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Predictors of clinical deterioration in non-severe patients with COVID-19: a retrospective cohort study.
Yitao, Zhang; Mu, Chen; Ling, Zhou; Shiyao, Cheng; Jiaojie, Xue; Zhichong, Chen; Huajing, Peng; Maode, Ou; Kanglin, Cheng; Mao, Ou Yang; Xiaoneng, Mo; Weijie, Zeng.
  • Yitao Z; The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
  • Mu C; Department of Pulmonology, Guangzhou Eighth People's Hospital, Guangzhou, China.
  • Ling Z; The First Clinical Medical College, Jinan University, Guangzhou, China.
  • Shiyao C; Ultrasonic Department, Hospital of South China University of Technology, Guangzhou, China.
  • Jiaojie X; The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
  • Zhichong C; The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
  • Huajing P; The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
  • Maode O; The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
  • Kanglin C; The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
  • Mao OY; The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
  • Xiaoneng M; The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
  • Weijie Z; Department of Pulmonology, Guangzhou Eighth People's Hospital, Guangzhou, China.
Curr Med Res Opin ; 37(3): 385-391, 2021 03.
Article in English | MEDLINE | ID: covidwho-1066084
ABSTRACT

OBJECTIVE:

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains pandemic with considerable morbidity and mortality around the world. The aim of this study was to identify the predictors for clinical deterioration in patients with COVID-19 who did not show clinical deterioration upon hospital admission.

METHODS:

Two hundred fifty-seven patients with confirmed COVID-19 pneumonia admitted to Guangzhou Eighth People's Hospital between 23 January and 21 March 2020 were retrospectively enrolled. Demographic data, symptoms, laboratory values, comorbidities and treatments were all collected. The study endpoint was clinical deterioration within 20 days from hospital admission. Univariate and multivariable logistic regression methods were used to explore the risk factors associated with clinical deterioration.

RESULTS:

A total of 49 (19%) patients showed clinical deterioration after admission. Compared with patients that did not experience clinical deterioration, clinically deteriorated patients had more dyspnea, cough and myalgia (65.3% versus 29.3%) symptoms and more had comorbidities (89.8% versus 36.1%). Clinical and laboratory characteristics at admission that were associated with clinical deterioration included senior age, diabetes, hypertension, myalgia, higher temperature, systolic blood pressure, C-reactive protein (CRP), procalcitonin, activated partial thromboplastin time, aspartate aminotransferase, alanine transaminase, direct bilirubin, plasma creatinine, lymphocytopenia, thrombocytopenia, decreased albumin and bicarbonate concentration. Medical history of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, calcium channel blockers and metformin were also risk factors.

CONCLUSION:

The four best predictors for clinical deterioration were CRP, procalcitonin, age and albumin. A "best" multivariable prediction model, resulting from using a variable selection procedure, included senior age, presentation with myalgia, and higher level of CRP and serum creatinine (bias-corrected c-statistic = 0.909). Sensitivity and specificity corresponding to a cut point of CRP ≥18.45 mg/L for predicting clinical deterioration were 85% and 74%, respectively.
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Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: C-Reactive Protein / Serum Albumin / Noncommunicable Diseases / Clinical Deterioration / Procalcitonin / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: Curr Med Res Opin Year: 2021 Document Type: Article Affiliation country: 03007995.2021.1876005

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Full text: Available Collection: International databases Database: MEDLINE Main subject: C-Reactive Protein / Serum Albumin / Noncommunicable Diseases / Clinical Deterioration / Procalcitonin / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: Curr Med Res Opin Year: 2021 Document Type: Article Affiliation country: 03007995.2021.1876005