Predictors of clinical deterioration in non-severe patients with COVID-19: a retrospective cohort study
Creators: name: Yitao, Zhang
name: Mu, Chen
name: Ling, Zhou
name: Shiyao, Cheng
name: Jiaojie, Xue
name: Zhichong, Chen
name: Huajing, Peng
name: Maode, Ou
name: Kanglin, Cheng
name: Mao, Ou Yang
name: Xiaoneng, Mo
name: Weijie, Zeng
Publisher: name: Taylor & Francis
Year: 2021
Subjects: subject: Medicine
subject: Microbiology
subject: FOS: Biological sciences
subject: FOS: Biological sciences
subject: Molecular Biology
subject: Pharmacology
subject: Biotechnology
subject: 39999 Chemical Sciences not elsewhere classified
subject: FOS: Chemical sciences
subject: FOS: Chemical sciences
subject: Immunology
subject: FOS: Clinical medicine
subject: FOS: Clinical medicine
subject: 19999 Mathematical Sciences not elsewhere classified
subject: FOS: Mathematics
subject: FOS: Mathematics
subject: Cancer
subject: 111714 Mental Health
subject: FOS: Health sciences
subject: FOS: Health sciences
subject: Hematology
subject: 110309 Infectious Diseases
subject: 60506 Virology

description: Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains pandemic with considerable morbidity and mortality around the world. The aim of this study was to identify the predictors for clinical deterioration in patients with COVID-19 who did not show clinical deterioration upon hospital admission. Two hundred fifty-seven patients with confirmed COVID-19 pneumonia admitted to Guangzhou Eighth People’s Hospital between 23 January and 21 March 2020 were retrospectively enrolled. Demographic data, symptoms, laboratory values, comorbidities and treatments were all collected. The study endpoint was clinical deterioration within 20 days from hospital admission. Univariate and multivariable logistic regression methods were used to explore the risk factors associated with clinical deterioration. A total of 49 (19%) patients showed clinical deterioration after admission. Compared with patients that did not experience clinical deterioration, clinically deteriorated patients had more dyspnea, cough and myalgia (65.3% versus 29.3%) symptoms and more had comorbidities (89.8% versus 36.1%). Clinical and laboratory characteristics at admission that were associated with clinical deterioration included senior age, diabetes, hypertension, myalgia, higher temperature, systolic blood pressure, C-reactive protein (CRP), procalcitonin, activated partial thromboplastin time, aspartate aminotransferase, alanine transaminase, direct bilirubin, plasma creatinine, lymphocytopenia, thrombocytopenia, decreased albumin and bicarbonate concentration. Medical history of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, calcium channel blockers and metformin were also risk factors. The four best predictors for clinical deterioration were CRP, procalcitonin, age and albumin. A “best” multivariable prediction model, resulting from using a variable selection procedure, included senior age, presentation with myalgia, and higher level of CRP and serum creatinine (bias-corrected <i>c</i>-statistic = 0.909). Sensitivity and specificity corresponding to a cut point of CRP ≥18.45 mg/L for predicting clinical deterioration were 85% and 74%, respectively.