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Early Warning Indicators of Severe COVID-19: A Single-Center Study of Cases From Shanghai, China

Background: Patients with severe novel coronavirus disease (COVID-19) can likely develop comorbidities, which can lead to irreversible organ damage and, eventually, death. However, early indicators of disease progression remain unclear. This study aimed to identify early indicators of disease progre...

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Autores principales: Lu, Yiming, Sun, Kuo, Guo, Shanshan, Wang, Junjie, Li, An, Rong, Xuli, Wang, Tingfang, Shang, Yan, Chang, Wenjun, Wang, Sheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379420/
https://www.ncbi.nlm.nih.gov/pubmed/32766268
http://dx.doi.org/10.3389/fmed.2020.00432
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author Lu, Yiming
Sun, Kuo
Guo, Shanshan
Wang, Junjie
Li, An
Rong, Xuli
Wang, Tingfang
Shang, Yan
Chang, Wenjun
Wang, Sheng
author_facet Lu, Yiming
Sun, Kuo
Guo, Shanshan
Wang, Junjie
Li, An
Rong, Xuli
Wang, Tingfang
Shang, Yan
Chang, Wenjun
Wang, Sheng
author_sort Lu, Yiming
collection PubMed
description Background: Patients with severe novel coronavirus disease (COVID-19) can likely develop comorbidities, which can lead to irreversible organ damage and, eventually, death. However, early indicators of disease progression remain unclear. This study aimed to identify early indicators of disease progression to provide a basis for improved prognostic prediction and disease management. Methods: We examined 53 recovered adult COVID-19 patients who were treated at Shanghai Public Health Clinical Center between January 20, 2020, and February 20, 2020. The patients were categorized into the following four groups according to their condition at admission: mild condition (n = 3), moderate (n = 41), severe (n = 7), and critical (n = 2). They were also categorized according to disease progression as mild or moderate conditions that remained stable (n = 26), moderate disease that progressed to severe condition (n = 18), and continuously severe or critical (n = 9). We then focused on investigating the differences in the epidemiological and laboratory indicators between remained stable cases and progressed to severe condition cases. Results: Mild or moderate patients were younger than severe or critical patients. The number of patients with shortness of breath and underlying diabetes and heart disease at admission was higher in the severe or critical group. This group also showed considerably lower or higher values in 28 laboratory indicators. In addition, mild and moderate patients who remained stable were younger than moderate patients progressing to severe disease. Men had a higher risk of disease progression. Patients who progressed had either higher or lower values in 11 laboratory indicators. Survival curve analysis showed that age, procalcitonin, D-dimer, serum C-reactive protein, lactate dehydrogenase, lymphocytes, neutrophils, CD4%, and CD4/CD8 ratio were significant predictors of progression to severe disease. Conclusions: Lactate dehydrogenase, procalcitonin, etc. are early warning indicators of severe COVID-19. Age (>64 years), shortness of breath, past histories of diabetes and heart disease, and abnormality in 28 other indicators at admission are indicative of severe or progression toward severe COVID-19. Meanwhile, abnormalities in 11 indicators and an abnormal coagulation function index at admission are risk factors for progression to severe disease.
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spelling pubmed-73794202020-08-05 Early Warning Indicators of Severe COVID-19: A Single-Center Study of Cases From Shanghai, China Lu, Yiming Sun, Kuo Guo, Shanshan Wang, Junjie Li, An Rong, Xuli Wang, Tingfang Shang, Yan Chang, Wenjun Wang, Sheng Front Med (Lausanne) Medicine Background: Patients with severe novel coronavirus disease (COVID-19) can likely develop comorbidities, which can lead to irreversible organ damage and, eventually, death. However, early indicators of disease progression remain unclear. This study aimed to identify early indicators of disease progression to provide a basis for improved prognostic prediction and disease management. Methods: We examined 53 recovered adult COVID-19 patients who were treated at Shanghai Public Health Clinical Center between January 20, 2020, and February 20, 2020. The patients were categorized into the following four groups according to their condition at admission: mild condition (n = 3), moderate (n = 41), severe (n = 7), and critical (n = 2). They were also categorized according to disease progression as mild or moderate conditions that remained stable (n = 26), moderate disease that progressed to severe condition (n = 18), and continuously severe or critical (n = 9). We then focused on investigating the differences in the epidemiological and laboratory indicators between remained stable cases and progressed to severe condition cases. Results: Mild or moderate patients were younger than severe or critical patients. The number of patients with shortness of breath and underlying diabetes and heart disease at admission was higher in the severe or critical group. This group also showed considerably lower or higher values in 28 laboratory indicators. In addition, mild and moderate patients who remained stable were younger than moderate patients progressing to severe disease. Men had a higher risk of disease progression. Patients who progressed had either higher or lower values in 11 laboratory indicators. Survival curve analysis showed that age, procalcitonin, D-dimer, serum C-reactive protein, lactate dehydrogenase, lymphocytes, neutrophils, CD4%, and CD4/CD8 ratio were significant predictors of progression to severe disease. Conclusions: Lactate dehydrogenase, procalcitonin, etc. are early warning indicators of severe COVID-19. Age (>64 years), shortness of breath, past histories of diabetes and heart disease, and abnormality in 28 other indicators at admission are indicative of severe or progression toward severe COVID-19. Meanwhile, abnormalities in 11 indicators and an abnormal coagulation function index at admission are risk factors for progression to severe disease. Frontiers Media S.A. 2020-07-17 /pmc/articles/PMC7379420/ /pubmed/32766268 http://dx.doi.org/10.3389/fmed.2020.00432 Text en Copyright © 2020 Lu, Sun, Guo, Wang, Li, Rong, Wang, Shang, Chang and Wang. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Lu, Yiming
Sun, Kuo
Guo, Shanshan
Wang, Junjie
Li, An
Rong, Xuli
Wang, Tingfang
Shang, Yan
Chang, Wenjun
Wang, Sheng
Early Warning Indicators of Severe COVID-19: A Single-Center Study of Cases From Shanghai, China
title Early Warning Indicators of Severe COVID-19: A Single-Center Study of Cases From Shanghai, China
title_full Early Warning Indicators of Severe COVID-19: A Single-Center Study of Cases From Shanghai, China
title_fullStr Early Warning Indicators of Severe COVID-19: A Single-Center Study of Cases From Shanghai, China
title_full_unstemmed Early Warning Indicators of Severe COVID-19: A Single-Center Study of Cases From Shanghai, China
title_short Early Warning Indicators of Severe COVID-19: A Single-Center Study of Cases From Shanghai, China
title_sort early warning indicators of severe covid-19: a single-center study of cases from shanghai, china
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379420/
https://www.ncbi.nlm.nih.gov/pubmed/32766268
http://dx.doi.org/10.3389/fmed.2020.00432
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