Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 21, 2022; 10(3): 840-855
Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.840
Clinical features and risk factors of severely and critically ill patients with COVID-19
Xin Chu, Gui-Fang Zhang, Yong-Ke Zheng, Yi-Gang Zhong, Li Wen, Ping Zeng, Chun-Yi Fu, Xun-Liang Tong, Yun-Fei Long, Jing Li, Ya-Lin Liu, Zhi-Gang Chang, Huan Xi
Xin Chu, Ya-Lin Liu, Zhi-Gang Chang, Department of Surgical Intensive Care Medicine, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
Gui-Fang Zhang, Ping Zeng, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital /National Center of Gerontology of National Health Commission, Beijing 100730, China
Yong-Ke Zheng, Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Yi-Gang Zhong, Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Li Wen, Chun-Yi Fu, Department of Emergency, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
Xun-Liang Tong, Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
Yun-Fei Long, Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
Jing Li, Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
Huan Xi, Department of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
Author contributions: Chu X, Zhang GF, Zheng YK, Zhong YG, Wen L, Zeng P, Fu CY, Tong XL, Long YF, Li J, Liu YL and Chang ZG created the database and collected the data; Chu X, Zhang GF, Chang ZG and Xi H performed the study and wrote the manuscript; Chu X and Zhang GF performed the statistical analysis and interpreted the data; all authors providing critical feedback and edits to subsequent revisions; Chu X and Zhang GF contributed equally to this study; Chang ZG and Xi H are the guarantors, and considered as co-corresponding authors; Chang ZG and Xi H attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Supported by Disciplines Construction Project of Peking Union Medical College, No. 201920202102.
Institutional review board statement: The study was approved by the Research Ethics Commission of Beijing Hospital (2020BJYYEC-047-01).
Informed consent statement: Written informed consent was waived by the Ethics.
Conflict-of-interest statement: None reported.
Data sharing statement: The datasets used and/or analyzed during the present study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Huan Xi, MD, Doctor, Department of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing 100730, China. xih@bjhmoh.cn
Received: September 2, 2021
Peer-review started: September 2, 2021
First decision: September 29, 2021
Revised: October 20, 2021
Accepted: December 23, 2021
Article in press: December 23, 2021
Published online: January 21, 2022
Processing time: 135 Days and 4.3 Hours
Abstract
BACKGROUND

As of June 1, 2020, over 370000 coronavirus disease 2019 (COVID-19) deaths have been reported to the World Health Organization. However, the risk factors for patients with moderate-to-severe or severe-to-critical COVID-19 remain unclear.

AIM

To explore the characteristics and predictive markers of severely and critically ill patients with COVID-19.

METHODS

A retrospective study was conducted at the B11 Zhongfaxincheng campus and E1-3 Guanggu campus of Tongji Hospital affiliated with Huazhong University of Science and Technology in Wuhan. Patients with COVID-19 admitted from 1st February 2020 to 8th March 2020 were enrolled and categorized into 3 groups: The moderate group, severe group and critically ill group. Epidemiological data, demographic data, clinical symptoms and outcomes, complications, laboratory tests and radiographic examinations were collected retrospectively from the hospital information system and then compared between groups.

RESULTS

A total of 126 patients were enrolled. There were 59 in the moderate group, 49 in the severe group, and 18 in the critically ill group. Multivariate logistic regression analysis showed that age [odd ratio (OR) = 1.055, 95% (confidence interval) CI: 1.099-1.104], elevated neutrophil-to-lymphocyte ratios (OR = 4.019, 95%CI: 1.045-15.467) and elevated high-sensitivity cardiac troponin I (OR = 10.126, 95%CI: 1.088 -94.247) were high-risk factors.

CONCLUSION

The following indicators can help clinicians identify patients with severe COVID-19 at an early stage: age, an elevated neutrophil-to-lymphocyte ratio and high sensitivity cardiac troponin I.

Keywords: COVID-19; SARS-CoV-2; Critically ill; Risk factors; Aspartate transaminase; Amino-terminal pro-brain natriuretic peptide; Creatinine; Calcium

Core Tip: Here, we conducted a case-control study and found out that early drug treatment is an important measure in the treatment of patients with coronavirus disease 2019 (COVID-19). And the following indicators can help clinicians identify patients with severe COVID-19 at an early stage: an elevated neutrophil-to-lymphocyte ratio; elevated aspartate transaminase, N-terminal pro b-type natriuretic peptide, and creatinine levels; as well as decreased serum calcium level.