Independent Risk Factors for the Dynamic Development of COVID-19: A Retrospective Study.

OBJECTIVE: To identify the risk factors for predicting the dynamic progression of COVID-19. METHODS: A total of 2321 eligible patients were included in this study from February 4 to April 15, 2020. Two illness conditions, including mild/moderate (M/M) subtype to severe/critical (S/C) and S/C to fatality, were classified. Clinical message was collected and compared, respectively. Kaplan-Meier method, Cox regression model and risk score system were used to predict disease progression in S/C COVID-19. RESULTS: A total of 112 of 1761 patients with M/M subtype were progressors (P) and 1649 non-progressors (NP). Increasing disease progression associated with higher levels of neutrophils count (HR=1.958, 95% CI=1.253-3.059, P=0.003), CK (HR=2.203, 95% CI=1.048-4.632, P=0.037), LDH (HR=3.309, 95% CI=2.083-5.256, P<0.001) and CRP (HR=2.575, 95% CI=1.638-4.049, P<0.001), and lower level of lymphocytes count (HR=1.549, 95% CI=1.018-2.355, P=0.041), as well as total lesion volume ratio greater than ≥10% (HR=2.286, 95% CI=1.451-3.601, P<0.001) on admission. In progression to fatality, 56 of the 672 S/C cases died and 616 survived. Increasing fatality associated with lower level of lymphocytes count (HR:2.060, 95% CI:1.000-4.242, P=0.050), higher levels of BUN (HR:2.715, 95% CI:1.539-4.790, P<0.001), CK-MB (HR:3.412, 95% CI:1.760-6.616, P<0.001), LDH (HR:5.578, 95% CI:2.317-13.427, P<0.001), and PT (HR:3.619, 95% CI:2.102-6.231, P<0.001). Furthermore, high risk of neutrophils count, lymphocytes count, CK, LDH, CRP, and total lesion volume ratio was powerfully correlated with the incidence of progression to S/C in patients with NS COVID-19 and high odds of lymphocytes count, BUN, CK-MB, LDH, and PT were significantly associated with death in patients with S/C COVID-19. In addition, the progression and mortality rates increased with increasing risk scores. CONCLUSION: Elevated LDH level and lymphopenia were independent predictors for COVID-19 sustainable management in classifying non-severe patients who progressed to severe condition and identifying S/C patients who deteriorated to fatal outcomes as well. Total lesion volume ratio ≥10% may provide early predictive evidence with COVID-19 patients at high risk of developing into S/C to improve prognosis.

Risk Factors for COVID-19 in Patients with Hypertension.

BACKGROUND: Hypertension, as the most common comorbidity for patients with coronavirus disease 19 (COVID-19), has resulted in cases with more severe symptoms and higher mortality. The risk factors associated with COVID-19 in patients with hypertension are unknown. METHODS: All the available and confirmed patients with COVID-19 from February 3 to March 10, 2020, were enrolled from Huoshenshan Hospital, Wuhan, China. The demographic characteristics, clinical manifestations, laboratory data, radiological assessments, and treatments on admission were extracted and compared. Univariate and multivariate logistic regression methods were used to explore risk factors associated with COVID-19 in patients with hypertension and the severity of the cohort. RESULTS: A total of 430 available patients with COVID-19 were enrolled in the study, including 151 eligible patients with COVID-19 and hypertension. After PSM analysis, 141 patients without hypertension and 141 cases with hypertension were well matched. Compared with cases without hypertension, patients with hypertension were more severe (28.4% vs. 12.1%, p=0.001). In multivariate analysis, we found that neutrophil count (OR: 1.471; p=0.001), coronary heart disease (OR: 5.281; p=0.011), and the level of K+ (OR: 0.273; p < 0.001) were associated with patients with hypertension. In addition, the percentage of pulmonary infection volume was larger in cases with hypertension (4.55 vs. 5.8, p=0.017) and was a high risk factor for severe COVID-19 in patients with hypertension (OR: 1.084; p < 0.001). CONCLUSION: On admission, coronary heart disease, neutrophil count, and the level of K+ were associated with COVID-19 patients with hypertension. The percentage of the pulmonary infection volume was significantly larger in COVID-19 patients with hypertension and was a risk factor for COVID-19 severity of the cohort.

Automated detection and quantification of COVID-19 pneumonia: CT imaging analysis by a deep learning-based software.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) is an emerging worldwide threat to public health. While chest computed tomography (CT) plays an indispensable role in its diagnosis, the quantification and localization of lesions cannot be accurately assessed manually. We employed deep learning-based software to aid in detection, localization and quantification of COVID-19 pneumonia. METHODS: A total of 2460 RT-PCR tested SARS-CoV-2-positive patients (1250 men and 1210 women; mean age, 57.7 ± 14.0 years (age range, 11-93 years) were retrospectively identified from Huoshenshan Hospital in Wuhan from February 11 to March 16, 2020. Basic clinical characteristics were reviewed. The uAI Intelligent Assistant Analysis System was used to assess the CT scans. RESULTS: CT scans of 2215 patients (90%) showed multiple lesions of which 36 (1%) and 50 patients (2%) had left and right lung infections, respectively (> 50% of each affected lung's volume), while 27 (1%) had total lung infection (> 50% of the total volume of both lungs). Overall, 298 (12%), 778 (32%) and 1300 (53%) patients exhibited pure ground glass opacities (GGOs), GGOs with sub-solid lesions and GGOs with both sub-solid and solid lesions, respectively. Moreover, 2305 (94%) and 71 (3%) patients presented primarily with GGOs and sub-solid lesions, respectively. Elderly patients (≥ 60 years) were more likely to exhibit sub-solid lesions. The generalized linear mixed model showed that the dorsal segment of the right lower lobe was the favoured site of COVID-19 pneumonia. CONCLUSION: Chest CT combined with analysis by the uAI Intelligent Assistant Analysis System can accurately evaluate pneumonia in COVID-19 patients.