Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2021; 9(2): 344-356
Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.344
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
Xing-Sheng Hu, Chun-Hong Hu, Ping Zhong, Ya-Jing Wen, Xiang-Yu Chen
Xing-Sheng Hu, Chun-Hong Hu, Department of Oncology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Ping Zhong, Department of Dermatology, Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
Ya-Jing Wen, Department of Clinical Medicine, Chengdu Medical College, Chengdu 610000, Sichuan Province, China
Xiang-Yu Chen, Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Author contributions: Hu XS designed the study, acquired and analyzed the data, and wrote the paper; Hu CH designed the research and contributed to the data analysis; Zhong P and Wen YJ contributed to the analysis and interpretation of the data, and drafted the article; Chen XY designed the research, revised the paper, and supervised the report; All authors made critical revisions related to important intellectual content of the manuscript and gave final approval of the version of the article to be published.
Supported by The Natural Science Foundation of Hunan Province, No. 2019JJ40435.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Second Xiangya Hospital of Central south university (2020-017).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. Written informed consent was waived by the Ethics Committee of the designated hospital.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
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:
Corresponding author: Xiang-Yu Chen, MD, Associate Professor, Department of Radiology, the Second Xiangya Hospital of Central South University, No. 139 Renmin Road Central, Changsha 410011, Hunan Province, China.
Received: October 16, 2020
Peer-review started: October 16, 2020
First decision: October 27, 2020
Revised: October 30, 2020
Accepted: November 12, 2020
Article in press: November 12, 2020
Published online: January 16, 2021
Research background

There were few reports on the risk factors of acute respiratory distress syndrome (ARDS) in coronavirus disease 2019 (COVID-19), and the differences in ADRS incidence between Wuhan and outside Wuhan in China.

Research motivation

To identify the risk factors of ARDS in COVID-19, and determine whether the incidence of ADRS in Wuhan was overestimated compared to real world research.

Research objectives

The first objective of this study was to identify the risk factors for ARDS in COVID-19 patients, and the second objective was to compare the different characteristics of ARDS between Wuhan and non-Wuhan studies in China.

Research methods

We retrospectively collected the patients’ clinical data, and the factors associated with ARDS were compared using the χ² test, Fisher’s exact test, Mann-Whitney U test. Univariate and multivariate logistic regression was used to compute and adjust odds ratio value. The ARDS incidence, mortality rate, and biomarkers of COVID-19 severity were collected and compared between studies in and outside Wuhan after literature review.

Research results

Older age, coexisting diseases, lower lymphocytes/albumin, higher D-dimer and C-reactive protein levels all affected the incidence of ADRS, and dyspnea, dry/moist rales and higher lactate dehydrogenase level were three independent risk factors. The ARDS incidence, mortality rate, and biomarkers of COVID-19 severity were higher in Wuhan than outside Wuhan in China.

Research conclusions

There were some risk factors associated with ARDS in COVID-19. The higher ARDS rate in Wuhan may result from the shortage of medical resources in the early stage of the epidemic. These findings may provide references for the researchers and policy makers of COVID-19.

Research perspectives

Biomarkers of disease severity are important risk factors for ARDS in COVID-19. The incidence of the disease should be assessed comprehensively. Accurate estimation of the incidence of ARDS will be helpful to both health workers and policy makers to develop appropriate strategies for COVID-19.