Copyright
©The Author(s) 2021.
World J Gastroenterol. Mar 7, 2021; 27(9): 835-853
Published online Mar 7, 2021. doi: 10.3748/wjg.v27.i9.835
Published online Mar 7, 2021. doi: 10.3748/wjg.v27.i9.835
All patients | Normal cumulative LB | Cumulative LBA (n = 185) | Cumulative ALI (n = 69) | Cumulative LBAI (n = 254) | OR (95%CI)1 | P value2 | |
Characteristics | |||||||
Age, yr, median (IQR) | 63 (25) | 61 (18) | 63 (23) | 65 (17) | 64 (18) | 2.536 | 0.012 |
< 50 | 65 (14.8) | 33 (50.8) | 23 (35.4) | 9 (13.8) | 32 (49.2) | Ref | Ref |
50-64 | 203 (46.1) | 91 (44.8) | 85 (41.9) | 27 (13.3) | 112 (55.2) | 1.27 (0.73 to 2.22) | 0.404 |
≥ 65 | 172 (39.1) | 62 (36.0) | 77 (44.8) | 33 (19.2) | 110 (64.0) | 1.83 (1.03 to 3.26) | 0.040 |
Sex, female | 233 (53.0) | 79 (33.9) | 109 (46.8) | 45 (19.3) | 154 (66.1) | 2.09 (1.42 to 3.06) | < 0.0001 |
BMI, ≥ 24 kg/m2 | 124 (49.8) | 63 (50.8) | 45 (36.3) | 16 (12.9) | 61 (49.2) | 0.95 (0.58 to 1.57) | 0.849 |
Epidemiological exposure3 | 268 (60.9) | 123 (45.9) | 104 (38.8) | 41 (15.3) | 145 (54.1) | 0.68 (0.46 to 1.01) | 0.055 |
Smoking history | 62 (20.9) | 21 (33.9) | 31 (50.0) | 10 (16.1) | 41 (61.1) | 1.48 (0.84 to 2.61) | 0.176 |
Comorbidities4 | 285 (64.8) | 109 (38.2) | 123 (43.2) | 53 (18.6) | 176 (61.8) | 1.59 (1.07 to 2.37) | 0.021 |
Hypertension | 181 (41.1) | 69 (38.1) | 83 (45.9) | 29 (16.0) | 112 (61.9) | 1.34 (0.91 to 1.97) | 0.141 |
Diabetes | 136 (30.9) | 48 (35.3) | 53 (39.0) | 35 (25.7) | 88 (64.7) | 1.52 (1.00 to 2.31) | 0.048 |
Cardiovascular disease | 56 (12.7) | 22 (39.3) | 19 (33.9) | 15 (26.8) | 34 (60.7) | 1.15 (0.65 to 2.04) | 0.628 |
Cerebrovascular disease | 16 (3.6) | 4 (25.0) | 8 (50.0) | 4 (25.0) | 12 (75.0) | 2.26 (0.72 to 7.11) | 0.165 |
Chronic renal disease | 21 (4.8) | 11 (52.4) | 9 (42.9) | 1 (4.8) | 10 (47.6) | 0.65 (0.27 to 1.57) | 0.340 |
Chronic liver disease | 12 (2.7) | 4 (33.3) | 7 (58.3) | 1 (8.3) | 8 (66.7) | 1.48 (0.44 to 4.99) | 0.527 |
Chronic hepatitis B | 8 (1.8) | 2 (25.0) | 5 (62.5) | 1 (12.5) | 6 (75.0) | 2.23 (0.44 to 11.15) | 0.331 |
Other chronic liver disease5 | 4 (0.9) | 2 (50.0) | 2 (50.0) | 0 | 2 (50.0) | 0.73 (0.10 to 5.23) | 0.754 |
Chronic respiratory disease | 31 (7.0) | 16 (51.6) | 9 (29.0) | 6 (19.4) | 15 (48.4) | 0.67 (0.32 to 1.39) | 0.278 |
Signs and symptoms at disease onset | |||||||
Fever (temperature ≥ 37.3 °C) | 369 (85.8) | 149 (40.4) | 159 (43.1) | 61 (16.5) | 220 (59.6) | 1.63 (0.95 to 2.81) | 0.079 |
Sputum | 236 (53.6) | 93 (39.4) | 104 (44.1) | 39 (16.5) | 143 (60.6) | 1.29 (0.88 to 1.88) | 0.191 |
Dyspnoea | 243 (55.2) | 82 (33.7) | 116 (47.7) | 45 (18.5) | 161 (66.3) | 2.2 (1.49 to 3.23) | < 0.0001 |
Haemoptysis | 63 (14.3) | 25 (39.7) | 26 (41.3) | 12 (19.0) | 38 (60.3) | 1.13 (0.66 to 1.95) | 0.653 |
Chest pain/tightness | 227 (51.6) | 88 (38.8) | 100 (44.1) | 39 (17.2) | 139 (61.2) | 1.35 (0.92 to 1.97) | 0.125 |
Pharyngalgia/nasal congestion/running | 94 (21.4) | 47 (50.0) | 33 (35.1) | 14 (14.9) | 47 (50.0) | 0.67 (0.42 to 1.06) | 0.088 |
Headaches/dizziness | 135 (30.7) | 57 (42.2) | 54 (40.0) | 24 (17.8) | 78 (57.8) | 1.00 (0.67 to 1.51) | 0.989 |
Myalgia/fatigue | 289 (65.7) | 122 (42.2) | 120 (41.5) | 47 (16.3) | 167 (57.8) | 1.01 (0.68 to 1.50) | 0.973 |
Nausea/vomiting | 133 (30.2) | 53 (39.8) | 59 (44.4) | 21 (15.8) | 80 (60.2) | 1.15 (0.76 to 1.75) | 0.498 |
Abdominal pain | 70 (15.9) | 29 (41.4) | 26 (37.1) | 15 (21.4) | 41 (58.6) | 1.04 (0.62 to 1.75) | 0.876 |
Diarrhea | 185 (42.0) | 78 (42.2) | 83 (44.9) | 24 (13.0) | 107 (57.8) | 1.01 (0.69 to 1.48) | 0.968 |
On-admission vital signs | |||||||
Temperature, ≥ 37.3 °C | 103 (23.8) | 26 (25.2) | 50 (48.5) | 27 (26.2) | 77 (74.8) | 2.74 (1.67 to 4.49) | < 0.0001 |
Respiratory rate, ≥ 30 breaths per min | 53 (12.1) | 13 (24.5) | 21 (39.6) | 19 (35.8) | 40 (75.5) | 2.50 (1.30 to 4.82) | 0.006 |
Pulse oximeter O2 saturation, ≤ 93% | 146 (35.0) | 25 (17.1) | 82 (56.2) | 39 (26.7) | 121 (82.9) | 6.37 (3.89 to 10.43) | < 0.0001 |
Systolic blood pressure, < 90 mmHg | 4 (0.9) | 2 (50.0) | 2 (50.0) | 0 | 2 (50.0) | 0.74 (0.10 to 5.27) | 0.760 |
Heart rate, > 125 beats per min | 23 (5.2) | 5 (21.7) | 10 (43.5) | 8 (34.8) | 18 (78.3) | 2.77 (1.01 to 7.61) | 0.048 |
Severity of illness | |||||||
In-hospital disease severity status, general | 128 (29.1) | 88 (68.8) | 37 (28.9) | 3 (2.3) | 40 (31.3) | Ref | Ref |
Severe | 184 (41.8) | 80 (43.5) | 84 (45.7) | 20 (10.9) | 104 (56.5) | 2.86 (1.78 to 4.59) | < 0.0001 |
Critical | 128 (29.1) | 18 (14.1) | 64 (50.0) | 46 (35.9) | 110 (85.9) | 13.44 (7.21 to 25.07) | < 0.0001 |
qSOFA score, 0 | 231 (52.7) | 114 (49.4) | 95 (41.1) | 22 (9.5) | 117 (50.6) | Ref | Ref |
1 | 179 (40.9) | 59 (33.0) | 80 (44.7) | 40 (22.3) | 120 (67.0) | 1.98 (1.32 to 2.97) | < 0.0001 |
2-3 | 28 (6.4) | 13 (46.4) | 9 (32.1) | 6 (21.4) | 15 (53.6) | 1.12 (0.51 to 2.47) | 0.770 |
CURB-65 score, 0-1 | 330 (75.3) | 159 (48.2) | 132 (40.0) | 39 (11.8) | 171 (51.8) | Ref | |
2 | 71 (16.2) | 17 (23.9) | 41 (57.7) | 13 (18.3) | 54 (76.1) | 2.95 (1.64 to 5.31) | < 0.0001 |
3-5 | 37 (8.4) | 10 (27.0) | 11 (29.7) | 16 (43.2) | 27 (73.0) | 2.51 (1.18 to 5.35) | 0.017 |
Routine blood results | |||||||
White blood cell count, < 3.5 × 109/L | 44 (10.0) | 17 (38.6) | 19 (43.2) | 8 (18.2) | 27 (61.4) | 0.68 (0.35 to 1.29) | 0.234 |
3.5-9.5 | 313 (71.3) | 151 (48.2) | 126 (40.3) | 36 (11.5) | 162 (51.8) | Ref | Ref |
> 9.5 | 82 (18.7) | 18 (22.0) | 40 (48.8) | 24 (29.3) | 64 (78.0) | 2.24 (1.00 to 4.99) | 0.049 |
Lymphocyte count, < 1.1 × 109/L | 232 (52.8) | 62 (26.7) | 115 (49.6) | 55 (23.7) | 170 (73.3) | 4.1 (2.74 to 6.12) | < 0.0001 |
Neutrophil count, > 6.3 × 109/L | 149 (33.9) | 44 (29.5) | 73 (49.0) | 32 (21.5) | 105 (70.5) | 2.29 (1.50 to 3.49) | < 0.0001 |
Hemoglobin, < 130 g/L for male; < 115 g/L for female | 194 (44.4) | 85 (43.8) | 76 (39.2) | 33 (17.0) | 109 (56.2) | 0.90 (0.61 to 1.31) | 0.576 |
Platelet count, < 125 × 109/L | 59 (13.5) | 17 (28.8) | 31 (52.5) | 11 (18.6) | 42 (71.2) | 1.98 (1.09 to 3.6) | 0.026 |
Biochemical results-basic values | |||||||
Albumin, < 35 g/L | 232 (52.7) | 58 (25.0) | 118 (50.9) | 56 (24.1) | 174 (75.0) | 4.80 (3.19 to 7.22) | < 0.0001 |
ALT, > 41 U/L for male; > 33 U/L for female | 113 (25.7) | 0 | 77 (68.1) | 36 (31.9) | 113 (100.0%) | - | - |
AST, > 40 U/L for males; > 32 U/L for females | 144 (32.7) | 0 | 91 (63.2) | 53 (36.8) | 144 (100.0) | - | - |
Total bilirubin, > 26 mmol/L for males; > 21 mmol/L for females | 25 (5.7) | 0 | 12 (48.0) | 13 (52.0) | 25 (100.0) | - | - |
Direct bilirubin, > 8.0 mmol/L | 61 (13.9) | 4 (6.6) | 29 (47.5) | 28 (45.9) | 57 (93.4) | 13.16 (4.68 to 37.01) | < 0.0001 |
Lactate dehydrogenase, > 225 U/L for males; > 214 U/L for females | 332 (75.5) | 105 (31.6) | 162 (48.8) | 65 (19.6) | 227 (68.4) | 6.49 (3.96 to 10.62) | < 0.0001 |
γ-Glutamyl transferase, > 71 U/L for males; > 42 U/L for females | 115 (26.4) | 20 (17.4) | 62 (53.9) | 33 (28.7) | 95 (82.6) | 5.12 (3.01 to 8.7) | < 0.0001 |
Creatinine, > 104 μmol/L for males; > 84 μmol/L for females | 70 (16.0) | 22 (31.4) | 31 (44.3) | 17 (24.3) | 48 (68.6) | 1.73 (1.01 to 2.99) | 0.048 |
C-reactive protein, ≥ 1 mg/L | 369 (87.6) | 145 (39.3) | 161 (43.6) | 63 (17.1) | 224 (60.7) | 2.92 (1.59 to 5.36) | 0.0010 |
Coagulation and inflammation index results | |||||||
Prothrombin time, ≤ 14.5 s | 289 (66.3) | 144 (49.8) | 116 (40.1) | 29 (10.0) | 145 (50.2) | 0.35 (0.23 to 0.54) | < 0.0001 |
Prothrombin activity, < 75% | 82 (18.8) | 14 (17.1) | 43 (52.4) | 25 (30.5) | 68 (82.9) | 4.39 (2.38 to 8.09) | < 0.0001 |
Activated partial thromboplastin time, > 42.0 s | 166 (38.2) | 46 (27.7) | 89 (53.6) | 31 (18.7) | 120 (72.3) | 2.69 (1.77 to 4.07) | < 0.0001 |
D-dimer, > 0.5 μg/mL | 295 (68.4) | 87 (29.5) | 145 (49.2) | 63 (21.4) | 208 (70.5) | 5.17 (3.33 to 8.03) | < 0.0001 |
Serum ferritin, > 400 μg/L for males; > 150 μg/L for females | 319 (81.0) | 111 (34.8) | 153 (48.0) | 55 (17.2) | 208 (65.2) | 6.91 (3.80 to 12.57) | < 0.0001 |
Interleukin-6, ≥ 7 pg/mL | 255 (62.3) | 73 (28.6) | 123 (48.2) | 59 (23.1) | 182 (71.4) | 4.62 (3.01 to 7.08) | < 0.0001 |
Interleukin-10, ≥ 5 pg/mL | 177 (44.1) | 41 (23.2) | 90 (50.8) | 46 (26.0) | 136 (76.8) | 4.67 (3.01 to 7.25) | < 0.0001 |
Procalcitonin, ≥ 0.5 ng/mL | 57 (13.6) | 10 (17.5) | 29 (50.9) | 18 (31.6) | 47 (82.5) | 3.76 (1.84 to 7.68) | < 0.0001 |
Imaging features | |||||||
Bilateral | 381 (93.2) | 155 (40.7) | 162 (42.5) | 64 (16.8) | 226 (59.3) | 2.62 (1.18 to 5.84) | 0.018 |
Ground-glass opacity | 306 (74.8) | 119 (38.9) | 131 (42.8) | 56 (18.3) | 187 (61.1) | 1.73 (1.10 to 2.72) | 0.017 |
Consolidation | 89 (21.8) | 29 (32.6) | 36 (40.4) | 24 (27.0) | 60 (67.4) | 1.69 (1.03 to 2.78) | 0.037 |
Pleural effusion | 47 (11.5) | 6 (12.8) | 25 (53.2) | 16 (34.0) | 41 (87.2) | 5.85 (2.42 to 14.13) | < 0.0001 |
All patients (n = 440) | Normal cumulative LB (n = 186) | Cumulative LBA (n = 185) | Cumulative ALI (n = 69) | Cumulative LBAI (n = 254) | P value1 | |
Outcomes | ||||||
Discharge | 304 (69.1) | 166 (54.6) | 117 (38.5) | 21 (6.9) | 138 (45.4) | < 0.00012 |
Death | 98 (22.3) | 11 (11.2) | 45 (45.9) | 42 (42.9) | 87 (88.8) | |
Still in hospital | 38 (8.6) | 9 (23.7) | 23 (60.5) | 6 (15.8) | 29 (76.3) | |
ICU admission | 91 (20.7) | 11 (12.1) | 45 (49.5) | 35 (38.5) | 80 (88.0) | < 0.0001 |
Time from illness onset to hospital admission (median, IQR), d | 438 | 19 (11 to 35) | 13 (9 to 19) | 11 (8 to 16) | 12 (9 to 18) | < 0.0001 |
Hospital stay time (median, IQR), d | 402 | 12 (6 to 22) | 19 (11 to 29) | 17 (8 to 28) | 19 (10 to 29) | < 0.0001 |
Time from illness onset to death (median, IQR), d | 93 | 19 (9 to 26) | 23 (16 to 33) | 28 (18 to 33) | 25 (17 to 33) | 0.037 |
Time from illness onset to discharge (median, IQR), d | 303 | 40 (32 to 49) | 40 (34 to 51) | 42 (31 to 51) | 40 (34 to 50) | 0.088 |
Time from illness onset to last day of follow-up (median, IQR), d | 37 | 61 (52 to 66) | 59 (49 to 64) | 58 (52 to 67) | 59 (51 to 65) | 0.689 |
Time from illness onset to ICU admission (median, IQR), d | 90 | 15 (13 to 25) | 18 (11 to 30) | 19 (14 to 26) | 18 (12 to 26) | 0.478 |
Duration of viral shedding after illness onset (median, IQR), d | 298 | 33 (24 to 42) | 30 (25 to 38) | 26 (21 to 36) | 30 (24 to 38) | 0.172 |
- Citation: Zhang SS, Dong L, Wang GM, Tian Y, Ye XF, Zhao Y, Liu ZY, Zhai JY, Zhao ZL, Wang JH, Zhang HM, Li XL, Wu CX, Yang CT, Yang LJ, Du HX, Wang H, Ge QG, Xiu DR, Shen N. Progressive liver injury and increased mortality risk in COVID-19 patients: A retrospective cohort study in China. World J Gastroenterol 2021; 27(9): 835-853
- URL: https://www.wjgnet.com/1007-9327/full/v27/i9/835.htm
- DOI: https://dx.doi.org/10.3748/wjg.v27.i9.835