Dynamic Clinical Features During the Para-Exacerbation Period of Critical COVID-19 Patients (preprint)

Background COVID-19 has been currently spread all over the world with high mortality reported in severe COVID-19 patients. Many severe COVID-19 patients exacerbated from mild illness several days after hospital admissions. Pathophysiological evolution within this para-exacerbation period remain unclear.Methods Twenty-two confirmed COVID-19 patients who underwent at least one exacerbation were included. Epidemiological, clinical, laboratory, and radiological data were extracted from electronic medical records and compared between the records of hospital admission day and the exacerbation day. Dynamic profiles of critical parameters were explored during the para-exacerbation period.Results Most of the patients were elder (67, IQR63-79), male (81.8%), coexisted with comorbidities (72.7%), multi-segments radiologically involved and exacerbated from mild to severe illness with anoxia at a median interval of 4 days (IQR, 2-7) from hospital admissions. On exacerbations, various clinical parameters were worsened, including respiratory rate, PaO2/FiO2 rate (PFR), alveolar-arterial PO2 difference (A-aDO2), hematological cellularities, biochemical parameters and radiological abnormalities. Dynamic profiles showed that neutrophil/lymphocyte ratio (NLR), and serum level of lactic acid, lactate dehydrogenase and coagulation parameters started to increase even at four days before the exacerbation. Conclusions Anoxia due to impaired gas exchange progress pathophysiologically characterized the exacerbation of COVID-19 patients. Continuously monitoring crucial clinical parameters, such as NLR, serum albumin, LDH, lactic acid, and CT involvement scale will be helpful to improve the recognition of the disease progression in patients with COVID-19 at early stage.Trial registration This retrospective study has been registered in Chinese Clinical Trial Registry (ChiCTR2000030580, www.chictr.org.cn)

Dynamic Clinical Features During the Para-Exacerbation Period of Critical COVID-19 Patients (preprint)

Background COVID-19 has been currently spread all over the world with high mortality reported in severe COVID-19 patients. Many severe COVID-19 patients exacerbated from mild illness several days after hospital admissions. Pathophysiological evolution within this para-exacerbation period remain unclear.Methods Twenty-two confirmed COVID-19 patients who underwent at least one exacerbation were included. Epidemiological, clinical, laboratory, and radiological data were extracted from electronic medical records and compared between the records of hospital admission day and the exacerbation day. Dynamic profiles of critical parameters were explored during the para-exacerbation period.Results Most of the patients were elder (67, IQR63-79), male (81.8%), coexisted with comorbidities (72.7%), multi-segments radiologically involved and exacerbated from mild to severe illness with anoxia at a median interval of 4 days (IQR, 2-7) from hospital admissions. On exacerbations, various clinical parameters were worsened, including respiratory rate, PaO2/FiO2 rate (PFR), alveolar-arterial PO2 difference (A-aDO2), hematological cellularities, biochemical parameters and radiological abnormalities. Dynamic profiles showed that neutrophil/lymphocyte ratio (NLR), and serum level of lactic acid, lactate dehydrogenase and coagulation parameters started to increase even at four days before the exacerbation.Conclusions Anoxia due to impaired gas exchange progress pathophysiologically characterized the exacerbation of COVID-19 patients. Continuously monitoring crucial clinical parameters, such as NLR, serum albumin, LDH, lactic acid, and CT involvement scale will be helpful to improve the recognition of the disease progression in patients with COVID-19 at early stage.Trial registration: This retrospective study has been registered in Chinese Clinical Trial Registry (ChiCTR2000030580, www.chictr.org.cn)