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
ARTICLE HIGHLIGHTS
Research background

Since it was first reported, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly throughout the world, posing a serious threat to global health. However, the risk factors for patients with moderate-to-severe or severe-to-critical coronavirus disease 2019 (COVID-19) remain unclear.

Research motivation

A comprehensive description of the clinical characteristics, laboratory changes, in addition to oxygen levels and radiographic examinations enable clinicians to provide more accurate prognoses and specific care which vary according to subclinical or latent severe cases.

Research objectives

This study aimed to explore the characteristics and predictive markers of severe COVID-19.

Research methods

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. Information was extracted from hospital information systems. Epidemiological and demographic, clinical symptoms and outcomes, complications, laboratory and radiographic examinations were collected retrospectively and then compared between groups.

Research 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. Over 50% patients have increased levels of lactate dehydrogenase, aspartate transaminase (AST), C-reactive protein, fibrinogen, D-dimer, tumor necrosis factor-α, ferritin, as well as decreased levels of hematocrit and calcium. Compared with the moderate group, the severe and critically ill group has significant higher rates of abnormality in levels of neutrophil ratio, eosinophil ratio, lymphocyte ratio, platelets count, neutrophil to lymphocyte ratio, AST, albumin, procalcitonin, calcium, D-dimer, interleukin-6, high-sensitivity cardiac troponin, amino-terminal pro-brain natriuretic peptide (NT-pro BNP), and ferritin. Multivariate logistic regression analysis showed that no drug treatment before admission, a higher neutrophil-to-lymphocyte ratio, a higher AST level, a higher NT-pro BNP level, a higher creatinine level, and serum calcium below the normal range were high-risk factors.

Research conclusions

People of all ages, both male and female, are susceptible to COVID-19. Early drug treatment is an important measure in the treatment of patients with 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 AST, NT-pro BNP, and creatinine levels; and serum calcium below the normal range.

Research perspectives

A large sample size with long-term survival data is needed in future studies.