Risk factors associated with acute respiratory distress syndrome in COVID-19 patients outside Wuhan: A double-center retrospective cohort study of 197 cases in Hunan, China

doi:10.12998/wjcc.v9.i2.344

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World Journal of Clinical Cases

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Clin Cases. Jan 16, 2021; 9(2): 344-356
Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.344

Table 1 Clinical characteristics and factors associated respiratory distress syndrome

Demographic characteristics	All patients (n = 197)	Non-ARDS (n = 184)	ARDS (n = 13)	P value
Ages (yr)	45.0 (34.0-58.5)	42 (34-57)	58 (48-65)	0.010
Sex
Male	93/197 (47.2%)	85/184 (46.2%)	8/13 (61.5%)	0.284
Female	104/197 (52.8%)	99/184 (53.8%)	5/13 (38.5%)	0.284
Body mass index	23.42 (21.39-25.69)	23.29 (21.29-25.49)	26.03 (21.50-26.89)	0.170
Smoking	11/171 (6.4%)	10/159 (6.3%)	1/12 (8.3%)	0.562¹
Travelling to Wuhan	45/133 (33.8%)	40/125 (32.0%)	5/8 (62.5%)	0.167
Imported cases	76/183 (41.5%)	73/184 (39.7%)	3/12 (25.0%)	0.481
Cluster exposure history	132/197 (67.0%)	127/184 (69.0%)	5/13 (38.5%)	0.050
Coexisting disease
Any	49/197 (24.9%)	42/184 (22.8%)	7/13 (53.8%)	0.030
Heart disease	8/197 (4.0%)	6/184 (3.3%)	2/13 (15.4%)	0.090¹
Hypertension	27/197 (13.7%)	24/184 (13.0%)	3/13 (23.1%)	0.549
Diabetes	13/197 (6.6%)	12/184 (6.5%)	1/13(7.7%)	0.600
Other	25/197 (12.7%)	22/184 (12.0%)	3/13 (23.1%)	0.464
Clinical manifestations
Fever
37.3–39.0 °C	115/197 (58.4%)	107/184 (58.2%)	8/13 (61.5%)	0.308
> 39.0 °C	17/197 (8.6%)	14/184 (7.6%)	3/13 (23.0%)	0.308
Non-fever	68/197 (34.5%)	65/184 (35.3%)	3/13 (23.0%)	0.551
Fever	129/197 (65.5%)	119/184 (64.7%)	10/13 (76.9%)	0.551
Cough	147/197 (74.6%)	137/184 (74.5%)	10/13 (76.9%)	1.000
Expectoration	76/197 (38.6%)	71/184 (38.6%)	7/13 (53.8%)	0.277
Dyspnea	39/197 (19.8%)	29/184 (15.8%)	10/13 (58.8%)	< 0.001
Diarrhea	27/197 (13.7%)	26/184 (14.1%)	1/13 (7.7%)	0.814
Nausea/vomit	17/197 (8.6%)	16/184 (8.7%)	1/13 (7.7%)	1.000
Fatigue	70/197 (35.5%)	64/184 (34.8%)	6/13 (46.2%)	0.597
Sore throat	18/197 (9.1%)	18/184 (9.8%)	0/13 (0.0%)	0.493
Headache	19/197 (9.6%)	18/184 (9.8%)	1/13 (7.7%)	1.000
Muscular soreness	15/197 (7.6%)	14/184 (7.6%)	1/13 (7.7%)	1.000¹
Total complications	21/197 (10.7%)	14/184 (7.6%)	7/13 (53.8%)	< 0.001
Dry/moist rales	11/162 (6.8%)	8/153 (5.2%)	3/9 (33.3%)	0.016
CT imagings
Single lung involvement	23/169 (13.6%)	23/150 (%)	0/13 (%)	0.268
Bilateral lung involvement	140/169 (82.8%)	127/150	13/13 (100.0%)	0.268
Ground glass opacities	143/165 (86.7%)	137/145 (94.5%)	6/9 (66.7%)	0.018¹
Consolidative/mixed opacities	11/165 (6.7%)	8/145 (5.5%)	3/9 (33.3%)	0.018¹
Number of lobe involvement
Single left lobe	58/158 (36.7%)	55/111 (49.5%)	3/8 (37.5%)	0.770
Double left lobe	61/158 (38.6%)	56/111 (50.5%)	5/8 (62.5%)	0.770
Single or double right lobe	65/157 (41.4%)	62/113 (54.9%)	3/8 (37.5%)	0.558
Triple right lobe	56/157 (35.7%)	51/113 (45.1%)	5/8 (62.5%)	0.558
Laboratory findings				P value
White cell count (× 10⁹/L)	4.75 (3.44-5.91)	4.75 (3.44-5.89)	4.51 (3.06-7.05)	0.990
< 4	71/197 (36.0%)	66/184 (35.9%)	5/13 (38.5%)	0.293
4-10	122/197 (61.9%)	115/184 (62.5%)	7/13 (53.8%)
> 10	4/197 (2.0%)	3/184 (1.6%)	1/13 (7.7%)
Neutrophil (× 10⁹/L)	2.89 (2.16-3.72)	2.88 (2.15-3.65)	3.31 (2.16-5.46)	0.260
< 2	40/197 (20.3%)	37/184 (20.1%)	3/13 (23.1%)	0.325
2-7	152/197 (77.2%)	143/184 (77.7%)	9/13 (69.2%)
> 7	5/197 (2.5%)	4/184 (2.2%)	1/13 (7.7%)
Lymphocyte (× 10⁹/L)	1.20 (0.81-1.66)	1.21 (0.88-1.69)	0.70 (0.60-0.94)	< 0.001
< 0.8	47/197 (23.9%)	38/184 (20.7%)	9/13 (69.2%)	< 0.001
Hemoglobin (g/L)	130.00 (119.00-141.00)	130.00 (119.25-140.75)	127.50 (103.25-148.00)	0.511
< 110 g/L	18/197 (9.1%)	16/184 (8.7%)	2/13 (15.4%)	0.756
Blood platelet	173.00 (139.00-230.00)	178.50 (139.00-229.50)	148.00 (91.25-225.25)	0.174
< 100, × 10⁹/L	12/197 (6.1%)	10/184 (5.4%)	2/13 (15.4%)	0.182¹
Prothrombin time (s)	11.5 (10.90-12.35)	11.55 (10.90-12.30)	11.40 (10.60-12.75)	0.964
> 16 s	21.1 (%)	1/184 (0.5%)	1/13 (7.7%)	0.128
APTT (s)	32.20 (29.80-34.75)	32.40 (30.20-34.57)	29.70 (26.90-35.90)	0.212
< 22	3/1971.5 (%)	2/184 (1.0%)	1/13 (%)	0.186
CK (U/L)	64.10 (41.97-93.87)	63.85 (41.17-91.85)	83.20 (47.00-187.30)	0.195
> 170 U/L	19/192 (9.9%)	15/182 (8.2%)	4/10 (40.0%)	0.010
CK-MB (U/L)	9.10 (5.90-12.05)	8.60 (5.60-11.90)	14.10 (10.43-30.50)	0.005
> 23	12/193 (6.2%)	19/183 (10.4%)	4/10 (40.0%)	0.021
D-dmier (mg/L)	0.26 (0.13-0.58)	0.26 (0.12-0.56)	1.17 (0.26-8.57)	0.001
> 0.5	52/165 (31.5%)	44/153 (28.8%)	8/12 (66.7%)	0.016
Albumin (g/L)	38.28 (35.35-41.08)	38.52 (35.78-41.59)	29.90 (27.86-34.88)	< 0.001
< 35	38/197 (19.3%)	26/155 (16.8%)	9/13 (69.2%)	< 0.001
ALT (U/L)	20.13 (14.12-30.29)	19.72 (13.91-28.75)	37.41 (23.93-78.65)	< 0.001
> 40	32/197 (16.2%)	26/184 (14.1%)	6/13 (46.2%)	0.008
AST (U/L)	23.38 (19.14-31.28)	23.12 (18.98-30.49)	33.24 (21.47-68.61)	0.029
> 40	24/197 (12.2%)	18/184 (9.8%)	6/13 (46.2%)	0.001
Total bilirubin (μmol/L)	10.80 (7.89-15.12)	10.67 (7.82-14.86)	13.26 (8.81-23.31)	0.114
> 17.1	40/197 (20.3%)	36/184 (19.6%)	4/13 (30.8%)	0.539
Creatinine (μmol/L)	64.10 (41.98-93.88)	51.25 (40.39-64.65)	46.17 (36.79-111.57)	0.684
> 133	6/197 (3.0%)	4/184 (2.2%)	2/13 (15.4%)	0.052
LDH (U/L)	161.15 (135.80-208.88)	157.80 (133.85-205.97)	313.60 (183.55-352.50)	< 0.001
> 250 U/L	25/197 (12.7%)	17/184 (9.2%)	8/13 (61.5%)	< 0.001
CRP (mg/L)	12.79 (3.55-28.50)	12.47 (3.49-25.52)	45.70 (13.30-72.08)	0.003
> 10	10/105 (53.3%)	96/184 (52.2%)	9/13 (69.2%)	0.064
Procalcitonin (μg/L)	0.08 (0.06-0.20)	0.70 (0.05-0.18)	0.80 (0.60-71.83)	0.117
> 0.5	4/187 (2.1%)	1/175 (0.6%)	2/12 (16.7%)	0.011¹
Blood glucose (mmol/L)	161/197 (81.7%)	5.32 (4.73-6.66)	6.03 (5.01-12.97)	0.169
> 7	31/161 (19.3%)	28/154 (18.2%)	3/7 (42.9%)	0.259
Treatments
Oxygen therapy
Mechanical ventilation	4/164 (2.0%)	0/155 (0.0%)	4/9 (44.4%)	< 0.001¹
Nasal cannula	151/164 (92.1%)	146/155 (94.2%)	5/9 (55.6%)
Did not oxygen therapy	9/164 (5.5%)	9/155 (5.8%)	0/9 (0.0%)
Antiviral therapy	161/162 (99.4%)	153/154 (99.4%)	8/8 (100.0%)	1.000¹
Antibiotic therapy	67/153 (43.8%)	62/147 (42.2%)	5/6 (83.3%)	0.116
Corticosteroid	40/161 (24.8%)	30/151 (19.9%)	10/10 (100.0%)	< 0.001
Convalescent plasma	4/197 (2.0%)	0/184 (0.0%)	4/13 (30.8%)	< 0.001¹
Gamma globulin	39/157 (24.8%)	32/150 (21.3%)	7/7 (100.0%)	< 0.001

¹Fisher exact test.

LDH: Lactate dehydrogenase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; LDH: Lactate dehydrogenase; CRP: C-reactive protein; LPV/r: Lopinavir/ritonavir; APTT: Activated partial; thromboplastin time; CK: Creatine kinase, CK-MB: Creatine kinase-MB.

Citation: Hu XS, Hu CH, Zhong P, Wen YJ, Chen XY. Risk factors associated with acute respiratory distress syndrome in COVID-19 patients outside Wuhan: A double-center retrospective cohort study of 197 cases in Hunan, China. World J Clin Cases 2021; 9(2): 344-356
URL: https://www.wjgnet.com/2307-8960/full/v9/i2/344.htm
DOI: https://dx.doi.org/10.12998/wjcc.v9.i2.344