 20, 2020, 159 (54.6%) patients were discharged and 2 (0.7%) patients died during hospitalization. The median length of hospital stay in discharged patients was 12 days (IQR: 10-15). Interpretation: The epidemiological and clinical characteristics of COVID-19 patients in Hunan is different from patients in Wuhan. The proportion of patients that had been to Wuhan in severe/critical group and moderate group were higher than mild group. Laboratory and imaging examination can assist in the diagnosis and classification of COVID-19 patients.